Ventriculo-Atrial Shunt in the Management of Posterior-Fossa Tumours

S URGERY of tumours of the posterior fossa is associated with higher mortali ty than surgery of supratentorial tumours. The mortal i ty for various cerebellar tumours varied between 10 and ~3 per cent in Cushing's series2 Grant, 2 in a s tudy of ~00 gliomas of the posterior fossa in children, reported a mortal i ty of 3~-50 per cent depending on the type of tumour. Our operative mortal i ty for gliomas of the posterior fossa has been 40-50 per cent. Death usually is caused by increased intracranial tension which, although continually present, is at its worst during the second and third day after operation. In an a t tempt to reduce this elevated pressure many centers use continuous ventricular drainage before, during and after operation. Because of the danger of infection associated with indwelling ventricular catheters, our practice has been to rely more heavily upon intermit tent ventricular punctures. Ventriculo-atrial shunt with the PudenzHeyer or Spitz-Holter valve offers a safe method for continuous ventricular drainage. During the past year we have used the Pudenz-Heyer valve for pre-operative, operative and postoperative management of 13 patients with posterior-fossa tumours. The results have been so impressive that we feel this preliminary report is justified.