Hydrocephalus shunt practice of experienced pediatric neurosurgeons

The objective of this study is to evaluate the ways experienced pediatric neurosurgeons insert ventriculo-peritoneal shunts and manage the shunted children afterward. Seven pediatric neurosurgeons with extensive experience in hydrocephalus were surveyed about their choice of shunts, methods of shunt insertion, shunt follow-ups, management of incidental ventriculomegaly, and prevention of slit-ventricle syndrome. The author completed the survey also. No particular shunt was used by a majority of respondents, although differential pressure valves were used most often. Adjuncts to insert the ventricular catheter were used by half. Shunt catheters were inserted frontally in half and posteriorly in half. No one obtained annual follow-up scans after 5 years of age, and no one operated on asymptomatic children with ventriculomegaly except perhaps in spina bifida cases. No techniques were identified to prevent slit-ventricle syndrome, but respondents emphasized the need for reticence in initial shunt insertions and in shunt revisions. There are substantial variations among extremely experienced pediatric neurosurgeons in their choice of shunts and their techniques of shunt insertion but reasonable uniformity in their frequency of follow-up, in not-obtaining routine scans after age five, and in rarely revising asymptomatic children. Methods to accurately position ventricular catheters and to prevent slit-ventricle syndrome need to be evaluated in multicenter studies.