Ventriculoperitoneal shunts for hydrocephalus: a focus group discussion on the selection of shunt systems in pediatrics. A report of the Pediatric Neurosurgery Research Group meeting, December 1992.

As part of the Continuing Quality Improvement Study, phase I, 12 pediatric neurosurgeons participated in a discussion group to respond to the various issues related to selection of ventriculoperitoneal shunt systems in their practice. It was estimated that between then all the 12 participants performed approximately 1200 shunt procedures per year in the USA. The data were analyzed by grid and fish-bone charts as part of the data collection. All 12 participants indicated that they preferred a reservoir in the shunt system, 8 of them indicating that they preferred this for a manual test of the system. Three indicated that they did not routinely manipulate the system for testing. One participant stated that he placed a reservoir within the shunt system primarily to prevent migration of the ventricular catheter. Nine neurosurgeons indicated that they employed cranial valves in their shunt systems, and three indicated that they employed slit-end peritoneal catheters only. In reference to Delta valves, nine participants indicated that they employed them on occasions. In reference to pressure in the valve system, one participant employed high-pressure valves at all times, five employed only medium-pressure systems, and the remaining six always employed low-pressure valves. All 12 neurosurgeons stated that the incidence of symptomatic slit ventricle in their practices was between 1% and 5%, in their mind irrespective of the system used. It was concluded that any form of ventriculoperitoneal shunt, with or without valves, with slit-end valves or cranial valves seemed to work equally well in the hands of a dedicated pediatric neurological surgeon.(ABSTRACT TRUNCATED AT 250 WORDS)