Ventriculovenous Anastomosis in Obstructive and Acquired Communicating Hydrocephalus

F OLLOWING Successes in controlling increasing intracranial pressure of infantile congenital hypocephalus by shunting the cerebrospinal fluid from the lateral cerebral ventricle into the internal jugular vein, superior vena cava, and right cardiac auricular system, other types of cases presented themselves in which indications for palliative shunting procedures seemed to be present. Both the Holter valve, as advocated by Nulsen and Spitz, ~ and the Heyer valve, introduced by Pudenz et al., 4 were utilized as the conveying system in the cases in this series. Falling into several categories, these cases m a y be broadly classified as inoperable lesions of the central nervous system producing progressive hydrocephalus. More specifically they may be divided into neoplastic or other lesions producing an obstruct ion in the flow of cerebrospinal fluid, and inflamma to ry or irr i tat ive lesions interfering with absorption of ccrebrospinal fluid. The use of a palliative shunting procedure in any given case brings up several serious considerations, an impor tant one being that the pat ient be given a chance for a period of useful survival, wi thout serious neurological deficit, as the direct result of the procedure. If the lesion can be successfully a t tacked directly, palliative shunting is contraindicated. Certainly, if radiological and clinical evidence indicate the possibility of an obstructive lesion below the aqueduct of Sylvius exploration of the posterior fossa is indicated,