{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:12:31Z","timestamp":1789776751731,"version":"4.0.1"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,17]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Endoscopic third ventriculostomy (ETV), an alternative to ventriculoperitoneal shunt (VPS) placement, is associated with a higher risk of early failure, sometimes necessitating subsequent VPS insertion. The authors evaluated the impact of ETV prior to VPS placement on the risk of VPS failure by using the Hydrocephalus Clinical Research Network (HCRN) Core Data Project.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors retrospectively reviewed prospectively collected data from the HCRN Core Data Project (registry) on all children who underwent VPS surgery between April 2008 and July 2023. Children who had undergone VPS placement as initial treatment for hydrocephalus were compared with those who had undergone ETV prior to VPS insertion. The primary outcome was initial VPS survival, with failure defined as any subsequent hydrocephalus procedure. Kaplan-Meier and Cox proportional hazards analyses were performed to assess the effect of prior ETV, controlling for age at the first permanent procedure (ETV or VPS placement), hydrocephalus etiology, and complex chronic conditions (CCCs).<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n VPS placement was performed in 6206 children, of whom 642 underwent VPS placement after failed ETV. VPS insertion after ETV improved shunt survival at 1 year (74.3% vs 67.8%, p < 0.001). Unadjusted analysis showed improved VPS survival after ETV (HR 0.78, 95% CI 0.68\u20130.90, p = 0.001). Corrected age \u2265 30 days at the time of the first permanent procedure, choroid plexus cauterization, etiology of hydrocephalus other than intraventricular hemorrhage of prematurity, and the absence of a CCC were also associated with improved shunt survival on univariable analysis. Multivariable analysis revealed that hydrocephalus etiology, the absence of a CCC, corrected age \u2265 30 days at the time of the first permanent procedure, and ETV prior to VPS insertion (HR 0.85, 95% CI 0.74\u20130.98) remained associated with shunt survival (all p < 0.05).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n This analysis demonstrates an association between ETV prior to VPS placement and improved VPS survival, even when controlling for age, comorbid conditions, and hydrocephalus etiology. Further work is needed to understand the mechanism of this effect.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.7.peds25119","type":"journal-article","created":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T02:08:23Z","timestamp":1760753303000},"page":"669-676","source":"Crossref","is-referenced-by-count":1,"title":["Effect of endoscopic third ventriculostomy on subsequent shunt failure: a Hydrocephalus Clinical Research Network study"],"prefix":"10.3171","volume":"36","author":[{"given":"Michael J.","family":"Feldman","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma Health College of Medicine, Oklahoma City, Oklahoma;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailey","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Arynchyna-Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s of Alabama, The University of Alabama at Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron W.","family":"Reeder","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Curtis J.","family":"Rozzelle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s of Alabama, The University of Alabama at Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer M.","family":"Strahle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St. Louis Children\u2019s Hospital, Washington University in St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William E.","family":"Whitehead","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatric Neurosurgery, Texas Children\u2019s Hospital, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Pindrik","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Division of Pediatric Neurosurgery, Nationwide Children\u2019s Hospital, The Ohio State University, Columbus, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert M.","family":"Isaacs","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Division of Pediatric Neurosurgery, Nationwide Children\u2019s Hospital, The Ohio State University, Columbus, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason S.","family":"Hauptman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatric Neurological Surgery, Phoenix Children\u2019s Hospital, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcie","family":"Langley","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick J.","family":"McDonald","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandeep S.","family":"Tamber","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Neurosurgery, British Columbia Children\u2019s Hospital, University of British Columbia, Vancouver, British Columbia, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian F.","family":"Pollack","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric M.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Wellons","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Naftel","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd C.","family":"Hankinson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital Colorado, University of Colorado, Aurora, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhaya V.","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Riva-Cambrin","sequence":"additional","affiliation":[{"name":"Alberta Children\u2019s Hospital, University of Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R. W.","family":"Kestle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon G.","family":"Rocque","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s of Alabama, The University of Alabama at Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"J Neurosurg Pediatr","first-page":"428","article-title":"Endoscopic third ventriculostomy in previously shunt-treated patients","volume":"30","author":"Rocque BG","year":"2022","unstructured":"Rocque BG, Jensen H, Reeder RW, Endoscopic third ventriculostomy in previously shunt-treated patients. J Neurosurg Pediatr. 2022;30(4):428\u2013436."},{"issue":"5","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"439","article-title":"Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment for infant hydrocephalus: a prospective North American series","volume":"14","author":"Stone SSD","year":"2014","unstructured":"Stone SSD, Warf BC. Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment for infant hydrocephalus: a prospective North American series. J Neurosurg Pediatr. 2014;14(5):439\u2013446."},{"key":"b3","series-title":"Surg Neurol Int","first-page":"467","article-title":"Endoscopic third ventriculostomy versus ventriculoperitoneal shunt insertion for the management of pediatric hydrocephalus in African centers - a systematic review and meta-analysis","volume":"13","author":"Jesuyajolu DA","year":"2022","unstructured":"Jesuyajolu DA, Zubair A, Nicholas AK, Endoscopic third ventriculostomy versus ventriculoperitoneal shunt insertion for the management of pediatric hydrocephalus in African centers - a systematic review and meta-analysis. Surg Neurol Int. 2022;13:467."},{"key":"b4","series-title":"World Neurosurg","first-page":"334","article-title":"Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in patients with obstructive hydrocephalus: meta-analysis of randomized controlled trials","volume":"129","author":"Lu L","year":"2019","unstructured":"Lu L, Chen H, Weng S, Xu Y. Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in patients with obstructive hydrocephalus: meta-analysis of randomized controlled trials. World Neurosurg. 2019;129:334\u2013340."},{"issue":"6","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"463","article-title":"Shunt survival after failed endoscopic treatment of hydrocephalus","volume":"10","author":"Warf BC","year":"2012","unstructured":"Warf BC, Bhai S, Kulkarni AV, Mugamba J. Shunt survival after failed endoscopic treatment of hydrocephalus. 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J Neurosurg Pediatr. 2016;17(4):382\u2013390."},{"issue":"1 Suppl","key":"b8","series-title":"J Neurosurg","first-page":"43","article-title":"Mechanisms of failure after endoscopic third ventriculostomy in young infants","volume":"103","author":"Wagner W","year":"2005","unstructured":"Wagner W, Koch D. Mechanisms of failure after endoscopic third ventriculostomy in young infants. J Neurosurg. 2005;103(1 Suppl):43\u201349."},{"issue":"10","key":"b9","series-title":"AJNR Am J Neuroradiol","first-page":"2514","article-title":"Functional analysis of third ventriculostomy patency by quantification of CSF stroke volume by using cine phase-contrast MR imaging","volume":"26","author":"Bargallo N","year":"2005","unstructured":"Bargallo N, Olondo L, Garcia AI, Capurro S, Caral L, Rumia J. Functional analysis of third ventriculostomy patency by quantification of CSF stroke volume by using cine phase-contrast MR imaging. AJNR Am J Neuroradiol. 2005;26(10):2514\u20132521."},{"issue":"5","key":"b10","series-title":"Neurosurg Focus","first-page":"E10","article-title":"Cerebrospinal fluid hypersecretion in pediatric hydrocephalus","volume":"41","author":"Karimy JK","year":"2016","unstructured":"Karimy JK, Duran D, Hu JK, Cerebrospinal fluid hypersecretion in pediatric hydrocephalus. Neurosurg Focus. 2016;41(5):E10."},{"issue":"2","key":"b11","series-title":"J Pediatr","first-page":"254","article-title":"Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus","volume":"155","author":"Kulkarni AV","year":"2009","unstructured":"Kulkarni AV, Drake JM, Mallucci CL, Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. 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J Neurosurg Pediatr. 2014;14(5):439\u2013446."},{"key":"b3","series-title":"Surg Neurol Int","first-page":"467","article-title":"Endoscopic third ventriculostomy versus ventriculoperitoneal shunt insertion for the management of pediatric hydrocephalus in African centers - a systematic review and meta-analysis","volume":"13","author":"Jesuyajolu DA","year":"2022","unstructured":"Jesuyajolu DA, Zubair A, Nicholas AK, Endoscopic third ventriculostomy versus ventriculoperitoneal shunt insertion for the management of pediatric hydrocephalus in African centers - a systematic review and meta-analysis. Surg Neurol Int. 2022;13:467."},{"key":"b4","series-title":"World Neurosurg","first-page":"334","article-title":"Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in patients with obstructive hydrocephalus: meta-analysis of randomized controlled trials","volume":"129","author":"Lu L","year":"2019","unstructured":"Lu L, Chen H, Weng S, Xu Y. Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in patients with obstructive hydrocephalus: meta-analysis of randomized controlled trials. World Neurosurg. 2019;129:334\u2013340."},{"issue":"6","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"463","article-title":"Shunt survival after failed endoscopic treatment of hydrocephalus","volume":"10","author":"Warf BC","year":"2012","unstructured":"Warf BC, Bhai S, Kulkarni AV, Mugamba J. Shunt survival after failed endoscopic treatment of hydrocephalus. J Neurosurg Pediatr. 2012;10(6):463\u2013470."},{"issue":"2","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"176","article-title":"Ventriculoperitoneal shunt placement following endoscopic third ventriculostomy failure in the treatment of pediatric hydrocephalus","volume":"34","author":"Evans AR","year":"2024","unstructured":"Evans AR, Villeneuve L, Bowen I, Ventriculoperitoneal shunt placement following endoscopic third ventriculostomy failure in the treatment of pediatric hydrocephalus. J Neurosurg Pediatr. 2024;34(2):176\u2013181."},{"issue":"4","key":"b7","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. 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AJNR Am J Neuroradiol. 2005;26(10):2514\u20132521."},{"issue":"5","key":"b10","series-title":"Neurosurg Focus","first-page":"E10","article-title":"Cerebrospinal fluid hypersecretion in pediatric hydrocephalus","volume":"41","author":"Karimy JK","year":"2016","unstructured":"Karimy JK, Duran D, Hu JK, Cerebrospinal fluid hypersecretion in pediatric hydrocephalus. Neurosurg Focus. 2016;41(5):E10."},{"issue":"2","key":"b11","series-title":"J Pediatr","first-page":"254","article-title":"Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus","volume":"155","author":"Kulkarni AV","year":"2009","unstructured":"Kulkarni AV, Drake JM, Mallucci CL, Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. J Pediatr. 2009;155(2):254\u2013259.e1."}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/36\/6\/article-p669.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/36\/6\/article-p669.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/36\/6\/article-p669.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:46:47Z","timestamp":1772804807000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/36\/6\/article-p669.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,17]]},"references-count":22,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2025.7.peds25119","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,17]]}}}