{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:12:05Z","timestamp":1772827925729,"version":"3.50.1"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n In children treated with a ventriculoperitoneal shunt (VPS), the growing body length increases the negative hydrostatic pressure within the shunt. At initial shunt insertion in neonates, infants, and small children, some surgeons traditionally shorten the distal catheter, although full length is generally well tolerated. Authors of this study investigate the effect of shortening distal shunt catheters on intracranial pressure (ICP) and cerebrospinal fluid (CSF) drainage rates in a bench test model set for different ages and with particular valve types.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n \n Using a hardware-in-the-loop test bench, three different VPS settings were evaluated with both a standard 120-cm-long distal catheter and a short distal catheter (SDC) of 60 cm: a miniNav differential pressure valve with a 10-cmH\n 2<\/jats:sub>\n O opening pressure (MN10) and adjustable proGAV valves with a 25-cmH\n 2<\/jats:sub>\n O gravitational unit set at 5-cmH\n 2<\/jats:sub>\n O (PG5) and 10-cmH\n 2<\/jats:sub>\n O (PG10) opening pressures. The hardware was adjusted for the body length of 1-, 5-, and 10-year-old children. The software simulated the age-adapted physiological conditions of intracranial and intra-abdominal pressures. All valve and catheter combinations were tested 5 times, each in 1-hour runs in three positions: first horizontal, vertical, and second horizontal. Flow through the VPS and intracranial pressure were measured.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The use of an SDC, as compared to the standard catheter, led to a significant ICP decrease in the vertical position using the PG5 across all age groups, PG10 for 5 year olds, and MN10 for 10 year olds. Using the SDC also resulted in a significantly higher drained CSF volume in the vertical position across all age groups with the MN10 and PG5.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Shortening the distal catheter leads to increased drainage rates with significant ICP decreases in a 1-year-old child model setup. This effect is more pronounced for low opening pressure valves, unprotected valve systems, and model setups for older children. These results suggest that an SDC may promote overdrainage of variable magnitude depending on the age and height of the child and the valve setting. Therefore, an SDC should be avoided.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.3.peds24409","type":"journal-article","created":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T01:55:20Z","timestamp":1752285320000},"page":"421-430","source":"Crossref","is-referenced-by-count":0,"title":["Effects of shortening distal shunt catheters in children as relates to patient age and valve type: a simulation study with clinical implications"],"prefix":"10.3171","volume":"36","author":[{"given":"Sandra","family":"Fernandes Dias","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurosurgery, University Children\u2019s Hospital of Zurich;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth","family":"Jehli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Zurich;"},{"name":"Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin U.","family":"Schuhmann","sequence":"additional","affiliation":[{"name":"Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital T\u00fcbingen, Germany; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianne","family":"Schmid Daners","sequence":"additional","affiliation":[{"name":"Department of Mechanical and Process Engineering, Institute for Dynamic Systems and Control, ETH Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Childs Nerv Syst","first-page":"425","article-title":"Shunt survival rates by using the adjustable differential pressure valve combined with a gravitational unit (proGAV) in pediatric neurosurgery","volume":"29","author":"Thomale UW","year":"2013","unstructured":"Thomale UW, Gebert AF, Haberl H, Schulz M. Shunt survival rates by using the adjustable differential pressure valve combined with a gravitational unit (proGAV) in pediatric neurosurgery. Childs Nerv Syst. 2013;29(3):425\u2013431."},{"issue":"3","key":"b2","series-title":"Neurosurgery","first-page":"465","article-title":"The adjustable proGAV shunt: a prospective safety and reliability multicenter study","volume":"66","author":"Sprung C","year":"2010","unstructured":"Sprung C, Schlosser HG, Lemcke J, The adjustable proGAV shunt: a prospective safety and reliability multicenter study. Neurosurgery. 2010;66(3):465\u2013474."},{"issue":"3","key":"b3","series-title":"J Neurosurg Pediatr","first-page":"289","article-title":"Experiences with a gravity-assisted valve in hydrocephalic children. Clinical article","volume":"4","author":"Haberl EJ","year":"2009","unstructured":"Haberl EJ, Messing-Juenger M, Schuhmann M, Experiences with a gravity-assisted valve in hydrocephalic children. Clinical article. J Neurosurg Pediatr. 2009;4(3):289\u2013294."},{"issue":"1","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"50","article-title":"Effect of antisiphon devices on ventriculoperitoneal shunt drainage dynamics in growing children","volume":"32","author":"Tachatos N","year":"2023","unstructured":"Tachatos N, Fernandes Dias S, Jehli E, L\u00fcbben D, Schuhmann MU, Schmid Daners M. Effect of antisiphon devices on ventriculoperitoneal shunt drainage dynamics in growing children. J Neurosurg Pediatr. 2023;32(1):50\u201359."},{"issue":"2","key":"b5","series-title":"IEEE Trans Biomed Eng","first-page":"348","article-title":"Patient specific hardware-in-the-loop testing of cerebrospinal fluid shunt systems","volume":"63","author":"Gehlen M","year":"2016","unstructured":"Gehlen M, Kurtcuoglu V, Schmid Daners M. Patient specific hardware-in-the-loop testing of cerebrospinal fluid shunt systems. IEEE Trans Biomed Eng. 2016;63(2):348\u2013358."},{"key":"b6","series-title":"Beitr\u00e4ge zur Gesundheitsberichterstattung des Bundes","article-title":"Referenzperzentile f\u00fcr anthropometrische Ma\u00dfzahlen und Blutdruck aus der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS)","author":"Neuhauser H","year":"2013","unstructured":"Neuhauser H, Schienkiewitz A, Rosario AS, Dortschy R, Kurth BM. Referenzperzentile f\u00fcr anthropometrische Ma\u00dfzahlen und Blutdruck aus der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS). In: Beitr\u00e4ge zur Gesundheitsberichterstattung des Bundes. Springer. Robert Koch-Institut; 2013."},{"issue":"4","key":"b7","series-title":"Pediatr Nephrol","first-page":"311","article-title":"Effect of posture on intraperitoneal pressure and peritoneal permeability in children","volume":"12","author":"Fischbach M","year":"1998","unstructured":"Fischbach M, Terzic J, Dangelser C, Schneider P, Roger ML, Geisert J. Effect of posture on intraperitoneal pressure and peritoneal permeability in children. Pediatr Nephrol. 1998;12(4):311\u2013314."},{"issue":"3","key":"b8","series-title":"Acta Neurochir (Wien)","first-page":"519","article-title":"A counterforce to diversion of cerebrospinal fluid during ventriculoperitoneal shunting: the intraperitoneal pressure. An observational study","volume":"160","author":"Bose B","year":"2018","unstructured":"Bose B, Rohde V, Fiss I, Freimann FB. A counterforce to diversion of cerebrospinal fluid during ventriculoperitoneal shunting: the intraperitoneal pressure. An observational study. Acta Neurochir (Wien). 2018;160(3):519\u2013524."},{"issue":"2","key":"b9","series-title":"Pediatr Neurosci","first-page":"75","article-title":"Abdominal CSF pseudocyst","volume":"12","author":"Hahn YS","year":"1985","unstructured":"Hahn YS, Engelhard H, McLone DG. Abdominal CSF pseudocyst. Pediatr Neurosci. 1985;12(2):75\u201379."},{"issue":"12","key":"b10","series-title":"Cureus","first-page":"e20546","article-title":"The intraventricular pseudocyst as a complication of ventriculoperitoneal shunt: a rare case report and review of literature","volume":"13","author":"da Silva AJF","year":"2021","unstructured":"da Silva AJF, Castro Pinheiro Gomes FE, De Lima SC. The intraventricular pseudocyst as a complication of ventriculoperitoneal shunt: a rare case report and review of literature. 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Spontaneous extrusion of ventriculoperitoneal shunt catheter through the right lumbar region: a case report and review of the literature. Pediatr Neurosurg. 2015;50(6):336\u2013338."},{"issue":"4","key":"b14","series-title":"Clin Neurol Neurosurg","first-page":"389","article-title":"Ventriculo-peritoneal shunts can cause liver injury, juxta and intrahepatic pseudocysts: imaging findings and review of literature","volume":"114","author":"Verma A","year":"2012","unstructured":"Verma A, Mohan S, Gupta A. Ventriculo-peritoneal shunts can cause liver injury, juxta and intrahepatic pseudocysts: imaging findings and review of literature. Clin Neurol Neurosurg. 2012;114(4):389\u2013391."},{"issue":"6","key":"b15","series-title":"Clin Anat","first-page":"821","article-title":"Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus: a comprehensive analytical review from an anatomical perspective","volume":"30","author":"Allouh MZ","year":"2017","unstructured":"Allouh MZ, Al Barbarawi MM, Asfour HA, Said RS. Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus: a comprehensive analytical review from an anatomical perspective. Clin Anat. 2017;30(6):821\u2013830."},{"issue":"11","key":"b16","series-title":"Expert Rev Med Devices","first-page":"1155","article-title":"Gravitational shunt valves in hydrocephalus to challenge the sequelae of over-drainage","volume":"17","author":"Gutowski P","year":"2020","unstructured":"Gutowski P, Golz L, Rot S, Lemcke J, Thomale UW. Gravitational shunt valves in hydrocephalus to challenge the sequelae of over-drainage. Expert Rev Med Devices. 2020;17(11):1155\u20131168."},{"issue":"3","key":"b17","series-title":"Childs Nerv Syst","first-page":"401","article-title":"Chronic overdrainage syndrome: pathophysiological insights based on ICP analysis: a case-based review","volume":"34","author":"Sainz LV","year":"2018","unstructured":"Sainz LV, Hockel K, Schuhmann MU. Chronic overdrainage syndrome: pathophysiological insights based on ICP analysis: a case-based review. Childs Nerv Syst. 2018;34(3):401\u2013408."},{"issue":"16","key":"b18","series-title":"J Clin Med","first-page":"3620","article-title":"Shunt overdrainage: reappraisal of the syndrome and proposal for an integrative model","volume":"10","author":"Ros B","year":"2021","unstructured":"Ros B, Iglesias S, Linares J, Cerro L, Casado J, Arraez MA. Shunt overdrainage: reappraisal of the syndrome and proposal for an integrative model. J Clin Med. 2021;10(16):3620."},{"issue":"10","key":"b19","series-title":"Cureus","first-page":"e30902","article-title":"Incidental and clinical significance of slit ventricles in fixed pressure valves","volume":"14","author":"Alghamdi KT","year":"2022","unstructured":"Alghamdi KT, Alghamdi MD, Neazy S, Incidental and clinical significance of slit ventricles in fixed pressure valves. Cureus. 2022;14(10):e30902."},{"key":"b20","series-title":"World Neurosurg","first-page":"e912","article-title":"Abdominal pseudocysts and peritoneal catheter revisions: surgical long-term results in pediatric hydrocephalus","volume":"111","author":"Gmeiner M","year":"2018","unstructured":"Gmeiner M, Wagner H, van Ouwerkerk WJR, Senker W, Holl K, Gruber A. Abdominal pseudocysts and peritoneal catheter revisions: surgical long-term results in pediatric hydrocephalus. World Neurosurg. 2018;111:e912\u2013e920."},{"issue":"8","key":"b21","series-title":"Childs Nerv Syst","first-page":"454","article-title":"The value of colour Doppler imaging in assessing flow through ventriculo-peritoneal shunts","volume":"12","author":"Sgouros S","year":"1996","unstructured":"Sgouros S, John P, Walsh AR, Hockley AD. The value of colour Doppler imaging in assessing flow through ventriculo-peritoneal shunts. Childs Nerv Syst. 1996;12(8):454\u2013459."},{"issue":"1","key":"b22","series-title":"Neurosurg Rev","first-page":"190","article-title":"Noninvasive CSF shunt patency evaluation by superb microvascular imaging","volume":"46","author":"Putzer D","year":"2023","unstructured":"Putzer D, Brawanski K, Verius M, Noninvasive CSF shunt patency evaluation by superb microvascular imaging. Neurosurg Rev. 2023;46(1):190."},{"issue":"3","key":"b1","series-title":"Childs Nerv Syst","first-page":"425","article-title":"Shunt survival rates by using the adjustable differential pressure valve combined with a gravitational unit (proGAV) in pediatric neurosurgery","volume":"29","author":"Thomale UW","year":"2013","unstructured":"Thomale UW, Gebert AF, Haberl H, Schulz M. Shunt survival rates by using the adjustable differential pressure valve combined with a gravitational unit (proGAV) in pediatric neurosurgery. Childs Nerv Syst. 2013;29(3):425\u2013431."},{"issue":"3","key":"b2","series-title":"Neurosurgery","first-page":"465","article-title":"The adjustable proGAV shunt: a prospective safety and reliability multicenter study","volume":"66","author":"Sprung C","year":"2010","unstructured":"Sprung C, Schlosser HG, Lemcke J, The adjustable proGAV shunt: a prospective safety and reliability multicenter study. Neurosurgery. 2010;66(3):465\u2013474."},{"issue":"3","key":"b3","series-title":"J Neurosurg Pediatr","first-page":"289","article-title":"Experiences with a gravity-assisted valve in hydrocephalic children. Clinical article","volume":"4","author":"Haberl EJ","year":"2009","unstructured":"Haberl EJ, Messing-Juenger M, Schuhmann M, Experiences with a gravity-assisted valve in hydrocephalic children. Clinical article. J Neurosurg Pediatr. 2009;4(3):289\u2013294."},{"issue":"1","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"50","article-title":"Effect of antisiphon devices on ventriculoperitoneal shunt drainage dynamics in growing children","volume":"32","author":"Tachatos N","year":"2023","unstructured":"Tachatos N, Fernandes Dias S, Jehli E, L\u00fcbben D, Schuhmann MU, Schmid Daners M. Effect of antisiphon devices on ventriculoperitoneal shunt drainage dynamics in growing children. J Neurosurg Pediatr. 2023;32(1):50\u201359."},{"issue":"2","key":"b5","series-title":"IEEE Trans Biomed Eng","first-page":"348","article-title":"Patient specific hardware-in-the-loop testing of cerebrospinal fluid shunt systems","volume":"63","author":"Gehlen M","year":"2016","unstructured":"Gehlen M, Kurtcuoglu V, Schmid Daners M. Patient specific hardware-in-the-loop testing of cerebrospinal fluid shunt systems. IEEE Trans Biomed Eng. 2016;63(2):348\u2013358."},{"key":"b6","series-title":"Beitr\u00e4ge zur Gesundheitsberichterstattung des Bundes","article-title":"Referenzperzentile f\u00fcr anthropometrische Ma\u00dfzahlen und Blutdruck aus der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS)","author":"Neuhauser H","year":"2013","unstructured":"Neuhauser H, Schienkiewitz A, Rosario AS, Dortschy R, Kurth BM. Referenzperzentile f\u00fcr anthropometrische Ma\u00dfzahlen und Blutdruck aus der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS). In: Beitr\u00e4ge zur Gesundheitsberichterstattung des Bundes. Springer. Robert Koch-Institut; 2013."},{"issue":"4","key":"b7","series-title":"Pediatr Nephrol","first-page":"311","article-title":"Effect of posture on intraperitoneal pressure and peritoneal permeability in children","volume":"12","author":"Fischbach M","year":"1998","unstructured":"Fischbach M, Terzic J, Dangelser C, Schneider P, Roger ML, Geisert J. Effect of posture on intraperitoneal pressure and peritoneal permeability in children. Pediatr Nephrol. 1998;12(4):311\u2013314."},{"issue":"3","key":"b8","series-title":"Acta Neurochir (Wien)","first-page":"519","article-title":"A counterforce to diversion of cerebrospinal fluid during ventriculoperitoneal shunting: the intraperitoneal pressure. An observational study","volume":"160","author":"Bose B","year":"2018","unstructured":"Bose B, Rohde V, Fiss I, Freimann FB. A counterforce to diversion of cerebrospinal fluid during ventriculoperitoneal shunting: the intraperitoneal pressure. An observational study. Acta Neurochir (Wien). 2018;160(3):519\u2013524."},{"issue":"2","key":"b9","series-title":"Pediatr Neurosci","first-page":"75","article-title":"Abdominal CSF pseudocyst","volume":"12","author":"Hahn YS","year":"1985","unstructured":"Hahn YS, Engelhard H, McLone DG. Abdominal CSF pseudocyst. Pediatr Neurosci. 1985;12(2):75\u201379."},{"issue":"12","key":"b10","series-title":"Cureus","first-page":"e20546","article-title":"The intraventricular pseudocyst as a complication of ventriculoperitoneal shunt: a rare case report and review of literature","volume":"13","author":"da Silva AJF","year":"2021","unstructured":"da Silva AJF, Castro Pinheiro Gomes FE, De Lima SC. The intraventricular pseudocyst as a complication of ventriculoperitoneal shunt: a rare case report and review of literature. Cureus. 2021;13(12):e20546."},{"issue":"2","key":"b11","series-title":"Cureus","first-page":"e13230","article-title":"Abdominal complications related to ventriculoperitoneal shunt placement: a comprehensive review of literature","volume":"13","author":"Ferreira Furtado LM","year":"2021","unstructured":"Ferreira Furtado LM, Da Costa Val Filho JA, Moreira Faleiro R, Lima Vieira JA, Dantas Dos Santos AK. Abdominal complications related to ventriculoperitoneal shunt placement: a comprehensive review of literature. Cureus. 2021;13(2):e13230."},{"issue":"6","key":"b12","series-title":"Pediatr Surg Int","first-page":"575","article-title":"Trans-anal protrusion of ventriculo-peritoneal shunt catheter with silent bowel perforation: report of ten cases in children","volume":"23","author":"Ghritlaharey RK","year":"2007","unstructured":"Ghritlaharey RK, Budhwani KS, Shrivastava DK, Trans-anal protrusion of ventriculo-peritoneal shunt catheter with silent bowel perforation: report of ten cases in children. Pediatr Surg Int. 2007;23(6):575\u2013580."},{"issue":"6","key":"b13","series-title":"Pediatr Neurosurg","first-page":"336","article-title":"Spontaneous extrusion of ventriculoperitoneal shunt catheter through the right lumbar region: a case report and review of the literature","volume":"50","author":"Oktay K","year":"2015","unstructured":"Oktay K, Erkoc YS, Ethemoglu KB, Olguner SK, Sarac ME. Spontaneous extrusion of ventriculoperitoneal shunt catheter through the right lumbar region: a case report and review of the literature. Pediatr Neurosurg. 2015;50(6):336\u2013338."},{"issue":"4","key":"b14","series-title":"Clin Neurol Neurosurg","first-page":"389","article-title":"Ventriculo-peritoneal shunts can cause liver injury, juxta and intrahepatic pseudocysts: imaging findings and review of literature","volume":"114","author":"Verma A","year":"2012","unstructured":"Verma A, Mohan S, Gupta A. Ventriculo-peritoneal shunts can cause liver injury, juxta and intrahepatic pseudocysts: imaging findings and review of literature. Clin Neurol Neurosurg. 2012;114(4):389\u2013391."},{"issue":"6","key":"b15","series-title":"Clin Anat","first-page":"821","article-title":"Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus: a comprehensive analytical review from an anatomical perspective","volume":"30","author":"Allouh MZ","year":"2017","unstructured":"Allouh MZ, Al Barbarawi MM, Asfour HA, Said RS. Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus: a comprehensive analytical review from an anatomical perspective. Clin Anat. 2017;30(6):821\u2013830."},{"issue":"11","key":"b16","series-title":"Expert Rev Med Devices","first-page":"1155","article-title":"Gravitational shunt valves in hydrocephalus to challenge the sequelae of over-drainage","volume":"17","author":"Gutowski P","year":"2020","unstructured":"Gutowski P, Golz L, Rot S, Lemcke J, Thomale UW. Gravitational shunt valves in hydrocephalus to challenge the sequelae of over-drainage. Expert Rev Med Devices. 2020;17(11):1155\u20131168."},{"issue":"3","key":"b17","series-title":"Childs Nerv Syst","first-page":"401","article-title":"Chronic overdrainage syndrome: pathophysiological insights based on ICP analysis: a case-based review","volume":"34","author":"Sainz LV","year":"2018","unstructured":"Sainz LV, Hockel K, Schuhmann MU. Chronic overdrainage syndrome: pathophysiological insights based on ICP analysis: a case-based review. Childs Nerv Syst. 2018;34(3):401\u2013408."},{"issue":"16","key":"b18","series-title":"J Clin Med","first-page":"3620","article-title":"Shunt overdrainage: reappraisal of the syndrome and proposal for an integrative model","volume":"10","author":"Ros B","year":"2021","unstructured":"Ros B, Iglesias S, Linares J, Cerro L, Casado J, Arraez MA. Shunt overdrainage: reappraisal of the syndrome and proposal for an integrative model. J Clin Med. 2021;10(16):3620."},{"issue":"10","key":"b19","series-title":"Cureus","first-page":"e30902","article-title":"Incidental and clinical significance of slit ventricles in fixed pressure valves","volume":"14","author":"Alghamdi KT","year":"2022","unstructured":"Alghamdi KT, Alghamdi MD, Neazy S, Incidental and clinical significance of slit ventricles in fixed pressure valves. Cureus. 2022;14(10):e30902."},{"key":"b20","series-title":"World Neurosurg","first-page":"e912","article-title":"Abdominal pseudocysts and peritoneal catheter revisions: surgical long-term results in pediatric hydrocephalus","volume":"111","author":"Gmeiner M","year":"2018","unstructured":"Gmeiner M, Wagner H, van Ouwerkerk WJR, Senker W, Holl K, Gruber A. Abdominal pseudocysts and peritoneal catheter revisions: surgical long-term results in pediatric hydrocephalus. World Neurosurg. 2018;111:e912\u2013e920."},{"issue":"8","key":"b21","series-title":"Childs Nerv Syst","first-page":"454","article-title":"The value of colour Doppler imaging in assessing flow through ventriculo-peritoneal shunts","volume":"12","author":"Sgouros S","year":"1996","unstructured":"Sgouros S, John P, Walsh AR, Hockley AD. The value of colour Doppler imaging in assessing flow through ventriculo-peritoneal shunts. Childs Nerv Syst. 1996;12(8):454\u2013459."},{"issue":"1","key":"b22","series-title":"Neurosurg Rev","first-page":"190","article-title":"Noninvasive CSF shunt patency evaluation by superb microvascular imaging","volume":"46","author":"Putzer D","year":"2023","unstructured":"Putzer D, Brawanski K, Verius M, Noninvasive CSF shunt patency evaluation by superb microvascular imaging. 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