{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:09:49Z","timestamp":1772827789976,"version":"3.50.1"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Ventriculoperitoneal shunt insertion is the primary treatment for pediatric hydrocephalus and is one of the most common procedures performed in pediatric neurosurgery. However, the value of routine postoperative imaging remains controversial. Although some evidence suggests that routine postoperative imaging provides a low yield after shunt revision, its role following initial shunt insertion in children has not been reported. Additionally, the role of routine postoperative imaging as a baseline study in altering the rate of longer-term shunt revision rates remains unexplored.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A retrospective review was conducted using a prospectively maintained surgical database, encompassing 10 years of consecutive cases from a quaternary pediatric neurosurgical center serving a population of 5.3 million. Statewide electronic medical records including imaging and mortality data were reviewed. Only cases involving the insertion of a new ventricular shunt system were included. Based on longstanding physician preferences, approximately half the neurosurgeons in the department did not routinely perform postoperative imaging during the study period. The primary outcomes were shunt-related mortality during the study period, shunt revision or mortality within 7 days of surgery, or hospital discharge, with time to first revision as a secondary outcome.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n During the study period 1485 shunt procedures were performed, of which 427 involved the placement of a new ventriculoperitoneal shunt system. The mean age of the patients was 5.2 years (range premature to 18 years). A total of 206\/427 (48%) underwent routine postoperative imaging with MR or CT, and 153\/427 (36%) underwent routine postoperative shunt series radiographs. During the study period, 2 abdominal radiographs identified preperitoneal placement; however, in both cases a symptomatic subcutaneous fluid collection was present (2\/427, 0.5%). Postoperative CT or MR studies identified 1 case of extraventricular catheter placement and 5 cases of a kink adjacent to the valve (6\/427, 1.4%), of which 4 cases were detected on routine imaging (4\/427, 0.9%). No significant differences were detected between patients with or without imaging in 7-day postoperative (14 [7%] vs 8 [4%], p = 0.25) or 7-day postdischarge (2 [1%] vs 1 [< 1%], p = 0.96) rates of noninfective shunt revision, shunt-related mortality (4 [2%] vs 5 [2%], respectively, p = 0.8) or Kaplan-Meier long-term shunt survival curves (all p > 0.05).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Routine postoperative imaging after pediatric shunt insertion rarely identifies clinically significant issues, and consideration could be given to its omission.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2024.12.peds24496","type":"journal-article","created":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T20:28:12Z","timestamp":1743280092000},"page":"546-553","source":"Crossref","is-referenced-by-count":2,"title":["The risks of omitting routine postoperative imaging after insertion of new ventricular shunts in children: a 10-year retrospective cohort study"],"prefix":"10.3171","volume":"35","author":[{"given":"Michael J.","family":"Stuart","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland; and"},{"name":"Faculty of Medicine, University of Queensland, Herston, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annabelle M.","family":"Harbison","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Ruder","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Queensland, Herston, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua","family":"Hackney","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norman","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A. J.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amelia J.","family":"Jardim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liam G.","family":"Coulthard","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland; and"},{"name":"Faculty of Medicine, University of Queensland, Herston, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Childs Nerv Syst","first-page":"101","article-title":"Long-term mortality rates in pediatric hydrocephalus\u2014a retrospective single-center study","volume":"33","author":"Gmeiner M","year":"2017","unstructured":"Gmeiner M, Wagner H, Zacherl C, Long-term mortality rates in pediatric hydrocephalus\u2014a retrospective single-center study. Childs Nerv Syst. 2017;33(1):101\u2013109."},{"issue":"6","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"633","article-title":"Pediatric hydrocephalus: 40-year outcomes in 128 hydrocephalic patients treated with shunts during childhood. Assessment of surgical outcome, work participation, and health-related quality of life","volume":"16","author":"Paulsen AH","year":"2015","unstructured":"Paulsen AH, Lundar T, Lindegaard KF. Pediatric hydrocephalus: 40-year outcomes in 128 hydrocephalic patients treated with shunts during childhood. Assessment of surgical outcome, work participation, and health-related quality of life. J Neurosurg Pediatr. 2015;16(6):633\u2013641."},{"issue":"4","key":"b3","series-title":"AJNR Am J Neuroradiol","first-page":"802","article-title":"Low-dose nonenhanced head CT protocol for follow-up evaluation of children with ventriculoperitoneal shunt: reduction of radiation and effect on image quality","volume":"29","author":"Udayasankar UK","year":"2008","unstructured":"Udayasankar UK, Braithwaite K, Arvaniti M, Low-dose nonenhanced head CT protocol for follow-up evaluation of children with ventriculoperitoneal shunt: reduction of radiation and effect on image quality. AJNR Am J Neuroradiol. 2008;29(4):802\u2013806."},{"issue":"6","key":"b4","series-title":"AJNR Am J Neuroradiol","first-page":"990","article-title":"How to reduce head CT Orders in children with hydrocephalus using the Lean Six Sigma methodology: experience at a major quaternary care academic children\u2019s center","volume":"37","author":"Tekes A","year":"2016","unstructured":"Tekes A, Jackson EM, Ogborn J, How to reduce head CT Orders in children with hydrocephalus using the Lean Six Sigma methodology: experience at a major quaternary care academic children\u2019s center. AJNR Am J Neuroradiol. 2016;37(6):990\u2013996."},{"issue":"11","key":"b5","series-title":"AJNR Am J Neuroradiol","first-page":"1597","article-title":"Diagnostic performance of whole-body ultra-low-dose CT for detection of mechanical ventriculoperitoneal shunt complications: a retrospective analysis","volume":"43","author":"Afat S","year":"2022","unstructured":"Afat S, Pjontek R, Nikoubashman O, Diagnostic performance of whole-body ultra-low-dose CT for detection of mechanical ventriculoperitoneal shunt complications: a retrospective analysis. AJNR Am J Neuroradiol. 2022;43(11):1597\u20131602."},{"issue":"3","key":"b6","series-title":"Pediatr Neurosurg","first-page":"141","article-title":"Radiographic imaging requirements following ventriculoperitoneal shunt procedures","volume":"22","author":"Steinbok P","year":"1995","unstructured":"Steinbok P, Boyd M, Flodmark CO, Cochrane DD. Radiographic imaging requirements following ventriculoperitoneal shunt procedures. Pediatr Neurosurg. 1995;22(3):141\u2013146."},{"key":"b7","series-title":"J Pediatr","first-page":"210","article-title":"The burden of ionizing radiation studies in children with ventricular shunts","volume":"182","author":"Antonucci MC","year":"2017","unstructured":"Antonucci MC, Zuckerbraun NS, Tyler-Kabara EC, Furtado AD, Murphy ME, Marin JR. The burden of ionizing radiation studies in children with ventricular shunts. J Pediatr. 2017;182:210\u2013216.e1."},{"issue":"5","key":"b8","series-title":"J Neurosurg Pediatr","first-page":"514","article-title":"Risk of radiation-induced malignancies from CT scanning in children who underwent shunt treatment before 6 years of age: a retrospective cohort study with a minimum 10-year follow-up","volume":"13","author":"White IK","year":"2014","unstructured":"White IK, Shaikh KA, Moore RJ, Risk of radiation-induced malignancies from CT scanning in children who underwent shunt treatment before 6 years of age: a retrospective cohort study with a minimum 10-year follow-up. J Neurosurg Pediatr. 2014;13(5):514\u2013519."},{"key":"b9","series-title":"World Neurosurg","first-page":"e159","article-title":"The value of computed tomography imaging of the head after ventriculoperitoneal shunt surgery in adults","volume":"121","author":"Behmanesh B","year":"2019","unstructured":"Behmanesh B, Keil F, Dubinski D, The value of computed tomography imaging of the head after ventriculoperitoneal shunt surgery in adults. World Neurosurg. 2019;121:e159\u2013e164."},{"issue":"5","key":"b10","series-title":"Childs Nerv Syst","first-page":"673","article-title":"Value of routine immediate postoperative brain computerized tomography in pediatric neurosurgical patients","volume":"28","author":"Jung JM","year":"2012","unstructured":"Jung JM, Lee JY, Phi JH, Value of routine immediate postoperative brain computerized tomography in pediatric neurosurgical patients. Childs Nerv Syst. 2012;28(5):673\u2013679."},{"issue":"6","key":"b11","series-title":"PLoS One","first-page":"e0198752","article-title":"Yield of early postoperative computed tomography after frontal ventriculoperitoneal shunt placement","volume":"13","author":"Kamenova M","year":"2018","unstructured":"Kamenova M, Rychen J, Guzman R, Mariani L, Soleman J. Yield of early postoperative computed tomography after frontal ventriculoperitoneal shunt placement. PLoS One. 2018;13(6):e0198752."},{"issue":"3","key":"b12","series-title":"J Neurosurg Pediatr","first-page":"276","article-title":"The low utility of routine cranial imaging after pediatric shunt revision","volume":"29","author":"Hulsbergen AFC","year":"2021","unstructured":"Hulsbergen AFC, Siddi F, McAvoy M, The low utility of routine cranial imaging after pediatric shunt revision. J Neurosurg Pediatr. 2021;29(3):276\u2013282."},{"key":"b13","article-title":"Search Census data. Australian Bureau of Statistics","unstructured":"Search Census data. Australian Bureau of Statistics. Accessed January 16, 2025. https:\/\/www.abs.gov.au\/census\/find-census-data\/search-by-area"},{"issue":"5","key":"b14","series-title":"Childs Nerv Syst","first-page":"791","article-title":"Analysis of factors affecting ventriculoperitoneal shunt survival in pediatric patients","volume":"29","author":"Khan F","year":"2013","unstructured":"Khan F, Shamim MS, Rehman A, Bari ME. Analysis of factors affecting ventriculoperitoneal shunt survival in pediatric patients. Childs Nerv Syst. 2013;29(5):791\u2013802."},{"issue":"1","key":"b15","series-title":"J Neurosurg","first-page":"151","article-title":"Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases","volume":"115","author":"Naftel RP","year":"2011","unstructured":"Naftel RP, Argo JL, Shannon CN, Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases. J Neurosurg. 2011;115(1):151\u2013158."},{"issue":"3 Suppl","key":"b16","series-title":"Neurosurgery","first-page":"167","article-title":"Laparoscopic peritoneal catheter placement: results of a new method in 111 patients","volume":"61","author":"Turner RD","year":"2007","unstructured":"Turner RD, Rosenblatt SM, Chand B, Luciano MG. Laparoscopic peritoneal catheter placement: results of a new method in 111 patients. Neurosurgery. 2007;61(3 Suppl):167\u2013174."},{"issue":"5","key":"b17","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Role of radiological parameters in predicting overall shunt outcome after ventriculoperitoneal shunt insertion in pediatric patients with obstructive hydrocephalus","volume":"41","author":"Patra DP","year":"2016","unstructured":"Patra DP, Bir SC, Maiti TK, Role of radiological parameters in predicting overall shunt outcome after ventriculoperitoneal shunt insertion in pediatric patients with obstructive hydrocephalus. Neurosurg Focus. 2016;41(5):E4."},{"issue":"1","key":"b1","series-title":"Childs Nerv Syst","first-page":"101","article-title":"Long-term mortality rates in pediatric hydrocephalus\u2014a retrospective single-center study","volume":"33","author":"Gmeiner M","year":"2017","unstructured":"Gmeiner M, Wagner H, Zacherl C, Long-term mortality rates in pediatric hydrocephalus\u2014a retrospective single-center study. Childs Nerv Syst. 2017;33(1):101\u2013109."},{"issue":"6","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"633","article-title":"Pediatric hydrocephalus: 40-year outcomes in 128 hydrocephalic patients treated with shunts during childhood. Assessment of surgical outcome, work participation, and health-related quality of life","volume":"16","author":"Paulsen AH","year":"2015","unstructured":"Paulsen AH, Lundar T, Lindegaard KF. Pediatric hydrocephalus: 40-year outcomes in 128 hydrocephalic patients treated with shunts during childhood. Assessment of surgical outcome, work participation, and health-related quality of life. J Neurosurg Pediatr. 2015;16(6):633\u2013641."},{"issue":"4","key":"b3","series-title":"AJNR Am J Neuroradiol","first-page":"802","article-title":"Low-dose nonenhanced head CT protocol for follow-up evaluation of children with ventriculoperitoneal shunt: reduction of radiation and effect on image quality","volume":"29","author":"Udayasankar UK","year":"2008","unstructured":"Udayasankar UK, Braithwaite K, Arvaniti M, Low-dose nonenhanced head CT protocol for follow-up evaluation of children with ventriculoperitoneal shunt: reduction of radiation and effect on image quality. AJNR Am J Neuroradiol. 2008;29(4):802\u2013806."},{"issue":"6","key":"b4","series-title":"AJNR Am J Neuroradiol","first-page":"990","article-title":"How to reduce head CT Orders in children with hydrocephalus using the Lean Six Sigma methodology: experience at a major quaternary care academic children\u2019s center","volume":"37","author":"Tekes A","year":"2016","unstructured":"Tekes A, Jackson EM, Ogborn J, How to reduce head CT Orders in children with hydrocephalus using the Lean Six Sigma methodology: experience at a major quaternary care academic children\u2019s center. AJNR Am J Neuroradiol. 2016;37(6):990\u2013996."},{"issue":"11","key":"b5","series-title":"AJNR Am J Neuroradiol","first-page":"1597","article-title":"Diagnostic performance of whole-body ultra-low-dose CT for detection of mechanical ventriculoperitoneal shunt complications: a retrospective analysis","volume":"43","author":"Afat S","year":"2022","unstructured":"Afat S, Pjontek R, Nikoubashman O, Diagnostic performance of whole-body ultra-low-dose CT for detection of mechanical ventriculoperitoneal shunt complications: a retrospective analysis. AJNR Am J Neuroradiol. 2022;43(11):1597\u20131602."},{"issue":"3","key":"b6","series-title":"Pediatr Neurosurg","first-page":"141","article-title":"Radiographic imaging requirements following ventriculoperitoneal shunt procedures","volume":"22","author":"Steinbok P","year":"1995","unstructured":"Steinbok P, Boyd M, Flodmark CO, Cochrane DD. Radiographic imaging requirements following ventriculoperitoneal shunt procedures. Pediatr Neurosurg. 1995;22(3):141\u2013146."},{"key":"b7","series-title":"J Pediatr","first-page":"210","article-title":"The burden of ionizing radiation studies in children with ventricular shunts","volume":"182","author":"Antonucci MC","year":"2017","unstructured":"Antonucci MC, Zuckerbraun NS, Tyler-Kabara EC, Furtado AD, Murphy ME, Marin JR. The burden of ionizing radiation studies in children with ventricular shunts. J Pediatr. 2017;182:210\u2013216.e1."},{"issue":"5","key":"b8","series-title":"J Neurosurg Pediatr","first-page":"514","article-title":"Risk of radiation-induced malignancies from CT scanning in children who underwent shunt treatment before 6 years of age: a retrospective cohort study with a minimum 10-year follow-up","volume":"13","author":"White IK","year":"2014","unstructured":"White IK, Shaikh KA, Moore RJ, Risk of radiation-induced malignancies from CT scanning in children who underwent shunt treatment before 6 years of age: a retrospective cohort study with a minimum 10-year follow-up. J Neurosurg Pediatr. 2014;13(5):514\u2013519."},{"key":"b9","series-title":"World Neurosurg","first-page":"e159","article-title":"The value of computed tomography imaging of the head after ventriculoperitoneal shunt surgery in adults","volume":"121","author":"Behmanesh B","year":"2019","unstructured":"Behmanesh B, Keil F, Dubinski D, The value of computed tomography imaging of the head after ventriculoperitoneal shunt surgery in adults. World Neurosurg. 2019;121:e159\u2013e164."},{"issue":"5","key":"b10","series-title":"Childs Nerv Syst","first-page":"673","article-title":"Value of routine immediate postoperative brain computerized tomography in pediatric neurosurgical patients","volume":"28","author":"Jung JM","year":"2012","unstructured":"Jung JM, Lee JY, Phi JH, Value of routine immediate postoperative brain computerized tomography in pediatric neurosurgical patients. Childs Nerv Syst. 2012;28(5):673\u2013679."},{"issue":"6","key":"b11","series-title":"PLoS One","first-page":"e0198752","article-title":"Yield of early postoperative computed tomography after frontal ventriculoperitoneal shunt placement","volume":"13","author":"Kamenova M","year":"2018","unstructured":"Kamenova M, Rychen J, Guzman R, Mariani L, Soleman J. Yield of early postoperative computed tomography after frontal ventriculoperitoneal shunt placement. PLoS One. 2018;13(6):e0198752."},{"issue":"3","key":"b12","series-title":"J Neurosurg Pediatr","first-page":"276","article-title":"The low utility of routine cranial imaging after pediatric shunt revision","volume":"29","author":"Hulsbergen AFC","year":"2021","unstructured":"Hulsbergen AFC, Siddi F, McAvoy M, The low utility of routine cranial imaging after pediatric shunt revision. J Neurosurg Pediatr. 2021;29(3):276\u2013282."},{"key":"b13","article-title":"Search Census data. Australian Bureau of Statistics","unstructured":"Search Census data. Australian Bureau of Statistics. Accessed January 16, 2025. https:\/\/www.abs.gov.au\/census\/find-census-data\/search-by-area"},{"issue":"5","key":"b14","series-title":"Childs Nerv Syst","first-page":"791","article-title":"Analysis of factors affecting ventriculoperitoneal shunt survival in pediatric patients","volume":"29","author":"Khan F","year":"2013","unstructured":"Khan F, Shamim MS, Rehman A, Bari ME. Analysis of factors affecting ventriculoperitoneal shunt survival in pediatric patients. Childs Nerv Syst. 2013;29(5):791\u2013802."},{"issue":"1","key":"b15","series-title":"J Neurosurg","first-page":"151","article-title":"Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases","volume":"115","author":"Naftel RP","year":"2011","unstructured":"Naftel RP, Argo JL, Shannon CN, Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases. J Neurosurg. 2011;115(1):151\u2013158."},{"issue":"3 Suppl","key":"b16","series-title":"Neurosurgery","first-page":"167","article-title":"Laparoscopic peritoneal catheter placement: results of a new method in 111 patients","volume":"61","author":"Turner RD","year":"2007","unstructured":"Turner RD, Rosenblatt SM, Chand B, Luciano MG. Laparoscopic peritoneal catheter placement: results of a new method in 111 patients. Neurosurgery. 2007;61(3 Suppl):167\u2013174."},{"issue":"5","key":"b17","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Role of radiological parameters in predicting overall shunt outcome after ventriculoperitoneal shunt insertion in pediatric patients with obstructive hydrocephalus","volume":"41","author":"Patra DP","year":"2016","unstructured":"Patra DP, Bir SC, Maiti TK, Role of radiological parameters in predicting overall shunt outcome after ventriculoperitoneal shunt insertion in pediatric patients with obstructive hydrocephalus. 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