Ventriculo-Peritoneal Shunts in the Management of Hydrocephalus

Abstract

ETWEEN 1950 and 1957, we performed a number of polyethylene tubing ventriculo-peritoneal shunts. The results were ahnost uniformly unsatisfactory, obstruction occurring within a mat te r of days or weeks, usually a t the peritoneal end of the shunt. When these shunts were revised it would be found ei ther tha t the distal end of the tube was encased in a dense mat of omenturn and bowel or tha t the distal inch or two of the tube was filled with a thick coagulum. However, during this discouraging period an occasional shunt worked well enough and long enough to suggest t ha t the abdominal cavi ty might indeed be a satisfactory shunt receptacle. Realizing tha t the newer techniques of shunting into the blood stream involved certain inherent problems, we decided to t ry the abdominal cavi ty once more, this t ime using silicone tubing because of its inert properties, along with a slit valve at the distal end to p reven t reflux of fluid from the abdominal cavi ty . The first such shunt was done in 1958. I t soon became obvious tha t the peritoneal cavi ty was admirably suited for cerebrospinal fluid shunting. Nothing has occurred since tha t t ime to alter this impression. I t was found qui te early tha t the lumbar subarachnoid peri toneal shunt could not be relied on in infants because of the small size of the spinal canal. Therefore, the ventricle has been used exclusively for infants al though several successful lumbar subarachnoid peri toneal shunts have been carried out in older children and adults. During the past 9 years we have performed approximate ly 1~0 ventriculo-peri-