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 Vol. 9 No. 4, April 2003
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Right arrow Neurological Surgery

AAP Grand Rounds 9:44 (2003)
© 2003 American Academy of Pediatrics

NEUROSURGERY

Improvement in CSF Shunt Outcomes is an Elusive Goal

Source: Kestle JRW, Drake JM, Cochrane DD, et al. Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a multicenter randomized trial. J Neurosurg. 2003;98:284–290.[Medline]

The first 20% of the full text of this article appears below.

The development of practical, valve-regulated cerebrospinal fluid (CSF) shunts in the 1950s transformed childhood hydrocephalus from a hopeless condition to a correctable surgical problem. Although endoscopic third ventriculostomy has recently allowed selected patients to be managed without CSF shunts,1–3 shunts remain the mainstay of treatment for the majority of patients, and current shunts are virtually unimproved from the original designs of the mid-20th century. For decades, patients from North America and Europe have been looking at a surprisingly consistent 30–40% risk of failure requiring reoperation within the first year of CSF shunt insertion.4–7 Fortunately, after the first year, the annual risk of failure drops to as low as 5% per year.5

This stagnation of clinical outcomes has so far resisted . . . [Full Text of this Article]

Joseph H Piatt, Jr, MD, FAAP
Neurological Surgery and Pediatrics, Drexel University College of Medicine, St. Christopher’s Hospital for Children, Philadelphia, PA