Hydrocephalus and Shunts

Abstract

cerebral puncture were employed but at the cost of great morbidity and mortality. Dandy and Blackfan further contributed, developing experimental models of hydrocephalus, and established a means of classification of hydro-cephalus, differentiating between the non-com-municating (obstructive) and communicating forms and proposing possible treatment strate-gies. The treatment options they advanced included extirpation of the choroid plexus, removing obstructive pathologies if these could be identified or the creation of conduits to drain the CSF from the intracranial compartment, either internally by the sub-frontal and sub-temporal routes or extracranially. Early means of CSF diversion included nephrectomy fol-lowed by the plumbing of the ureter into the spinal theca, thus draining CSF to the bladder. Other surgical approaches devised at this time included Torkildsen's procedure of draining the lateral ventricle into the cisterna magna, ven-triculocisternostomy in cases of aqueductal obstruction and the first descriptions of endoscopic third ventriculostomy by Mixter – a procedure that has recently undergone a renais-sance. Morbidity and failure rates, however, remained high. Removing choroid plexus failed to account for the extra-choroidal production of CSF and early artificial conduits were prone to mechanical malfunction. In the 1950s, synthetic, biologically tolerated polymers, in particular silicone elastomer, became available and thus heralded the onset of the shunt era of hydro-cephalus management.