A retrospective analysis 21 to 35 years after birth of hydrocephalic patients born from 1946 to 1955. An overall description of the material and the criteria used.

219 patients diagnosed as having hydrocephalus before the age of 5 years were traced 21 to 35 years after birth. Fifty-four patients had had operations, but those used before the introduction of ventriculo-atrial shunts did not influence the outcome; the series may be considered to represent the natural history of hydrocephalus. Based on available information in the case notes, patients were divided into 2 groups: 1) proven hydrocephalus, and 2) unproven hydrocephalus. Strict criteria were used. Ninety-nine patients (45%) had died. Serious prognostic factors as to survival were early admission, increasing head circumference, downward displacement of the eyes, and seizures. Together with the criteria suggested for proven hydrocephalus, the above factors may act as a guideline to operative treatment. Fifty-seven percent of 116 known survivors were able to work, 9% lived independently but had no working ability, and 34% needed permanent care or supervision. This outcome is similar to that of shunt-operated patients followed for a shorter period. The only parameters indicative of socio-economic independence in adult life were early admission and absence of seizures in childhood.