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“Not a lot” may be the general impression, but then it is easy to forget that, until the advent of shunts (almost 50 years ago), hydrocephalus was usually fatal. It is probably true to say that further fundamental advances have been slow in coming, but this has not been through lack of endeavour. What has occurred over the years is an understanding of how shunts malfunction (and technical attempts to combat this, including the development of endoscopic treatment for certain types of hydrocephalus) and a greater awareness of the metabolic and hydrodynamic changes that occur in the brain as a result of hydrocephalus (fig 1). Although perhaps overdue, reasonable studies on long term follow up of patients with hydrocephalus are now becoming available. The prevalence of congenital and infantile hydrocephalus is between 0.48 and 0.81 per 1000 births (live and still), 1 2 and a significant percentage of these patients …