Pre-Valve Pioneers

Arne Torkildsen — The Torkildsen Shunt

In the late 1930s, a Norwegian neurosurgeon named Arne Torkildsen faced a difficult problem: patients with hydrocephalus had very few options. Brain surgery was dangerous, and the tools were crude. Torkildsen's solution was elegant: instead of trying to fix the blockage, he created a detour. He invented a procedure called a ventriculocisternostomy (now known as the Torkildsen Shunt), which connected one fluid-filled space in the brain to another, allowing the trapped fluid to escape. He performed the first operation in 1937 and published his results in 1939. Torkildsen's shunt was the first clinically successful procedure to divert cerebrospinal fluid (CSF) in hydrocephalus. It became widely used throughout the 1940s and 1950s. It was a breakthrough, but it had limits: it only worked for certain types of hydrocephalus, and it drained CSF internally rather than removing it from the skull entirely.

Donald Matson — The Lumboureteral Shunt

Around the same time, Boston neurosurgeon Donald Matson popularized another early approach: the lumboureteral shunt, which drained CSF from the lower spine into the ureter (the tube connecting the kidney to the bladder). One advantage of this clever design was that no separate valve was needed; the ureter's natural resistance to flow acted like a built-in regulator. While this technique was eventually followed by better options, Matson’s work helped establish the idea that CSF could be safely redirected to other parts of the body.

The Valve Revolution

Frank Nulsen and Eugene Spitz – The First Valved Shunt

The modern era of hydrocephalus treatment began on a single day in 1949, at the Children's Hospital of Philadelphia. Neurosurgeons Frank Nulsen and Eugene Spitz implanted the first shunt with a valve into an 18-month-old infant. The valve used a ball-and-cone design with tiny helix springs that allowed CSF to flow in only one direction while maintaining pressure. This proof of concept demonstrated that a small, implanted device could regulate the flow of CSF in the brain. However, the tissue-contacting material was not ideal.

John Holter — The Father Who Built a Valve

In the mid-1950s, John Holter's son Casey was born with myelomeningocele, a form of spina bifida, and developed hydrocephalus as a result. During a visit to the hospital, Holter noticed something: the valve on a standard IV drip line allowed a needle to be inserted and withdrawn without CSF leaking out. He wondered whether the same principle could prevent his son's shunt from becoming blocked. Holter was a machinist and hydraulics technician who began working with criteria provided by Dr. Eugene Spitz. He designed a dual silicone slit valve mounted on a helix spring. The silicone material used was better treated by the body than earlier materials. Spitz successfully placed it in an atrial shunt (draining into the heart), and it worked. John Holter's valve, known today as the "Spitz-Holter valve", is still used in modern shunts.

John and Carol Newkirk – Additional Concerned Parents

John Holter was not the only concerned parent who saw a need in the field of hydrocephalus and developed a solution to address it. John (“Jack”) Newkirk earned a doctoral degree at the Carnegie Institute of Technology (now Carnegie Mellon) and followed with post-doctoral studies as a Fulbright Scholar at the University of Cambridge (King's College) in England. He married Carol in 1951, and she would be the business genius behind the success of his developments. Jack designed and patented a number of shunt designs that improved the quality of life for many people around the world. In the 1960s, he saw a need when one of Newkirk’s four children, Victoria, at about the age of 3 years old, was diagnosed with hydrocephalus and was implanted with a shunt. The shunt was soon obstructed and needed to be replaced. In collaboration with her neurosurgeon and with the cooperation of a machinist, Jack designed and patented an all-silicone rubber shunting device that could be cleared by external digital manipulation. This device was successful and was manufactured in quantity and shipped internationally through a company, Denver Biomaterials. Inc. which Jack and Carol organized, and Carol operated in Evergreen, Colorado.

Robert Pudenz & Ted Heyer — Refining the Design

That same year, neurosurgeon Robert Pudenz and engineer Ted Heyer developed a different valve made of Teflon. A distal slit valve that is placed at the far end of the shunt, near where the CSF exits. Pudenz also made a crucial discovery about where to drain the CSF: the right atrium of the heart turned out to be the ideal destination, reducing the risk of blockages and clots. Pudenz and Heyer’s teamwork helped establish the ventriculoatrial shunt as the gold standard, and in many areas of the world, the ventriculoatrial approach is the preferred shunt placement

Rudi Schulte — The Watchmaker's Gift

In 1960, a young German watchmaker named Rudi Schulte brought his jeweler's eye to the problem of shunt valves. Working alongside Pudenz and Heyer, Schulte patented the diaphragm valve; a thin, flexible membrane that opens under increased pressure and closes when pressure drops. It was a reliable design that was directly inspired by the miniature mechanisms watchmakers had been crafting for centuries.

A Famous Partnership: The Wade-Dahl-Till Valve

In 1960, the car outside a New York City school struck four-year-old Theo Dahl, the son of celebrated children’s author Roald Dahl. Theo survived, but he developed severe hydrocephalus and would require a shunt. The Holter valves available at the time were prone to clogging. Debris that accumulated in the ventricles would block the tiny openings. Kenneth Till, a pediatric neurosurgeon at the Great Ormond Street Hospital in London, explained the problem to Theo's father. Dahl brought in Stanley Wade, a hydraulic engineer, and together the three men collaborated to design a new valve specifically engineered to resist blockage from debris. The Wade-Dahl-Till (WDT) valve was subsequently born in 1962.

Harold Portnoy & R.R. Schulte — The Anti-Siphon Device (1973)

As shunts became more widely used, doctors noticed a troubling side effect: when patients stood up, gravity caused the CSF to drain too quickly. This "siphoning" effect could lead to the brain being starved of CSF, sometimes causing headaches, collapsed ventricles, or bleeding between the brain and skull. Neurosurgeon Harold Portnoy and engineer Rudi Schulte then developed the anti-siphon device: an addition to the shunt that responded to the change in pressure when a patient moved from lying down to standing up, slowing drainage automatically.

Groundbreaking Programmable and Gravitational Valves

Salomón and Carlos Hakim – The Codman-Hakim Programmable Valve

For decades, the only way to adjust the flow of CSF within a shunt was a surgical valve replacement. All the risks of brain surgery returned every time a patient needed a pressure adjustment, creating space for the development of the programmable valves. Colombian neurosurgeon Salomón Hakim is one of the most important figures in hydrocephalus history. He is credited not only with identifying normal-pressure hydrocephalus (NPH) as a distinct and treatable condition in 1964, but also with developing several valve innovations, including the perfection of the ball-in-cone valve design, and with Cordis Engineer Don Harris, the development of the first gravitational valve in 1976 (the Horizontal-Vertical (HV) Lumbar Valve). In the late 1980s, Hakim and his engineer son Carlos Hakim worked to develop the world's first programmable valve. Working with Swiss watchmakers and neurosurgeon Peter Black at Harvard, they created the Codman-Hakim valve, which could be adjusted from outside the body using a small magnetic programmer. The valve could be set anywhere from 30 to 200 mm of water pressure, in steps of 18 mm, all without surgical intervention. The Codman-Hakim valve became the foundation for virtually all adjustable shunt valves used today and remains in use after more than 40 years.

Miethke Engineers – The Gravity-Assisted Shunt

Even with programmable valves, one problem remained stubborn: the human body is not always in the same position. A shunt set to drain at just the right rate while lying down might drain too much when the patient is upright, and vice versa. Engineers at Miethke, a German medical device company based in Potsdam, developed gravity-assisted valves that could automatically adjust their resistance depending on body position. Their adjustable gravitational assistant represented the cutting edge of passive, self-regulating shunt technology that relied solely on physics.

The Hydrocephalus Association and the Power of Parents

The power of parents to make a difference in the health of their children cannot be underestimated. This has been continuously demonstrated by the Hydrocephalus Association (HA), who have invested $17 million in research funding for hydrocephalus since 2009. The predecessor of the organization that would become the Hydrocephalus Association was formed by a group of concerned parents at the suggestion of Michael Edwards, MD, a pediatric neurosurgeon in the San Francisco Bay area in the early 1980s. Initially known as the Neurosurgery Parent Support Group, it would become the Hydrocephalus Foundation of Northern California.

It began in 1984 when Cynthia Solomon, a parent of a son with hydrocephalus, and co-organizer Emily Fudge, contacted Cordis Corporation and requested financial support for their organization. They expressed concern that shunt companies produce informational literature directed toward physicians, not patients, and were looking for patient-focused information and communication about hydrocephalus. Cordis enthusiastically offered financial and technical support to foster the success of the group where they provided funding for their first national conference in San Francisco in 1988. The Cordis art department developed the organization’s first logo as well as illustrations for the association’s early literature. They also developed multiple patient support materials including a patient manual, pediatric-focused information in the form of a coloring book, and a teaching doll with an implanted shunt. The biannual conference has become a tradition, attracting leading clinicians and experts from around the nation to interact with patients and their families. Today, HA persistently advocates for hydrocephalus awareness, oversees funding for clinical research networks focused on pediatric and adult hydrocephalus, and has raised millions of dollars to support research in hydrocephalus, while also working alongside national offices such as the National Institutes of Health (NIH), Department of War, and Federal Drug Administration (FDA) to accomplish this goal.

• Check out our Evolution of Shunt Valves article and video.
• To learn more about the mechanisms and purposes of shunting surgery, visit our Shunt Systems page.