Shunts and Shunt Malfunction

TLDR: The modern-day shunt remains similar now as when it was created (1955, implanted in 1957/58): slight modifications to the catheter, major iterations to the shunt valve, and the addition of compensators for gravity and siphoning are key components to treatment.

Abstract: Perhaps one of the most intriguing events in neurosurgical history is the invention and use of the shunt system to treat hydrocephalus, despite the shunt’s high failure rates. The shunt system, classically composed of a proximal catheter, valve, and distal catheter, was developed in the 1950s. The system was envisioned by John Holter, a toolmaker, whose son, Casey, had hydrocephalus. The concept, modeled after the nipple of a baby bottle, allowed for one-way flow through a pressure-regulated valve. The shunt system could take advantage of surgical aseptic technique (1860s), and followed historical predecessors: the external ventricular drain (1881), and ventricular-subdural shunts made of glass wool, gold tubes, bundled catgut (1890s), rubber (1903), glass, silver, and linen threads (1908–1926). Catheters from the ventricles to the cisterna magna and Nulsen-Spitz’s ventriculo-jugular shunt were revolutionary precursors made of rubber or polyethylene (1940–1950) [1]. The Spitz–Holter valve is the result of these efforts and that of John Holter. The modern-day shunt remains similar now as when it was created (1955, implanted in 1957/58): slight modifications to the catheter, major iterations to the shunt valve, and the addition of compensators for gravity and siphoning are key components to treatment.