A History Hydrocephalus Treatment

The History of treatment

Charles 'Casey' Holter, the son of an American engineer, was found to have hydrocephalus. The surgeon explained that there was no satisfactory treatment. John Holter, the child's father, questioned the surgeon and gained an idea of the sort of treatment required. He experimented at home and soon developed such a device, made from silicone rubber which had never been implanted into people before. Silicone was used as insulation for the electrical systems of airplanes. The surgeon decided to try this, with great success. The Holter valve soon became the treatment of choice for hydrocephalus, and it also revolutionised the treatment of spina bifida, removing the principal cause of death and encouraging orthopaedic and urological surgeons to develop procedures to improve mobility and continence. Other similar devices were developed soon afterwards, all made from the same material and having similar valve mechanisms.
In the 1960's investigations were proceeding into how CSF was produced, and drugs were tried experimentally to reduce the rate of CSF production. Some of these showed initially promising results, but they had unpleasant side effects and their use was abandoned. However, new investigations are now being undertaken on drugs which might reduce CSF production in the hope of avoiding a shunt, but even if this approach is successful it could be many years before it is used.
A relatively new approach, based on an old method, is to pass a tube (endoscope) into the ventricles and to use this to remove part of the CSF-producing mechanism (choroid plexus), or to make an opening in the wall of the ventricle to allow CSF to escape. Such techniques, if successful, avoid the use of a shunt but they do not always work, and some patients will have a type of hydrocephalus for which the treatment is not suitable.