HYDROCEPHALUS TREATED BY ARACHNOID-URETEROSTOMY

Parents of an infant with hydrocephalus are interested not in having their child kept alive but in giving it a chance for normal development. Therefore, once it is established that progressive hydrocephalus exists, temporizing measures and prolonged observation should be discouraged in favor of a definitive procedure which will immediately and continuously reduce spinal fluid pressure to within normal limits. This series of patients indicates that this objective can be accomplished by diversion of cerebrospinal fluid into the urinary tract. The complications of this procedure are three: (1) mechanical obstruction of the shunt, which has been seen in only a few cases and has always been remediable; (2) meningitis, which has occurred in 8 out of 50 patients postoperatively and has been fatal in 3; and (3) acute dehydration secondary to intercurrent infection because of unreplaced loss of fluid and electrolytes through the shunt, which has been fatal in 8 to 10 of these patients. Thirty-three out of 50 patients with severe communicating hydrocephalus treated by arachnoid-ureterostomy are living, and of these 31 are satisfactory to excellent results to date. At least 24 of these children appear to be entirely asymptomatic with normal or close to normal mental and physical development at periods from a few months to over four years.