Another look at ventriculosubgaleal shunting procedures.

Ventriculosubgaleal shunts were available at the turn of the century as a treatment for hydrocephalus. Almost 80 years later, Perret and Graf advocated such shunting for the temporary decompression of ventricles enlarged by tumors or by hydrocephalus. The use of a subgaleal shunt in acute head trauma was first published in 1983. No direct measurement of intracranial pressure was attempted in 30 cases. Evidence by computed tomography of compressed ventricles and cerebral contusion correlated well with elevated pressure. When the Camino intracranial pressure monitor became available, the device was inserted before placement of the shunt to assess the appropriateness and efficacy of the method in 21 patients. An additional 22 cases of intraventricular hemorrhage with acute hydrocephalus were treated over a 17-year period. The simple method of shunting into the subgaleal space has broad application for the temporary relief of increased intracranial or high-pressure hydrocephalus.