Once a shunt, always a shunt?

Over a period of 15 years, during which some 1000 operations were performed, CSF-drainage systems were able to be removed in 40 of a total of 444 children with communicating hydrocephalus or hydrocephalus associated with myelomeningocele. Shunts were removed from 26 children in the former group, of whom 17 continued to be compensated; in the latter group there were 14 removals, all of whom remained compensated. It is stressed that true compensation can be proven only by continuous measurement of ventricular fluid pressure over periods of several hours or at intervals of days or weeks, and four cases are discussed in which decompensation occurred, in two cases with fatal results.