Treatment of hydrocephalus using saphenous vein homograft.

The literature abounds with a multitude of surgical procedures for hydrocephalus, and CSF has been shunted in every conceivable manner. The very number of these operations is an eloquent testimony to their inadequacy. In 1908, Payr (quoted by Benson et al., 1962) described an operation whereby the CSF was shunted from the lateral ventricle into the jugular vein, with the help of tubes made from the hardened arteries of calves. However, due to regurgitation of blood into the lateral ventricle the operation soon fell into disrepute. Almost half a century later, thanks to advances in the science of bioengineering, Payr's principle was revived in the Spitz-Holter and the Pudenz-Heyer procedures. The introduction of the Spitz-Holter and PudenzHeyer valves has to a large extent standardized the treatment of hydrocephalus in the West. In India and other developing countries dire financial stringency precludes the use of these valves, and enforces the adoption of alternative operative procedures as an economic necessity. It is the purpose of this paper to present the results of treatment in 70 cases of hydrocephalus in infancy and childhood. The occasional child who could afford the 'luxury' of a Spitz or Pudenz valve is not included in this series. Table I shows the mode of treatment of these 70 cases: 55 were treated by 'conventional' procedures, and 15 by a new operation whereby CSF is shunted into the venous circulation using a reversed, valvebearing segment of the saphenous vein. In every case subjected to operation, it was established that the hydrocephalus was progressive.