Early Shunts

As a better understanding of CSF circulation emerged, there were attempts to circumvent "obstructions" in the ventricular system in order to relieve hydrocephalus. Initial attempts to "shunt" CSF included external drainage in the late 19th century, invariably complicated by fatal infections. Other attempts were made using glass wool, gold tubes, catgut strands, and other materials to create conduits from the ventricles to the space beneath the scalp, the dura, and other areas. In 1908, Payr attempted the use of autologous vein to drain the ventricles into the sagittal sinus initially and later the jugular veins with some success. Others could not duplicate his results.

Cushing attempted bypass from the spinal subar-achnoid space into the peritoneal cavity or retro-peritoneal space by passing silver cannulae through the fourth lumbar vertebra. This had some success. The introduction of vulcanized rubber led to the availability of suitable conduit for the creation of shunts from the ventricular system to other body cavities. The first major innovation with the use of rubber catheters was by Torkildsen in 1939 to divert CSF from the lateral ventricles to the cisterna magna, but operative mortality remained high. It was eventually replaced by the more modern shunting procedures.

Numerous shunting procedures were created to other body cavities, notably the ureters. The ventricu-loureteral shunt, reported by Matson in the 1950s, required a nephrectomy and had several infectious and metabolic complications. It also had a number of long-term survivors, however, and was the first effective shunt system used. Later shunts were developed to the atrial system, the pleura, and the peritoneum.

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