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 pedia tric neurosurgeons participated in a discussion group to respond to th e various issues related to selection of ventriculoperitoneal shunt sy stems in their practice. It was estimated that between then all the 12 participants performed approximately 1200 shunt procedures per year i n the USA. The data were analyzed by grid and fish-bone charts as part of the data collection. All 12 participants indicated that they prefe rred a reservoir in the shunt system, 8 of them indicating that they p referred this for a manual test of the system. Three indicated that th ey did not routinely manipulate the system for testing. One participan t stated that he placed a reservoir within the shunt system primarily to prevent migration of the ventricular catheter. Nine neurosurgeons i ndicated 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 syst em, one participant employed high-pressure valves at all times, five e mployed only medium-pressure systems, and the remaining six always emp loyed low-pressure valves. All 12 neurosurgeons stated that the incide nce of symptomatic slit ventricle in their practices was between 1% an d 5%, in their mind irrespective of the system used. It was con eluded 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. This suggests that there is little scientific basis by which the pediatric neurosur geon selects a shunt system in the United States. It also indicates th e need for a comprehensive approach to the most frequent operation per formed in pediatric neurosurgical practice. It is suggested that some form of prospective study or centralized data bank registry be institu ted where information can be analyzed, documented and processed.