{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T05:16:56Z","timestamp":1788585416872,"version":"build-2803163510"},"reference-count":17,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: The optimal sequencing of cranioplasty (CP) and ventriculoperitoneal shunt (VPS) placement after decompressive craniectomy (DC) remains uncertain, particularly in pediatric patients. This study aimed to describe our pediatric experience and provide an exploratory comparison of simultaneous and staged procedures. Methods: We retrospectively reviewed the medical records of 12 pediatric patients who developed hydrocephalus after DC at a single tertiary center between 2015 and 2023. Six patients underwent simultaneous CP and VPS placement, while six underwent staged VPS placement followed by CP. Demographic and clinical characteristics, surgical timing, postoperative complications, and neurological outcomes were compared. Given the small sample size, analyses were exploratory and primarily descriptive. Results: Postoperative complications occurred in two patients in each group (33.3%), including one wound infection and one shunt dysfunction requiring revision. No intracranial hemorrhage or deep shunt infection occurred in either group. The complication rate did not differ between the groups (p = 1.000). The median final Glasgow Outcome Scale score was 2.5 (range, 2\u20133) in the simultaneous group and 3.0 (range, 1\u20135) in the staged group (p = 0.457). Neurological outcomes likely reflected the severity of the underlying brain injury; however, the small sample size precluded adjustment for prognostic factors. Conclusion: In this small retrospective pediatric cohort, simultaneous CP and VPS placement was technically feasible, but postoperative complications occurred in one-third of patients. No significant differences were observed between the simultaneous and staged groups; however, these findings should not be interpreted as evidence of equivalence because of the limited sample size and non-randomized design. Surgical strategy should be individualized, and larger multicenter pediatric studies are needed.<\/jats:p>","DOI":"10.3390\/jcm15176777","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:45:13Z","timestamp":1788241513000},"page":"6777","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Simultaneous Cranioplasty and Ventriculoperitoneal Shunt Placement After Decompressive Craniectomy in Children: A Single-Center Experience"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6929-4401","authenticated-orcid":false,"given":"Duygu","family":"Dolen Burak","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3626-8637","authenticated-orcid":false,"given":"Mustafa Selim","family":"\u015eahin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9246-1378","authenticated-orcid":false,"given":"Cafer Ikbal","family":"G\u00fclsever","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hakkari State Hospital, Ministry of Health, 30000 Hakkari, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duran","family":"Sahin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hakkari State Hospital, Ministry of Health, 30000 Hakkari, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tugrul Cem","family":"Unal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3425-3220","authenticated-orcid":false,"given":"Ilyas","family":"Dolas","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Faculty, Istanbul Bilim University, 34394 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pulat Akin","family":"Sabanci","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yavuz","family":"Aras","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayd\u0131n","family":"Aydoseli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Altay","family":"Sencer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"102761","DOI":"10.1016\/j.bas.2024.102761","article-title":"Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel","volume":"4","author":"Iaccarino","year":"2024","journal-title":"Brain Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3136","DOI":"10.1111\/cns.14347","article-title":"Staged or simultaneous operations for ventriculoperitoneal shunt and cranioplasty: Evidence from a meta-analysis","volume":"29","author":"Zhang","year":"2023","journal-title":"CNS Neurosci. Ther."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Zhou, Q., Shen, W., Zhou, Z., Yang, X., and Wen, L. (2022). Is simultaneous cranioplasty with cerebrospinal fluid shunts implantation as safe as staged procedures?. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.995897"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"313","DOI":"10.3171\/2014.2.JNS131480","article-title":"Evaluation of simultaneous cranioplasty and ventriculoperitoneal shunt procedures","volume":"121","author":"Heo","year":"2014","journal-title":"J. Neurosurg."},{"key":"ref_5","first-page":"855","article-title":"Management of hydrocephalus after decompressive craniectomy","volume":"24","author":"Pachatouridis","year":"2014","journal-title":"Turk. Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1016\/j.wneu.2015.05.066","article-title":"Cranioplasty and Ventriculoperitoneal Shunt Placement after Decompressive Craniectomy: Staged Surgery Is Associated with Fewer Postoperative Complications","volume":"84","author":"Schuss","year":"2015","journal-title":"World Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"93","DOI":"10.13004\/kjnt.2015.11.2.93","article-title":"An Improved One-Stage Operation of Cranioplasty and Ventriculoperitoneal Shunt in Patient with Hydrocephalus and Large Cranial Defect","volume":"11","author":"Jung","year":"2015","journal-title":"Korean J. Neurotrauma"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"019","DOI":"10.1055\/s-0035-1558410","article-title":"Open Traumatic Brain Injury Is a Strong Predictor for Aseptic Bone Necrosis after Cranioplasty Surgery: A Retrospective Analysis of 219 Patients","volume":"77","author":"Stojanovski","year":"2015","journal-title":"J. Neurol. Surg. A Cent. Eur. Neurosurg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/j.wneu.2017.08.034","article-title":"Risk of Complications with Simultaneous Cranioplasty and Placement of Ventriculoperitoneal Shunt","volume":"107","author":"Meyer","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1080\/02699052.2017.1332781","article-title":"The safety of simultaneous cranioplasty and shunt implantation","volume":"31","author":"Yang","year":"2017","journal-title":"Brain Inj."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e648","DOI":"10.1016\/j.wneu.2020.08.062","article-title":"Concurrent Versus Staged Procedures for Ventriculoperitoneal Shunt and Cranioplasty: A 10-Year Retrospective Comparative Analysis of Surgical Outcomes","volume":"143","author":"Rosinski","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"235","DOI":"10.13004\/kjnt.2020.16.e16","article-title":"Comparison of Postoperative Surgical-Site Infection and Symptomatic Intracranial Hemorrhage between Staged and Simultaneous Cranioplasty with Ventriculoperitoneal Shunt Placement: A Meta-Analysis","volume":"16","author":"Jung","year":"2020","journal-title":"Korean J. Neurotrauma"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jocn.2020.07.015","article-title":"Simultaneous cranioplasty and ventriculoperitoneal shunt placement in patients with traumatic brain injury undergoing unilateral decompressive craniectomy","volume":"79","author":"Ting","year":"2020","journal-title":"J. Clin. Neurosci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"100","DOI":"10.13004\/kjnt.2021.17.e20","article-title":"Comparison of Postoperative Complications between Simultaneous and Staged Surgery in Cranioplasty and Ventriculoperitoneal Shunt Placement after Decompressive Craniectomy","volume":"17","author":"Gill","year":"2021","journal-title":"Korean J. Neurotrauma."},{"key":"ref_15","first-page":"195","article-title":"Safety analysis of simultaneous cranioplasty and ventriculoperitoneal shunt placement","volume":"32","author":"Zhang","year":"2020","journal-title":"Turk. Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Wang, K., Guo, H., Zhu, Y., Li, J., Niu, H., Wang, Y., and Cai, X. (2023). Improved strategy for post-traumatic hydrocephalus following decompressive craniectomy: Experience of a single center. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.935171"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1179\/016164106X98008","article-title":"Early combined cranioplasty and programmable shunt in patients with skull bone defects and CSF-circulation disorders","volume":"28","year":"2006","journal-title":"Neurol. Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6777\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T04:46:58Z","timestamp":1788583618000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6777"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":17,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176777"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176777","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]}}}