Control of Hydrocephalus by Valve-Regulated Venous Shunt: Avoidance of Complications in Prolonged Shunt Maintenance

Abstract

N A previous paper the technical measures necessary for ideal placement of the Holter valve-controlled shunt from ventricle to venous system were described. 16 Our accumulated experience with 140 venous shunts for progressive hydrocephalus in infancy from 1956 to 1966 now provides a basis for understanding and preventing shunt dysfunction or infection which often necessitate shunt removal. Cases in which shunts were used in the management of a known neoplasm are not included in this series. Prior experience with simple check valves for venous shunts first performed in 1949 had pointed up the problems resulting from overdrainage of ventricular fluid? s Check valves of proper resistance were simultaneously developed by Pudenz, et al., 2~ and SpitzY In considering this artificial but mechanically effective method for controlling ventricular pressure and size, three principles have gradually established themselves and now form the basis of our philosophy and plan of management. First, severe uncomplicated infantile hydrocephalus, when properly treated, clearly can be followed by normal brain development much more frequently than has been taught in the past. 6a4,15 Second, the ultimate result, although related in part to the original cause and severity of the hydrocephalus, is strongly affected by the adequacy of continued mechanical palliation. Even children who are apparently tolerating a shunt blockade will often be found to have re-enlarged ventricles with sufficient elevation of pressure to prevent optimal development, a,5 Third, the many technical problems posed by continuous maintenance of shunt function in the rapidly growing infant can be minimized by expert planning. In this paper we will deal primarily with