Classifications of hydrocephalus based on Walter Dandy and his paradigm

Abstract

Purpose: The purpose of this review is to assess the early work of Walter Dandy leading to a paradigm or model that led to the first classification of hydrocephalus and resulted in the development of treatments.

Methods: The modern understanding of hydrocephalus begins with the works of Walter Dandy. The purpose of this review is to discuss what was changed in the second decade of the 20th century and how the outcome is useful today. As a result of his experiments during that time he was able to recognize the role of the choroid plexus in the production of cerebrospinal fluid (CSF) within the cerebral ventricles. He then identified the role of obstruction blocking the flow of CSF from the ventricles to the absorption of CSF to the systemic vascular. As a result of those findings he showed that there were two forms of hydrocephalus and therefore the first classification of hydrocephalus into obstructive hydrocephalus and communicating hydrocephalus. Very soon after the publication of the experiments there was general agreement of this work by neurosurgeons working on hydrocephalus. The findings published in "experimental hydrocephalus" became a paradigm useful for all or the vast percentage of those neurosurgeons.

Results: Dandy was the first to create a classification of hydrocephalus into obstructive and communicating hydrocephalus. He developed treatments for hydrocephalus such as removal of the choroid plexuses that remained in use until effective valved shunts became available in the 1950s. Essentially all subsequent classifications begin with this paradigm.

Conclusion: Over time there have been new classifications primarily focused on specific uses. It is important that classifications in the sciences be reviewed periodically to include new findings and new ideas. Since the expectation that hydrocephalus can be treated or even cured new classifications tend to focus on the physics of CSF, the choice of treatment and the outcome in specific subgroups. These thoughts should be seen as additions to the paradigm.

Keywords: Anomaly; Classification; Hydrocephalus; Paradigm.