Reduction of head size in advanced hydrocephalus: a case report.

On October 8, 1951, at the dawn of modern neurosurgical treatment of hydrocephalus and other cranial abnormalities, the parents of a child with advanced hydrocephalus posed the question: might the size of the head be reduced so as to allow sitting, standing, and perhaps walking? With the ingenious assistance of the child's father, who devised and made unique surgical instruments, the objectives were accomplished over a period of almost 2 years during which more than a dozen operations were carried out, including one of the first lumbar subarachnoid to peritoneum shunts using the Touhy needle instead of laminectomy. The operations conducted, the devices and tactics used, and the end results are described. No opportunity to treat another patient similarly has presented itself in the over 30-year interval since then, but I believe that the concept is valid and that success is realizable by others who may wish to use some of the techniques described, with appropriate modification.