
five-year comparative study of hydrocephalus in
children with and without operation (113 cases)
on the basis of a 5-year study of 113 hy-
drocephalic children of whom 65 were oper-
ated on early with ventriculo-atrial shunting
and 48 were not operated on, all of them hav-
ing been studied periodically in a similar
manner to determine mortality, morbidity,
intelligence, and related factors, the follow-
ing conclusions are justified:
the program in which shunting opera-
tions were done apparently gives significant
advantages to the children over the program
in which no shunting operations were done
(based on life-table data projected from birth
to 10 years)
survival: 61.8 per cent as compared to
22.2 per cent;
number of competent children (i.q. of
75 or better): 33.8 per cent vs. 5.5 per
cent;
number of noncompetitive children
(i.q. below 75): 27.6 per cent vs. 16.7
per cent.
the major cause of death and morbid-
ity in both groups is infection.
in the operative group, morbidity
associated with the shunting procedure is
related to obstruction of the shunt and
septicemia.  the early occlusions show a
correlation with abnormal, inflammatory
type of spinal fluid being shunted into the
blood stream.  the late obstructions are
associated with mechanical breakage of the
shunt or factors of growth causing retraction
of the cardiac end from the atrium.  prompt
re-establishment of a functioning shunt has
been possible in all instances.  periodic follow-
up examinations, irrespective of symptoms,
have proved invaluable in early recognition
of malfunctioning shunts.  septicemia usually
required removal of the shunt.
from the program of periodic evalua-
tions, including "bubble" ventriculograms,
studies of clearance of risa, and psycho-
logical testings, correlations showed:
intellectual ability seemed associated
with width of cerebral mantle;
width of cerebral mantle in hydrocepha-
lus decreases with ventricular pressures
of 120 or over; it increases with pres-
sures less than this;
prolonged shunting of cerebrospinal
fluid can give dramatic increase in
width of cerebral mantle, apparently
irrespective of basic etiology of the
hydrocephalus;
intellectual capacity could not be cor-
related with the basic etiology of the
hydrocephalus, but did correlate in-
versely with duration of increased in-
tracranial pressure.
the many etiologies of hydrocephalus
require large numbers of patients in each
group for thorough evaluation.  factors
favoring such studies should be carried out in
medical centers where appropriate disciplines
can study in depth.  prevention should be the
ultimate goal.
in the operative group, only 1 patient
compensated his hydrocephalic process and
no single patient demonstrated "arrest" of or
recovery from the basic hydrocephalus-pro-
ducing process in spite of numerous attempts
to demonstrate this.  this might imply a
necessity for life-long shunting of cerebro-
spinal fluid in these cases.
