{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:43:05Z","timestamp":1785775385082,"version":"3.56.0"},"reference-count":62,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>A hallmark feature of failed ventriculoperitoneal shunts in pediatric patients with hydrocephalus is raised intracranial pressure, necessitating immediate shunt revision or temporization to prevent significant morbidity and mortality. Neuro-ophthalmological findings (NOFs) are essential objective indicators for diagnosing shunt failure, which include papilledema, vision loss, optic disc pallor, and disturbances in ocular motility and alignment. These NOFs are also invaluable for long-term follow-up and monitoring of the progression and treatment response in hydrocephalus. However, there are nuances in their sensitivity and specificity regarding shunt failure. This study presents a systematic review of the literature on the clinical correlation between NOFs and shunt failure and their responses following treatment for hydrocephalus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      A systematic review of the literature focused on the association between NOFs and shunt failure was conducted according to established guidelines. Data were extracted from studies that included patients &lt; 21 years of age with confirmed shunt failure and reported NOFs. Shunt failure was only considered if surgery confirmed the diagnosis. Patients with idiopathic intracranial hypertension and those with ventriculoperitoneal shunt failure without documented prerevision assessment of NOFs were excluded. Descriptive statistics were reported, including percentages for categorical variables and means for continuous variables. The risk of bias was assessed for each study. A common-effects model was used to calculate pooled estimates and account for study variances, with heterogeneity assessed using the I\n                      <jats:sup>2<\/jats:sup>\n                      statistic. Forest plots illustrated the prevalence of NOFs, overall rates, 95% confidence intervals, and contributing weights.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Four studies with 82 patients had surgically confirmed shunt failures, of whom 51 (62%) exhibited NOFs, including 17 (21%) with papilledema, 11 (13%) with cranial nerve palsy, 9 (11%) with upgaze palsy, and 14 (17%) with vision loss. Concomitant neurological symptoms were noted in 20 (24%) of those patients, including headaches (15%), nausea\/vomiting (10%), and lethargy or neurological symptoms (13%). Following shunt revision, improvement in papilledema was reported in 83% of affected patients, and 92% in those with cranial nerve or upgaze palsy, but no improvement was observed in visual acuity. The overall weighted prevalence of papilledema was 30% (95% CI 0.07\u20130.70; I\n                      <jats:sup>2<\/jats:sup>\n                      = 67%, p = 0.03).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>These findings advocate for the integration of neuro-ophthalmological evaluations in addition to radiographic and clinical assessments to enhance the diagnostic accuracy of shunt failures in pediatric patients with hydrocephalus. Adopting a multidisciplinary approach can augment diagnostic precision and potentially hasten the initiation of treatment for these complex and often nuanced pathologies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.12.peds24397","type":"journal-article","created":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T23:01:04Z","timestamp":1744412464000},"page":"29-35","source":"Crossref","is-referenced-by-count":1,"title":["Neuro-ophthalmological findings in pediatric ventricular shunt failure: a systematic review"],"prefix":"10.3171","volume":"36","author":[{"given":"Soren","family":"Jonzzon","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Price","sequence":"additional","affiliation":[{"name":"University of Texas Medical Branch School of Medicine, Galveston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Truong","sequence":"additional","affiliation":[{"name":"University of Texas Medical Branch School of Medicine, Galveston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert P.","family":"Naftel","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul H.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Arkansas Children\u2019s Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Wellons","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert M.","family":"Isaacs","sequence":"additional","affiliation":[{"name":"Institute for Genomic Medicine and"},{"name":"Division of Neurosurgery, Nationwide Children\u2019s Hospital, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"J Neurosurg Pediatr","first-page":"337","article-title":"Surgical resource utilization after initial treatment of infant hydrocephalus: comparing ETV, early experience of ETV with choroid plexus cauterization, and shunt insertion in the Hydrocephalus Clinical Research Network","volume":"26","author":"Pindrik J","year":"2020","unstructured":"Pindrik J, Riva-Cambrin J, Kulkarni AV,  Surgical resource utilization after initial treatment of infant hydrocephalus: comparing ETV, early experience of ETV with choroid plexus cauterization, and shunt insertion in the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr. 2020;26(4):337\u2013345."},{"issue":"3","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"277","article-title":"Predictors of fast and ultrafast shunt failure in pediatric hydrocephalus: a Hydrocephalus Clinical Research Network study","volume":"27","author":"Hauptman JS","year":"2020","unstructured":"Hauptman JS, Kestle J, Riva-Cambrin J,  Predictors of fast and ultrafast shunt failure in pediatric hydrocephalus: a Hydrocephalus Clinical Research Network study. J Neurosurg Pediatr. 2020;27(3):277\u2013286."},{"issue":"5","key":"b3","series-title":"J Neurosurg","first-page":"721","article-title":"Shunt failure without ventriculomegaly proclaimed by ophthalmic findings","volume":"81","author":"Katz DM","year":"1994","unstructured":"Katz DM, Trobe JD, Muraszko KM, Dauser RC. Shunt failure without ventriculomegaly proclaimed by ophthalmic findings. J Neurosurg. 1994;81(5):721\u2013725."},{"issue":"6","key":"b4","series-title":"Pediatrics","first-page":"1031","article-title":"Pitfalls in the diagnosis of ventricular shunt dysfunction: radiology reports and ventricular size","volume":"101","author":"Iskandar BJ","year":"1998","unstructured":"Iskandar BJ, McLaughlin C, Mapstone TB, Grabb PA, Oakes WJ. Pitfalls in the diagnosis of ventricular shunt dysfunction: radiology reports and ventricular size. Pediatrics. 1998;101(6):1031\u20131036."},{"key":"b5","series-title":"Interdiscip Neurosurg","first-page":"66","article-title":"Ventriculoperitoneal shunt complications: a review","volume":"13","author":"Paff M","year":"2018","unstructured":"Paff M, Alexandru-Abrams D, Muhonen M, Loudon W. Ventriculoperitoneal shunt complications: a review. 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