Historical aspects of hydrocephalus.

From early days on physicians took interest in hydrocephaly because of its grotesque appearance. Already Hippocrates recommended decompression-trepanation for the treatment of hydrocephalus. Only since anatomy and pathophysiology of hydrocephalus as well as production and absorption of the cerebrospinal fluid was clarified, more effective operative techniques could be developed. Conservative treatment was unsuccessful or was useful only as temporary or adjuvant therapy supporting surgical procedures. A great variety of operative methods was described since the middle of 19th century which yielded, however, unsatisfactory results in most instances. Results improved since the introduction of effective valve systems in combination with ventriculoatrial and ventriculoperitoneal shunts. Despite of improved results, the treatment of hydrocephalus remains problematic as is shown by the still high complication rate and the restless search for more effective ways of treatment.