{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T02:25:15Z","timestamp":1787970315961,"version":"build-2784847793"},"reference-count":13,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,12]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Clinical features of shunt malfunction are often nonspecific and neuroimaging is a well-established aid in diagnosis. In practice, qualitative assessment of overall ventricular change guides management; however, change in third ventricular diameter (TVD) alone has been proposed as a low-complexity quantitative index of overall ventricular change. This study aimed to evaluate the diagnostic utility of change in TVD compared with global assessment of ventricular caliber change by a neurosurgeon in detecting shunt malfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective review of all pediatric ventricular shunt revisions performed at a single center (November 2014\u2013September 2024) was conducted. TVDs were measured when the patient was last known well and on preoperative imaging. Quantitative change was compared to the overall impression of change in ventricular caliber by neurosurgeons for detecting shunt malfunction. Shunt malfunction was defined as the need to replace one or more shunt components at the time of surgery (diagnostic gold standard). Diagnostic performance was assessed using comparison of areas under the receiver operating characteristic (ROC) curve.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 422 shunt revisions were performed during the study period, of which 315 (75%) were found to have shunt malfunction. ROC analysis utilizing a cutoff of \u2265 2-mm TVD increase detected shunt malfunction with 63% sensitivity and 58% specificity (area under the curve [AUC] 0.62, 95% CI 0.55\u20130.69; p &lt; 0.001). Pragmatic refinement by restricting the cohort to the subset of 136 patients known to have a change in ventricular caliber at the time of previous shunt failure and selecting a \u2265 1-mm cutoff increased the discriminative power of change in TVD to 92% sensitivity and 21% specificity. In this restricted cohort, the overall assessment of ventricular change by neurosurgeons yielded 81% sensitivity and 62% specificity (AUC 0.72, 95% CI 0.59\u20130.84) and the AUC difference between the two techniques was not statistically significant (AUC difference 0.08, 95% CI \u22120.03 to 0.20; p = 0.16).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>In a pragmatically selected cohort, an increase \u2265 1 mm from baseline TVD alone provides sensitivity comparable to that of overall assessment of ventricular change by a neurosurgeon identifying shunt malfunction in a cohort undergoing shunt revision. This simple linear measurement could be integrated as a screening test in clinical, imaging, and\/or AI algorithms to facilitate rapid recognition of pediatric shunt failure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.2.peds25625","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:45Z","timestamp":1781049645000},"page":"1-9","source":"Crossref","is-referenced-by-count":0,"title":["Comparative sensitivity and specificity of change in third ventricular diameter or global ventricular change for detecting pediatric ventriculoperitoneal shunt malfunction: a 10-year retrospective cohort study"],"prefix":"10.3171","author":[{"given":"Charlie","family":"Cho","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liam G.","family":"Coulthard","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland;"},{"name":"Faculty of Medicine, University of Queensland, Herston, Queensland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annabelle M.","family":"Harbison","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norman","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A. J.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia J.","family":"Jardim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"How","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Stuart","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland;"},{"name":"Faculty of Medicine, University of Queensland, Herston, Queensland; and"},{"name":"Queensland Brain Aneurysm Institute, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Pediatr Neurol","first-page":"83","article-title":"Failure of cerebrospinal fluid shunts: part I: obstruction and mechanical failure","volume":"34","author":"Browd SR","year":"2006","unstructured":"Browd SR, Ragel BT, Gottfried ON, Kestle JR. Failure of cerebrospinal fluid shunts: part I: obstruction and mechanical failure. Pediatr Neurol. 2006;34(2):83\u201392. doi:10.1016\/j.pediatrneurol.2005.05.020"},{"issue":"4","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"338","article-title":"The utility of routine intraoperative CSF during ventricular shunt insertion: a 10-year retrospective cohort study","volume":"35","author":"Stuart MJ","year":"2025","unstructured":"Stuart MJ, Harbison AM, Ruder T,  The utility of routine intraoperative CSF during ventricular shunt insertion: a 10-year retrospective cohort study. J Neurosurg Pediatr. 2025;35(4):338\u2013344. doi:10.3171\/2024.11.PEDS24513"},{"issue":"4","key":"b3","series-title":"Eur J Paediatr Neurol","first-page":"571","article-title":"Changes of third ventricle diameter (TVD) mirror changes of the entire ventricular system after initial therapy and during follow-up in pediatric hydrocephalus","volume":"23","author":"Kerscher SR","year":"2019","unstructured":"Kerscher SR, Schweizer LL, N\u00e4gele T, Weichselbaum A, Haas-Lude K, Schuhmann MU. Changes of third ventricle diameter (TVD) mirror changes of the entire ventricular system after initial therapy and during follow-up in pediatric hydrocephalus. Eur J Paediatr Neurol. 2019;23(4):571\u2013580. doi:10.1016\/j.ejpn.2019.05.008"},{"issue":"9","key":"b4","series-title":"Childs Nerv Syst","first-page":"2033","article-title":"Changes of third ventricle diameter (TVD) mirror changes of the entire ventricular system at acute shunt failure and after shunt revision in pediatric hydrocephalus","volume":"36","author":"Kerscher SR","year":"2020","unstructured":"Kerscher SR, Schweizer LL, Haas-Lude K, Bevot A, Schuhmann MU. Changes of third ventricle diameter (TVD) mirror changes of the entire ventricular system at acute shunt failure and after shunt revision in pediatric hydrocephalus. Childs Nerv Syst. 2020;36(9):2033\u20132039. doi:10.1007\/s00381-020-04570-1"},{"issue":"2","key":"b5","series-title":"Pediatr Radiol","first-page":"282","article-title":"Morphological evaluation of the normal and hydrocephalic third ventricle on cranial magnetic resonance imaging in children: a retrospective study","volume":"53","author":"Isiklar S","year":"2023","unstructured":"Isiklar S, Turan Ozdemir S, Ozkaya G, Ozpar R, Parlak M. Morphological evaluation of the normal and hydrocephalic third ventricle on cranial magnetic resonance imaging in children: a retrospective study. Pediatr Radiol. 2023;53(2):282\u2013296."},{"issue":"3","key":"b6","series-title":"Neuropediatrics","first-page":"185","article-title":"Transtemporal ultrasound (US) assessment of third ventricle diameter (TVD): comparison of US and MRI TVD in pediatric patients","volume":"51","author":"Kerscher SR","year":"2020","unstructured":"Kerscher SR, Schweizer LL, N\u00e4gele T, Bevot A, Alber M, Schuhmann MU. Transtemporal ultrasound (US) assessment of third ventricle diameter (TVD): comparison of US and MRI TVD in pediatric patients. Neuropediatrics. 2020;51(3):185\u2013191. doi:10.1055\/s-0039-3400978"},{"issue":"6","key":"b7","series-title":"J Neurosurg Pediatr","first-page":"703","article-title":"Risk factors for unchanged ventricles during pediatric shunt malfunction","volume":"28","author":"Reynolds RA","year":"2021","unstructured":"Reynolds RA, Ahluwalia R, Krishnan V,  Risk factors for unchanged ventricles during pediatric shunt malfunction. J Neurosurg Pediatr. 2021;28(6):703\u2013709. doi:10.3171\/2021.6.PEDS2125"},{"issue":"6","key":"b8","series-title":"J Neurosurg Pediatr","first-page":"547","article-title":"The accuracy of linear indices of ventricular volume in pediatric hydrocephalus: technical note","volume":"15","author":"Ragan DK","year":"2015","unstructured":"Ragan DK, Cerqua J, Nash T,  The accuracy of linear indices of ventricular volume in pediatric hydrocephalus: technical note. J Neurosurg Pediatr. 2015;15(6):547\u2013551. doi:10.3171\/2014.10.PEDS14209"},{"issue":"1","key":"b9","series-title":"Childs Nerv Syst","first-page":"105","article-title":"Validating the modified Canadian Preoperative Prediction Rule for Hydrocephalus for accurate hydrocephalus prediction in a statewide pediatric brain tumor cohort","volume":"41","author":"Obeng-Gyasi B","year":"2025","unstructured":"Obeng-Gyasi B, Line TA, Chinthala AS, Tailor J. Validating the modified Canadian Preoperative Prediction Rule for Hydrocephalus for accurate hydrocephalus prediction in a statewide pediatric brain tumor cohort. Childs Nerv Syst. 2025;41(1):105. doi:10.1007\/s00381-025-06761-0"},{"key":"b10","series-title":"Front Neurol","first-page":"1255858","article-title":"Current role of portable MRI in diagnosis of acute neurological conditions","volume":"14","author":"Shoghli A","year":"2023","unstructured":"Shoghli A, Chow D, Kuoy E, Yaghmai V. Current role of portable MRI in diagnosis of acute neurological conditions. Front Neurol. 2023;14:1255858. doi:10.3389\/fneur.2023.1255858"},{"issue":"1","key":"b11","series-title":"AJNR Am J Neuroradiol","first-page":"47","article-title":"Viz.ai implementation of stroke augmented intelligence and communications platform to improve indicators and outcomes for a comprehensive stroke center and network","volume":"44","author":"Figurelle ME","year":"2023","unstructured":"Figurelle ME, Meyer DM, Perrinez ES,  Viz.ai implementation of stroke augmented intelligence and communications platform to improve indicators and outcomes for a comprehensive stroke center and network. AJNR Am J Neuroradiol. 2023;44(1):47\u201353. doi:10.3174\/ajnr.A7716"},{"issue":"6","key":"b12","series-title":"J Neurosurg Pediatr","first-page":"546","article-title":"The risks of omitting routine postoperative imaging after insertion of new ventricular shunts in children: a 10-year retrospective cohort study","volume":"35","author":"Stuart MJ","year":"2025","unstructured":"Stuart MJ, Harbison AM, Ruder T,  The risks of omitting routine postoperative imaging after insertion of new ventricular shunts in children: a 10-year retrospective cohort study. J Neurosurg Pediatr. 2025;35(6):546\u2013553. doi:10.3171\/2024.12.PEDS24496"},{"issue":"4","key":"b13","series-title":"J Neurosurg Pediatr","first-page":"327","article-title":"Reimagining durability of hydrocephalus treatment using conditional survival","volume":"35","author":"Yengo-Kahn AM","year":"2025","unstructured":"Yengo-Kahn AM, Wellons JC, Jensen H,  Reimagining durability of hydrocephalus treatment using conditional survival. J Neurosurg Pediatr. 2025;35(4):327\u2013337. doi:10.3171\/2024.10.PEDS24454"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/aop\/article-10.3171-2026.2.PEDS25625\/article-10.3171-2026.2.PEDS25625.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/aop\/article-10.3171-2026.2.PEDS25625\/article-10.3171-2026.2.PEDS25625.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/aop\/article-10.3171-2026.2.PEDS25625\/article-10.3171-2026.2.PEDS25625.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T02:07:23Z","timestamp":1787969243000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/aop\/article-10.3171-2026.2.PEDS25625\/article-10.3171-2026.2.PEDS25625.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":13,"URL":"https:\/\/doi.org\/10.3171\/2026.2.peds25625","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]}}}