Treatment of hydrocephalus: an historical and critical review of methods and results

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Abstract
This review of methods and results in the treatment of hydrocephalus establishes the superiority of those operations which do not require the use of mechanical tubes and valves. Reports of 527 cases of hydrocephalus treated by means of 3d ventriculostomy, 91 cases treated by destruction of the choroid plexus and 1087 cases treated by operations requiring the use of mechanical tubes and valves permanently implanted within the body of the patient showed that the operative mortality and initial success in relieving hydrocephalus was essentially the same in all cases. The incidence of severe late complications, however, is 10 to 20 times greater after operations requiring mechanical tubes and valves. Later complications were of such severity as to cause death of the patient, require re-operation or critically endanger the patient''s life. The incidence of these complications varied from 35% to 100%, depending on the type of shunt employed as opposed to an incidence of 3% to 5% following the other 2 simple "physiological" operations. It is suggested that more effort be directed to refining the two basic physiological operations, third ventriculostomy, and endoscopic cauterization of the choroid plexuses.