Treatment of hydrocephalus: mere survival is not enough.

Seventy-five years after Leo Davidhoff made this statement, treatment failure remains the rule, not the exception, in the management of hydrocephalus. Hydrocephalus is the one condition we deal with in neurosurgery where we have made little progress since the development of the shunt valve. We are still using the same basic shunt designs and mechanisms that we have used through all of these years. Shunts definitely save lives. We try to control hydrocephalus, not cure it. There is no question that the ability to place intracranial shunts has benefited many thousands of patients since their development approximately 50 years ago. Our focus, however, in the management of hydrocephalus seems to be on the valve control of cerebrospinal fluid (CSF) flow and less on the correction on the underlying pathophysiology of hydrocephalus.