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There have been many references to the complications that result from the surgical treatment for hydrocephalic children, but only a few papers about radiological changes of skull following the procedure have been reported. During the last 6 years 120 cases of pediatric hydrocephalic patients were treated with ventriculo-atrial (V-A) or ventriculo-peritoneal (V-P) shunts. Significant skull changes were observed radiologically in those patients who showed increased head circumference at the time of initial surgical procedure performed after the age of one year. Selection of cases for this study was made upon the following criteria. 1. The diagnosis of hydrocephalus with enlarged skull and dilated ventricles was confirmed on the basis of cerebral pneumoencephalography and other diagnostic studies. 2. The shunting procedure was performed after one year of age. 3. The head circumference at the initial operation was over 50 cm. 4. The patients had been followed for at least 2 years after the initial operation. 5. Adequate pre and postoperative skull films were available. 20 cases were selected using the above criteria, and 15 cases among these cases showed significant radiological skull changes. The radiological abnormalities of the skull are as follows: 1) Thicking of the vault, 12 cases. 2) Premature fusion of sutures, 12 cases. 3) Marked reduction in size of the sella turcica, 9 cases. 4) Lamination of the diploe, 6 cases. 5) Others: thickening of the cribriform plate, thickening of the planum sphenoidale and calcification of subdural hematoma etc. These alterations of the skull are due to inward growth of the inner table of the skull in response to the prolonged cerebrospinal fluid shunting precedure and probably due to reduction of cerebrospinal fluid pressure and pulsation. Marked skull changes were observed in cases of marked hydrocephalus with brain atrophy or hypoplasia, but no difference were observed between the patients with V-A and V-P shunting procedures. These skull changes, especially premature fusion of sutures, may affect prognosis of children. But adequate treatment of these patients with the apparatus available at present seems to be difficult. We feel that it is important to make diagnosis in early stage and that the surgical treatment for infantile hydrocephalus should be performed before the size of the skull and ventricles are makedly increased. The appropriate shunting apparatus to prevent excessive low intracranial pressure should be selected for the operative procedure for these patients.

Roentgenographic Skull Changes Following Prolonged Cerebrospinal Fluid Shunting