Introduction

Numerous definitions of hydrocephalus have been advanced; common to these is an underlying imbalance between the production of CSF and its absorption. Although overproduction of CSF resulting in hydrocephalus is well recognized in association with choroid plexus papillomas, these are rare tumors and, in practice, hydrocephalus is most commonly the result of some impairment of the circulation or absorption of CSF.

The accumulation of fluid in various intracranial compartments was recognized by Hippocrates (BC 460-377) and Claudius Galen (130-200 AD); however, the first morphological description of hydrocephalus, recognizing the ventricular enlargement and brain destruction is attributed to Andreus Vesalius (1514-64). More complete descriptions subsequently appeared in the works of Jean Louis Petit (1664-1750), in Robert Whytt's "Observations on dropsy of the brain" and in the writings of Giovanni Morgani (1682-1771), who described the clinical features of bulging fontanelle and sutural widening in childhood hydrocephalus. The anatomy of the ventricular system and the CSF pathways began to be understood during this period, facilitated in particular by the studies of Thomas Willis (1621-75). It was he who first proposed the choroid plexus as the site of CSF production and who introduced the concept of absorption into the venous system via what he termed the meningeal "glandules", presumed to be the arachnoid granulations. Franciscus Sylvius (1614-72), Alexander Monro (17331817) and Francois Magendie (1783-1855) also made important anatomical contributions but it was not until the more physiological investigations of Key and Retzius (1876) that the modern concept of CSF circulation was established.

During this period, crude attempts at treatment of hydrocephalus by means of repeated

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