{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T06:31:44Z","timestamp":1776234704313,"version":"3.50.1"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"22","license":[{"start":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T00:00:00Z","timestamp":1701043200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,27]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Ventriculoperitoneal shunting (VPS) is a standard procedure for the treatment of hydrocephalus, and the management of its complications is common in the practice of pediatric neurosurgery. Shunt exposure, though a rare complication, can occur because of thin, fragile skin, a young patient age, protuberant hardware, poor scalp perfusion, and a multitude of other patient factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The authors report a complex case of VPS erosion through the scalp in a young female with Pfeiffer syndrome treated with external ventricular drainage, empirical antibiotics, and reinternalization with countersinking of replaced shunt hardware into the calvarium to prevent internal skin pressure points, reduce wound tension, and allow wound healing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Recessing the shunt hardware, or countersinking the implant, into the calvarium is a simple technique often used in functional neurosurgical implantation surgeries, providing a safe surgical strategy to optimize wound healing in select cases in which the skin flap is unfavorable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23310","type":"journal-article","created":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T19:13:29Z","timestamp":1701112409000},"source":"Crossref","is-referenced-by-count":1,"title":["Approaches to ventriculoperitoneal shunt scalp erosion: countersinking into the calvarium. Illustrative case"],"prefix":"10.3171","volume":"6","author":[{"given":"Denise","family":"Brunozzi","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Illinois Chicago, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa A","family":"LoPresti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Neurological Surgery, Ann & Robert H. Lurie Children\u2019s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois"},{"name":"Division of Pediatric Neurosurgery, Departments of Neurosurgery and Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer L","family":"McGrath","sequence":"additional","affiliation":[{"name":"Division of Plastic & Reconstructive Surgery, Ann & Robert H. Lurie Children\u2019s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tord D","family":"Alden","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Neurological Surgery, Ann & Robert H. Lurie Children\u2019s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Childs Nerv Syst","first-page":"1229","article-title":"Management of exposed ventriculoperitoneal shunt on the scalp in pediatric patients","volume":"34","author":"Akdag O","year":"2018","unstructured":"Akdag O. Management of exposed ventriculoperitoneal shunt on the scalp in pediatric patients. Childs Nerv Syst. 2018;34(6):1229\u20131233."},{"key":"b2","series-title":"Int J Surg Case Rep","first-page":"484","article-title":"Shunt exposure as a ventriculoperitoneal shunt complication: a case series","volume":"79","author":"Suryaningtyas W","year":"2021","unstructured":"Suryaningtyas W, Ranuh IGMAR, Parenrengi MA. Shunt exposure as a ventriculoperitoneal shunt complication: a case series. Int J Surg Case Rep. 2021;79:484\u2013491."},{"issue":"8","key":"b3","series-title":"Childs Nerv Syst","first-page":"1431","article-title":"Subpericranial shunt valve placement: a technique in patients with friable skin","volume":"30","author":"Bot GM","year":"2014","unstructured":"Bot GM, Ismail NJ, Usman B,  Subpericranial shunt valve placement: a technique in patients with friable skin. Childs Nerv Syst. 2014;30(8):1431\u20131433."},{"issue":"10","key":"b4","series-title":"Dermatol Online J","article-title":"Scalp necrosis overlying a ventriculoperitoneal shunt: a case report and literature review","volume":"21","author":"Nguyen TA","year":"2015","unstructured":"Nguyen TA, Cohen PR. Scalp necrosis overlying a ventriculoperitoneal shunt: a case report and literature review. Dermatol Online J. 2015;21(10):13030\/qt2rs544f9."},{"key":"b5","series-title":"World Neurosurg","first-page":"98","article-title":"A stencil instrument for countersinking deep brain stimulator lead anchoring devices","volume":"167","author":"Miller KJ","year":"2022","unstructured":"Miller KJ. A stencil instrument for countersinking deep brain stimulator lead anchoring devices. World Neurosurg. 2022;167:98\u2013101."},{"key":"b6","series-title":"Surg Neurol Int","first-page":"280","article-title":"Dual floor burr hole technique in deep brain stimulation: a retrospective study on 209 patients","volume":"8","author":"Servello D","year":"2017","unstructured":"Servello D, Saleh C, Bona AR, Minichiello M, Zekaj E. Dual floor burr hole technique in deep brain stimulation: a retrospective study on 209 patients. Surg Neurol Int. 2017;8:280."},{"issue":"2","key":"b7","series-title":"Neurosurgery","first-page":"445","article-title":"A multi-institutional, 5-year analysis of initial and multiple ventricular shunt revisions in children","volume":"62","author":"Berry JG","year":"2008","unstructured":"Berry JG, Hall MA, Sharma V, Goumnerova L, Slonim AD, Shah SS. A multi-institutional, 5-year analysis of initial and multiple ventricular shunt revisions in children. Neurosurgery. 2008;62(2):445\u2013453, discussion 453\u2013454."},{"issue":"4","key":"b8","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 JR, Holubkov R,  Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study. J Neurosurg Pediatr. 2016;17(4):382\u2013390."},{"key":"b9","series-title":"Orphanet J Rare Dis","first-page":"19","article-title":"Pfeiffer syndrome","volume":"1","author":"Vogels A","year":"2006","unstructured":"Vogels A, Fryns JP. Pfeiffer syndrome. Orphanet J Rare Dis. 2006;1:19."},{"issue":"4","key":"b10","series-title":"J Neurosurg","first-page":"783","article-title":"Dual-floor burr hole adjusted to burr-hole ring and cap for implantation of stimulation electrodes. Technical note","volume":"99","author":"Yamamoto T","year":"2003","unstructured":"Yamamoto T, Katayama Y, Kobayashi K, Oshima H, Fukaya C. Dual-floor burr hole adjusted to burr-hole ring and cap for implantation of stimulation electrodes. Technical note. J Neurosurg. 2003;99(4):783\u2013784."},{"issue":"1","key":"b11","series-title":"Neurosurg Rev","first-page":"111","article-title":"Management of skin erosion following deep brain stimulation","volume":"32","author":"Lanotte M","year":"2009","unstructured":"Lanotte M, Verna G, Panciani PP,  Management of skin erosion following deep brain stimulation. Neurosurg Rev. 2009;32(1):111\u2013115."},{"issue":"3","key":"b12","series-title":"Ann Plast Surg","first-page":"291","article-title":"The reconstructive management of hardware-related scalp erosion in deep brain stimulation for Parkinson disease","volume":"73","author":"G\u00f3mez R","year":"2014","unstructured":"G\u00f3mez R, Hontanilla B. The reconstructive management of hardware-related scalp erosion in deep brain stimulation for Parkinson disease. Ann Plast Surg. 2014;73(3):291\u2013294."},{"issue":"8","key":"b13","series-title":"J Plast Reconstr Aesthet Surg","first-page":"1807","article-title":"Reconstruction of chronic scalp erosion after deep brain stimulation surgery","volume":"74","author":"Tao R","year":"2021","unstructured":"Tao R, Xue C, Yang C,  Reconstruction of chronic scalp erosion after deep brain stimulation surgery. J Plast Reconstr Aesthet Surg. 2021;74(8):1807\u20131813."},{"issue":"1","key":"b14","series-title":"Neurosurg Rev","first-page":"65","article-title":"A long-term complication of burying a shunt valve in the skull","volume":"18","author":"Ammar A","year":"1995","unstructured":"Ammar A, Nasser M. A long-term complication of burying a shunt valve in the skull. Neurosurg Rev. 1995;18(1):65\u201367."},{"issue":"6","key":"b1","series-title":"Childs Nerv Syst","first-page":"1229","article-title":"Management of exposed ventriculoperitoneal shunt on the scalp in pediatric patients","volume":"34","author":"Akdag O","year":"2018","unstructured":"Akdag O. Management of exposed ventriculoperitoneal shunt on the scalp in pediatric patients. Childs Nerv Syst. 2018;34(6):1229\u20131233."},{"key":"b2","series-title":"Int J Surg Case Rep","first-page":"484","article-title":"Shunt exposure as a ventriculoperitoneal shunt complication: a case series","volume":"79","author":"Suryaningtyas W","year":"2021","unstructured":"Suryaningtyas W, Ranuh IGMAR, Parenrengi MA. Shunt exposure as a ventriculoperitoneal shunt complication: a case series. Int J Surg Case Rep. 2021;79:484\u2013491."},{"issue":"8","key":"b3","series-title":"Childs Nerv Syst","first-page":"1431","article-title":"Subpericranial shunt valve placement: a technique in patients with friable skin","volume":"30","author":"Bot GM","year":"2014","unstructured":"Bot GM, Ismail NJ, Usman B,  Subpericranial shunt valve placement: a technique in patients with friable skin. Childs Nerv Syst. 2014;30(8):1431\u20131433."},{"issue":"10","key":"b4","series-title":"Dermatol Online J","article-title":"Scalp necrosis overlying a ventriculoperitoneal shunt: a case report and literature review","volume":"21","author":"Nguyen TA","year":"2015","unstructured":"Nguyen TA, Cohen PR. Scalp necrosis overlying a ventriculoperitoneal shunt: a case report and literature review. Dermatol Online J. 2015;21(10):13030\/qt2rs544f9."},{"key":"b5","series-title":"World Neurosurg","first-page":"98","article-title":"A stencil instrument for countersinking deep brain stimulator lead anchoring devices","volume":"167","author":"Miller KJ","year":"2022","unstructured":"Miller KJ. A stencil instrument for countersinking deep brain stimulator lead anchoring devices. World Neurosurg. 2022;167:98\u2013101."},{"key":"b6","series-title":"Surg Neurol Int","first-page":"280","article-title":"Dual floor burr hole technique in deep brain stimulation: a retrospective study on 209 patients","volume":"8","author":"Servello D","year":"2017","unstructured":"Servello D, Saleh C, Bona AR, Minichiello M, Zekaj E. Dual floor burr hole technique in deep brain stimulation: a retrospective study on 209 patients. Surg Neurol Int. 2017;8:280."},{"issue":"2","key":"b7","series-title":"Neurosurgery","first-page":"445","article-title":"A multi-institutional, 5-year analysis of initial and multiple ventricular shunt revisions in children","volume":"62","author":"Berry JG","year":"2008","unstructured":"Berry JG, Hall MA, Sharma V, Goumnerova L, Slonim AD, Shah SS. A multi-institutional, 5-year analysis of initial and multiple ventricular shunt revisions in children. Neurosurgery. 2008;62(2):445\u2013453, discussion 453\u2013454."},{"issue":"4","key":"b8","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 JR, Holubkov R,  Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study. J Neurosurg Pediatr. 2016;17(4):382\u2013390."},{"key":"b9","series-title":"Orphanet J Rare Dis","first-page":"19","article-title":"Pfeiffer syndrome","volume":"1","author":"Vogels A","year":"2006","unstructured":"Vogels A, Fryns JP. Pfeiffer syndrome. Orphanet J Rare Dis. 2006;1:19."},{"issue":"4","key":"b10","series-title":"J Neurosurg","first-page":"783","article-title":"Dual-floor burr hole adjusted to burr-hole ring and cap for implantation of stimulation electrodes. Technical note","volume":"99","author":"Yamamoto T","year":"2003","unstructured":"Yamamoto T, Katayama Y, Kobayashi K, Oshima H, Fukaya C. Dual-floor burr hole adjusted to burr-hole ring and cap for implantation of stimulation electrodes. Technical note. J Neurosurg. 2003;99(4):783\u2013784."},{"issue":"1","key":"b11","series-title":"Neurosurg Rev","first-page":"111","article-title":"Management of skin erosion following deep brain stimulation","volume":"32","author":"Lanotte M","year":"2009","unstructured":"Lanotte M, Verna G, Panciani PP,  Management of skin erosion following deep brain stimulation. Neurosurg Rev. 2009;32(1):111\u2013115."},{"issue":"3","key":"b12","series-title":"Ann Plast Surg","first-page":"291","article-title":"The reconstructive management of hardware-related scalp erosion in deep brain stimulation for Parkinson disease","volume":"73","author":"G\u00f3mez R","year":"2014","unstructured":"G\u00f3mez R, Hontanilla B. The reconstructive management of hardware-related scalp erosion in deep brain stimulation for Parkinson disease. Ann Plast Surg. 2014;73(3):291\u2013294."},{"issue":"8","key":"b13","series-title":"J Plast Reconstr Aesthet Surg","first-page":"1807","article-title":"Reconstruction of chronic scalp erosion after deep brain stimulation surgery","volume":"74","author":"Tao R","year":"2021","unstructured":"Tao R, Xue C, Yang C,  Reconstruction of chronic scalp erosion after deep brain stimulation surgery. J Plast Reconstr Aesthet Surg. 2021;74(8):1807\u20131813."},{"issue":"1","key":"b14","series-title":"Neurosurg Rev","first-page":"65","article-title":"A long-term complication of burying a shunt valve in the skull","volume":"18","author":"Ammar A","year":"1995","unstructured":"Ammar A, Nasser M. A long-term complication of burying a shunt valve in the skull. Neurosurg Rev. 1995;18(1):65\u201367."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/6\/22\/article-CASE23310.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/6\/22\/article-CASE23310.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/6\/22\/article-CASE23310.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T14:32:47Z","timestamp":1770301967000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/6\/22\/article-CASE23310.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,27]]},"references-count":28,"journal-issue":{"issue":"22"},"URL":"https:\/\/doi.org\/10.3171\/case23310","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,27]]}}}