{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:14:24Z","timestamp":1772828064042,"version":"3.50.1"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Treatment of multiloculated hydrocephalus can require multiple procedures and shunt catheters. This study aimed to determine whether there are differences in shunt survival or complications in patients with complex shunt systems based on whether they have separate systems or multiple intracranial catheters with a single distal catheter and a Y- or T-connector.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors retrospectively reviewed the Hydrocephalus Clinical Research Network (HCRN) Core Data Project, a prospective multicenter registry. Patients undergoing first-time placement of a complex ventriculoperitoneal shunt or first-time conversion to a complex shunt were identified and included in the analysis. Propensity-weighted Cox regression was used to control for HCRN center and etiology using the rate of shunt failure (shunt malfunction or shunt infection) as the primary outcome. The final regression model was also adjusted for age and complex chronic conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>In total, 369 patients were included. One hundred fifty-one patients had separate systems and 218 had Y\/T-connectors. After adjustment for age and comorbidities, the rate of shunt failure for systems with Y\/T-connectors was not significantly different than that for separate shunt systems: 62% versus 55% (HR 1.20, 95% CI 0.91\u20131.59, p = 0.197). There was a statistically significant difference in operative time with separate systems having shorter operative times (mean time 63.0 vs 80.0 minutes; mean difference 16.32, 95% CI 7.53\u201325.10, p &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>There were no differences in the shunt failure rates or complications between the separate shunt systems and Y\/T-connector systems used to treat complex shunts. However, surgical time was significantly shorter with separate shunt systems. These findings suggest that surgeons can tailor the shunt system on the basis of individual patient characteristics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.2.peds24622","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T22:44:15Z","timestamp":1746225855000},"page":"127-134","source":"Crossref","is-referenced-by-count":1,"title":["Complex shunt system comparison: an observational study by the Hydrocephalus Clinical Research Network"],"prefix":"10.3171","volume":"36","author":[{"given":"Eric M.","family":"Jackson","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, The Johns Hopkins Hospital, John Hopkins University, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hailey","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah, Salt Lake City, Utah;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ron W.","family":"Reeder","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah, Salt Lake City, Utah;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter A.","family":"Chiarelli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital of Los Angeles, University of Southern California, Los Angeles, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd C.","family":"Hankinson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital Colorado, Aurora, Colorado;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason S.","family":"Hauptman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Phoenix Children\u2019s Hospital, Phoenix, Arizona;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert M.","family":"Isaacs","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nationwide Children\u2019s Hospital, The Ohio State University College of Medicine, Columbus, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhaya V.","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David D.","family":"Limbrick","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick J.","family":"McDonald","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan A.","family":"Pindrik","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nationwide Children\u2019s Hospital, The Ohio State University College of Medicine, Columbus, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian F.","family":"Pollack","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandon G.","family":"Rocque","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Children\u2019s of Alabama, University of Alabama at Birmingham, Alabama;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Curtis J.","family":"Rozzelle","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Children\u2019s of Alabama, University of Alabama at Birmingham, Alabama;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer M.","family":"Strahle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St. Louis Children\u2019s Hospital, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandeep S.","family":"Tamber","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, British Columbia Children\u2019s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John C.","family":"Wellons","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John R. W.","family":"Kestle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William E.","family":"Whitehead","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Texas Children\u2019s Hospital, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay","family":"Riva-Cambrin","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Alberta Children\u2019s Hospital, University of Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Childs Nerv Syst","first-page":"357","article-title":"Multiloculated hydrocephalus: a review of current problems in classification and treatment","volume":"28","author":"Andresen M","year":"2012","unstructured":"Andresen M, Juhler M. Multiloculated hydrocephalus: a review of current problems in classification and treatment. Childs Nerv Syst. 2012;28(3):357\u2013362."},{"issue":"2","key":"b2","series-title":"Childs Nerv Syst","first-page":"243","article-title":"Surgical management of complex multiloculated hydrocephalus in infants and children","volume":"31","author":"Akbari SHA","year":"2015","unstructured":"Akbari SHA, Holekamp TF, Murphy TM,  Surgical management of complex multiloculated hydrocephalus in infants and children. Childs Nerv Syst. 2015;31(2):243\u2013249."},{"issue":"3","key":"b3","series-title":"J Korean Neurosurg Soc","first-page":"301","article-title":"Multiloculated hydrocephalus: open craniotomy or endoscopy?","volume":"60","author":"Lee YH","year":"2017","unstructured":"Lee YH, Kwon YS, Yang KH. Multiloculated hydrocephalus: open craniotomy or endoscopy?. J Korean Neurosurg Soc. 2017;60(3):301\u2013305."},{"key":"b4","series-title":"World Neurosurg","first-page":"e482","article-title":"Endoscopic management of pediatric complex hydrocephalus","volume":"119","author":"Peraio S","year":"2018","unstructured":"Peraio S, Amen MM, Ali NM, Zaher A, Mohamed Taha AN, Tamburrini G. Endoscopic management of pediatric complex hydrocephalus. World Neurosurg. 2018;119:e482\u2013e490."},{"issue":"3","key":"b5","series-title":"J Pediatr Neurosci","first-page":"232","article-title":"Multiloculated hydrocephalus: evolution of treatments and outcome","volume":"16","author":"Venkataramana NK","year":"2021","unstructured":"Venkataramana NK. Multiloculated hydrocephalus: evolution of treatments and outcome. J Pediatr Neurosci. 2021;16(3):232\u2013239."},{"issue":"5","key":"b6","series-title":"Childs Nerv Syst","first-page":"1587","article-title":"Endoscopic aqueductoplasty and stenting in the treatment of isolated fourth ventricle in children: 20-year institutional experience","volume":"37","author":"Imperato A","year":"2021","unstructured":"Imperato A, Almaguer Ascencio LM, Ruggiero C,  Endoscopic aqueductoplasty and stenting in the treatment of isolated fourth ventricle in children: 20-year institutional experience. Childs Nerv Syst. 2021;37(5):1587\u20131596."},{"issue":"8","key":"b7","series-title":"Chin Med J (Engl)","first-page":"980","article-title":"Y-shaped branched ventriculo-peritoneal shunt for adult multiloculated hydrocephalus","volume":"135","author":"Ren X","year":"2022","unstructured":"Ren X, Yang C, Li X,  Y-shaped branched ventriculo-peritoneal shunt for adult multiloculated hydrocephalus. Chin Med J (Engl). 2022;135(8):980\u2013982."},{"key":"b8","series-title":"World Neurosurg","first-page":"e514","article-title":"Transtentorial distortion syndrome: consistent complication following lateral and fourth ventricular shunting in adults","volume":"110","author":"Craven CL","year":"2018","unstructured":"Craven CL, Baudracco I, Thompson SD, Thorne L, Watkins LD, Toma AK. Transtentorial distortion syndrome: consistent complication following lateral and fourth ventricular shunting in adults. World Neurosurg. 2018;110:e514\u2013e519."},{"issue":"3","key":"b9","series-title":"J Neurosurg Pediatr","first-page":"269","article-title":"Temporal trends in surgical procedures for pediatric hydrocephalus: an analysis of the Hydrocephalus Clinical Research Network Core Data Project","volume":"27","author":"Tamber MS","year":"2020","unstructured":"Tamber MS, Kestle JRW, Reeder RW,  Temporal trends in surgical procedures for pediatric hydrocephalus: an analysis of the Hydrocephalus Clinical Research Network Core Data Project. J Neurosurg Pediatr. 2020;27(3):269\u2013276."},{"issue":"4","key":"b10","series-title":"J Neurosurg Pediatr","first-page":"382","article-title":"Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study","volume":"17","author":"Riva-Cambrin J","year":"2016","unstructured":"Riva-Cambrin J, Kestle JRW, Holubkov R,  Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study. J Neurosurg Pediatr. 2016;17(4):382\u2013390."},{"issue":"1 Pt 2","key":"b11","series-title":"Pediatrics","first-page":"205","article-title":"Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980\u20131997","volume":"106","author":"Feudtner C","year":"2000","unstructured":"Feudtner C, Christakis DA, Connell FA. Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980\u20131997. Pediatrics. 2000;106(1 Pt 2):205\u2013209."},{"issue":"15","key":"b12","series-title":"JAMA","first-page":"1637","article-title":"The Propensity Score","volume":"314","author":"Haukoos JS","year":"2015","unstructured":"Haukoos JS, Lewis RJ. The Propensity Score. JAMA. 2015;314(15):1637\u20131638."},{"issue":"6","key":"b13","series-title":"J Neurosurg","first-page":"1747","article-title":"Classes of evidence in neurosurgery","volume":"126","author":"Rutka JT","year":"2017","unstructured":"Rutka JT. Editorial. Classes of evidence in neurosurgery. J Neurosurg. 2017;126(6):1747\u20131748."},{"issue":"5","key":"b14","series-title":"J Neurosurg Pediatr","first-page":"473","article-title":"Center effect and other factors influencing temporization and shunting of cerebrospinal fluid in preterm infants with intraventricular hemorrhage","volume":"9","author":"Riva-Cambrin J","year":"2012","unstructured":"Riva-Cambrin J, Shannon CN, Holubkov R,  Center effect and other factors influencing temporization and shunting of cerebrospinal fluid in preterm infants with intraventricular hemorrhage. J Neurosurg Pediatr. 2012;9(5):473\u2013481."},{"issue":"1","key":"b15","series-title":"Childs Nerv Syst","first-page":"13","article-title":"Complications after shunting isolated IV ventricles","volume":"13","author":"Eder HG","year":"1997","unstructured":"Eder HG, Leber KA, Gruber W. Complications after shunting isolated IV ventricles. Childs Nerv Syst. 1997;13(1):13\u201316."},{"issue":"6","key":"b16","series-title":"Pediatr Neurosurg","first-page":"309","article-title":"Complications of fourth-ventricular shunts","volume":"22","author":"Lee M","year":"1995","unstructured":"Lee M, Leahu D, Weiner HL, Abbott R, Wisoff JH, Epstein FJ. Complications of fourth-ventricular shunts. Pediatr Neurosurg. 1995;22(6):309\u2013314."},{"issue":"3","key":"b1","series-title":"Childs Nerv Syst","first-page":"357","article-title":"Multiloculated hydrocephalus: a review of current problems in classification and treatment","volume":"28","author":"Andresen M","year":"2012","unstructured":"Andresen M, Juhler M. Multiloculated hydrocephalus: a review of current problems in classification and treatment. Childs Nerv Syst. 2012;28(3):357\u2013362."},{"issue":"2","key":"b2","series-title":"Childs Nerv Syst","first-page":"243","article-title":"Surgical management of complex multiloculated hydrocephalus in infants and children","volume":"31","author":"Akbari SHA","year":"2015","unstructured":"Akbari SHA, Holekamp TF, Murphy TM,  Surgical management of complex multiloculated hydrocephalus in infants and children. Childs Nerv Syst. 2015;31(2):243\u2013249."},{"issue":"3","key":"b3","series-title":"J Korean Neurosurg Soc","first-page":"301","article-title":"Multiloculated hydrocephalus: open craniotomy or endoscopy?","volume":"60","author":"Lee YH","year":"2017","unstructured":"Lee YH, Kwon YS, Yang KH. Multiloculated hydrocephalus: open craniotomy or endoscopy?. J Korean Neurosurg Soc. 2017;60(3):301\u2013305."},{"key":"b4","series-title":"World Neurosurg","first-page":"e482","article-title":"Endoscopic management of pediatric complex hydrocephalus","volume":"119","author":"Peraio S","year":"2018","unstructured":"Peraio S, Amen MM, Ali NM, Zaher A, Mohamed Taha AN, Tamburrini G. Endoscopic management of pediatric complex hydrocephalus. World Neurosurg. 2018;119:e482\u2013e490."},{"issue":"3","key":"b5","series-title":"J Pediatr Neurosci","first-page":"232","article-title":"Multiloculated hydrocephalus: evolution of treatments and outcome","volume":"16","author":"Venkataramana NK","year":"2021","unstructured":"Venkataramana NK. Multiloculated hydrocephalus: evolution of treatments and outcome. J Pediatr Neurosci. 2021;16(3):232\u2013239."},{"issue":"5","key":"b6","series-title":"Childs Nerv Syst","first-page":"1587","article-title":"Endoscopic aqueductoplasty and stenting in the treatment of isolated fourth ventricle in children: 20-year institutional experience","volume":"37","author":"Imperato A","year":"2021","unstructured":"Imperato A, Almaguer Ascencio LM, Ruggiero C,  Endoscopic aqueductoplasty and stenting in the treatment of isolated fourth ventricle in children: 20-year institutional experience. Childs Nerv Syst. 2021;37(5):1587\u20131596."},{"issue":"8","key":"b7","series-title":"Chin Med J (Engl)","first-page":"980","article-title":"Y-shaped branched ventriculo-peritoneal shunt for adult multiloculated hydrocephalus","volume":"135","author":"Ren X","year":"2022","unstructured":"Ren X, Yang C, Li X,  Y-shaped branched ventriculo-peritoneal shunt for adult multiloculated hydrocephalus. Chin Med J (Engl). 2022;135(8):980\u2013982."},{"key":"b8","series-title":"World Neurosurg","first-page":"e514","article-title":"Transtentorial distortion syndrome: consistent complication following lateral and fourth ventricular shunting in adults","volume":"110","author":"Craven CL","year":"2018","unstructured":"Craven CL, Baudracco I, Thompson SD, Thorne L, Watkins LD, Toma AK. Transtentorial distortion syndrome: consistent complication following lateral and fourth ventricular shunting in adults. World Neurosurg. 2018;110:e514\u2013e519."},{"issue":"3","key":"b9","series-title":"J Neurosurg Pediatr","first-page":"269","article-title":"Temporal trends in surgical procedures for pediatric hydrocephalus: an analysis of the Hydrocephalus Clinical Research Network Core Data Project","volume":"27","author":"Tamber MS","year":"2020","unstructured":"Tamber MS, Kestle JRW, Reeder RW,  Temporal trends in surgical procedures for pediatric hydrocephalus: an analysis of the Hydrocephalus Clinical Research Network Core Data Project. J Neurosurg Pediatr. 2020;27(3):269\u2013276."},{"issue":"4","key":"b10","series-title":"J Neurosurg Pediatr","first-page":"382","article-title":"Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study","volume":"17","author":"Riva-Cambrin J","year":"2016","unstructured":"Riva-Cambrin J, Kestle JRW, Holubkov R,  Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study. J Neurosurg Pediatr. 2016;17(4):382\u2013390."},{"issue":"1 Pt 2","key":"b11","series-title":"Pediatrics","first-page":"205","article-title":"Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980\u20131997","volume":"106","author":"Feudtner C","year":"2000","unstructured":"Feudtner C, Christakis DA, Connell FA. Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980\u20131997. Pediatrics. 2000;106(1 Pt 2):205\u2013209."},{"issue":"15","key":"b12","series-title":"JAMA","first-page":"1637","article-title":"The Propensity Score","volume":"314","author":"Haukoos JS","year":"2015","unstructured":"Haukoos JS, Lewis RJ. The Propensity Score. JAMA. 2015;314(15):1637\u20131638."},{"issue":"6","key":"b13","series-title":"J Neurosurg","first-page":"1747","article-title":"Classes of evidence in neurosurgery","volume":"126","author":"Rutka JT","year":"2017","unstructured":"Rutka JT. Editorial. Classes of evidence in neurosurgery. J Neurosurg. 2017;126(6):1747\u20131748."},{"issue":"5","key":"b14","series-title":"J Neurosurg Pediatr","first-page":"473","article-title":"Center effect and other factors influencing temporization and shunting of cerebrospinal fluid in preterm infants with intraventricular hemorrhage","volume":"9","author":"Riva-Cambrin J","year":"2012","unstructured":"Riva-Cambrin J, Shannon CN, Holubkov R,  Center effect and other factors influencing temporization and shunting of cerebrospinal fluid in preterm infants with intraventricular hemorrhage. J Neurosurg Pediatr. 2012;9(5):473\u2013481."},{"issue":"1","key":"b15","series-title":"Childs Nerv Syst","first-page":"13","article-title":"Complications after shunting isolated IV ventricles","volume":"13","author":"Eder HG","year":"1997","unstructured":"Eder HG, Leber KA, Gruber W. Complications after shunting isolated IV ventricles. Childs Nerv Syst. 1997;13(1):13\u201316."},{"issue":"6","key":"b16","series-title":"Pediatr Neurosurg","first-page":"309","article-title":"Complications of fourth-ventricular shunts","volume":"22","author":"Lee M","year":"1995","unstructured":"Lee M, Leahu D, Weiner HL, Abbott R, Wisoff JH, Epstein FJ. Complications of fourth-ventricular shunts. 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