Cerebrospinal fluid shunts

Hydrocephalus is a congenital or acquired condition in which cerebrospinal fluid (CSF) accumulates in the ventricles and the subarachnoid space around the brain (Fig. 1). It can lead to an increase in intracranial pressure. It has existed since primitive man roamed the earth. Man's understanding of anatomy and physiology has often consisted mainly of myth and superstition. The earliest recording of the awareness of CSF can be found in the Edwin Smith Papyrus (2200 BC) (1,2) that describes the spillage of clear fluid from the inner brain in ancient Egypt. Hippocrates (460-377 BC) is credited with attributing the enlargement of the head to a buildup of fluid. His treatment consisted of drilling a hole in the skull and puncturing the meninges to allow the fluid to escape (3). Erasistratus of Alexandria (280 BC) was the first author to describe the ventricular system based on human dissection. He believed that the seat of the soul lay within the fourth ventricle (4). The great Roman physician Galen (129-210 AD) described CSF as a waste product of the animal spirit that was discharged from the nose as the pituita (5).