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At a time when the intrauterine diagnosis of hydrocephalus is commonplace and pioneering efforts of antenatal therapy are evolving, review of the chronology of treatment of this disorder becomes pertinent. The history of therapy of hydrocephalus may be divided into three phases. The first two largely involved accumulation of basic anatomical and pathophysiological information. The last phase dates only from the 1950s and may be considered an era of rapid technical development. This account discloses the obligatory relationship between useful therapy and basic knowledge.

The past history of fetal surgery is briefly reviewed. The current controversies revolving around the fetal treatment of hydrocephalus and obstructive uropathies (posterior urethral valves, prune belly syndrome, hydronephrosis) are compared and contrasted with the remarkably similar controversies that raged when fetal transfusions were first introduced. The future of fetal surgery is discussed in the light of the ethical issues raised by the prospect of fetal surgery and the rather disturbing medicolegal climate. There are already important legal precedents which will affect the field of fetal surgery. The strong opinion is expressed that fetal surgery must only remain an option offered to the mother and never forced upon her.