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A series of stereotaxic percutaneous third ventriculostomies has been carried out on 46 shunt-dependent hydrocephalic children. The technique and results are presented. The advantages of this procedure over the open craniotomy type are discussed. There has been low morbidity and one mortality. The necessity of preoperative shunting to provide a ‘slack brain’ is emphasized.

To select adult patients with benign non-communicating hydrocephalus for microsurgical third ventriculostomy, cerebrospinal fluid (CSF) pressure, intercompartmental flow of CSF, and CSF draining capacity were measured in 14 patients with clinical high pressure hydrocephalus and 5 patients with clinical normal pressure hydrocephalus. The testing was of value in selecting patients with high pressure hydrocephalus for third ventriculostomy. Based on the clinical picture and the hydromechanical balance between the two separate CSF compartments one could distinguish two different patterns: (1) unbalanced high pressure hydrocephalus which improved after third ventriculostomy, and (2) balanced high pressure hydrocephalus which had to have a ventriculo-atrial shunt. All patients with normal pressure hydrocephalus had an almost balanced hydrocephalus, and the testing was shown to be of no value in this small group.

A radioisotope scanning and clearance procedure has been developed for the postoperative assessment of third ventriculostomy patients. The patency of third ventriculostomy sites can be verified by this procedure, and the bulk flow clearance of CSF can be quantitated. 4 postoperstive third ventriculostomy patients have been evaluated by this procedure to date. In each case the third ventriculostomy site was shown to be patent. The bulk flow clearance of CSF ranged from 170 to 342 cm3/24 h. Comparison of these figures with estimates of CSF production suggests that the majority of CSF reabsorption in these patients occurs through the arachnoid villi.

This report describes a computed tomography-based computer-assisted stereotactic technique for performing 3rd ventriculostomy. The procedure has been performed on seven patients with acquired obstructive hydrocephalus of various etiologies. None of these patients have yet required shunting. (18:791–794, 1986)

Percutaneous anterior and posterior third ventriculostomy utilizing a McKinney leukotome has been performed with fluoroscopic control in 9 newborn infants with meningomyelocele and hydrocephalus immediately following their shunt. The procedure was instituted in 1975, and there have been not shunt revisions in such patients since that time. Wider application of this or a similar technique in newborn meningomyelocele infants seems warranted.

Thirty-three surgical treated cases of aquaductal stenosis are presented. Beside the classical clinical representation of the disease, the symptomatology caused by anterior and posterior herniation of dilated third ventricle is discussed. The impotence in one male patient which is caused by anterior herniation was proved by means of N PT (Nocturnal Penile Tumescence) recording. In one patient bilateral partial deafness and Parinaud syndrome which was caused by posterior herniation was cured by third ventriculostomy.In the surgical treatment of aquaductal stenosis, the effectiveness of various surgical procedures are presented and the superiority of third ventriculostomy by microtechnique is emphasised.

EPORTS have amply demonstrated that third ventriculostomy can relieve acquired obstructive hydrocephalus, with a low operative morbidity and mortality2 The operation might be more widely used except for the fact that unpredictable failures occur from time to time. Although a number of authors have mentioned in passing that the perforations in the third ventricle sometimes seal, 5,8,t2 they have not analyzed the cause of failure or the criteria for the selection of patients. Consequently we performed postoperative encephalography with air, Pantopaque, or radioiodinated albumin in six cases in which third ventriculostomy was unsuccessful. These studies, and postmortem examinations in two more patients, demonstrated an obstruction of the subarachnoid cerebrospinal fluid pathways that accounted for the failure.

After a review of the literature on the treatment of benign stricture of the aqueduct, the results obtained in 28 personal cases with theStookey andScarff's operation are reported, and the opinion is put forward that it is the best operative procedure for this condition.

HYDROCEPHALUS due to an obstruction or block in the ventricles or subarachnoid spaces is commoner in the infant than is generally supposed. A routine investigation of cases of infantile hydrocephalus will readily satisfy any one on this point. In my experience, the ratio of cases of obstructive hydrocephalus to cases of communicating hydrocephalus is about 2:1. Patients with obstructive hydrocephalus present an obvious challenge to the neurosurgeon, for if the obstruction can be relieved or circuited the intraventricular pressure, with its damage to cerebral tissue and progressive enlargement of the head, may be brought under control. Since there are many causes of obstruction, the same procedure cannot be used or considered for all patients. A frequent cause of obstruction or block in infantile hydrocephalus is the Arnold-Chiari malformation, associated with spina bifida in many patients, especially those with myelocele. In this condition the medulla oblongata is elongated and extends downward

THE GROWING dissatisfaction with the results obtained in the treatment of hydrocephalus by operations requiring the use of mechanical tubes and valves, namely, the so-called "cerebrospinal fluid (CSF) shunts," indicates that there is need to reevaluate the methods of treatment of hydrocephalus. The purpose of this article is to present the long-term results obtained by me and my colleagues in the treatment of hydrocephalus by the use of operations not requiring mechanical tubes or valves, namely, third ventriculostomy for obstructive hydrocephalus and endoscopic cauterization of the choroid plexuses for nonobstructive (communicating) hydrocephalus. The further prupose of this paper is to compare these results with those obtained by the mechanical shunts. Principles for the Treatment of Hydrocephalus Proposed by Dandy Between 1918 and 1922 Dandy laid down three principles for the treatment of hydrocephalus: First, he insisted that in every case of hydrocephalus it be established whether the hydrocephalus is of