EXPERIENCES WITH THE VENTRICULO ATRIAL SHUNT OPERATION FOR HYDROCEPHALUS

　During the past ten years ventriculo-caval and　ventriculo-atrial shunt operations have been used　internationally in the treatment of hydrocephalus．　Judging from the published reports and personal　communications, these procedures have become the　operations of choice in the treatment of obstructive　and communicating hydrocephalus of infants．　In　the earlier publications, enthusiastic acceptance was　the watchword．　However, within the past few years　we have come to realize that this is not an innocuous　surgical procedure．　Mechanical failure of the shunt　system, major venous thrombosis and septicemia have　been reported．　The time has come, therefore, to　re-evaluate this operation and to interpret the com—plications in the light of the surgical principles on　which this type of shunt is based．

　The treatment of hydrocephalus by shunting cere—brospinal fluid into the venous system is not a new　idea．　It was first proposed by Gäin 1907^5）．　Payr's efforts　were unsuccessful, and during the first half of this　century there were sporadic but fruitless attempts by　other surgeons．　The first encouraging report came　from Nulsen and Spitz^4）　in 1951, who implanted a　shunt system containing steel ball valves between　the lateral ventricle and internal jugular vein of a　14—month old infant with hydrocephalus．　At the　time of their report this system had been function—ing satisfactorily for two and onehalf years．