title: Positional plagiocephaly following ventriculoperitoneal shunting in neonates and infancy-how serious is it?
abstract: OBJECTIVE
  We test the hypothesis that ventriculoperitoneal (VP) shunt insertion significantly increases contralateral positional plagiocephaly.
  
  
  METHODS
  We reviewed 339 children who had a VP shunt inserted at Birmingham Children's Hospital between 2006 and 2013, noting laterality of shunt insertion and frontal or occipital position. We ascertained the presence of post-operative positional plagiocephaly using the cranial vault asymmetry index. Multinomial logistic regression modelling was used to examine relationships between plagiocephaly, shunt position, gender and age. Adjusted odds and risk ratios for effect of variables on plagiocephaly were calculated.
  
  
  RESULTS
  Children with occipital VP shunts are at significant risk of developing contralateral positional plagiocephaly, particularly in the first 12 months of life.
  
  
  CONCLUSIONS
  We recommend careful follow-up and advice regarding head positioning following surgery. There should be consideration for active monitoring to avoid plagiocephaly, including physiotherapy and health visitor interventions. Endoscopic third ventriculostomy in selected cases or anterior shunt placement could be considered. A larger national study would be of interest to evaluate the extent of an otherwise correctable problem.
authors.affiliation: Department of Paediatric Neurosurgery, Birmingham Children's Hospital, Birmingham, West Midlands, UK. stuartroberts@nhs.net.|The Computational, Cognitive and Clinical Neuroimaging Laboratory (C3NL), The Hammersmith Hospital, 3rd Floor, Burlington Danes Building, Du Cane Road, W12 0NN, London, UK. stuartroberts@nhs.net.
authors.forename: Stuart A G
authors.initials: SAG
authors.lastname: Roberts
authors.affiliation: Fraser of Allander Neurosciences Unit, Royal Hospital for Children, G51 4TF, Glasgow, UK.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Symonds
authors.affiliation: Department of Paediatric Neurosurgery, Birmingham Children's Hospital, Birmingham, West Midlands, UK.
authors.forename: Reema
authors.initials: R
authors.lastname: Chawla
authors.affiliation: National Institute for Health Research (NIHR), Surgical Reconstruction & Microbiology Research Centre (SRMRC), Birmingham, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Toman
authors.affiliation: Birmingham Clinical Trials Unit, Robert Aitken Institute, University of Birmingham, B15 2TT, Edgbaston, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bishop
authors.affiliation: Department of Paediatric Neurosurgery, Birmingham Children's Hospital, Birmingham, West Midlands, UK.
authors.forename: Guirish A
authors.initials: GA
authors.lastname: Solanki
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D049068:Plagiocephaly, Nonsynostotic / Q000601:surgery*; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*; D014696:Ventriculostomy
keywords: Plagiocephaly; Ventriculoperitoneal; Ventriculostomy