gms | German Medical Science

Objective: For over 26 years Erwin Payr was the Chief of Surgery in Leipzig (1911–1937) and one of the most important pioneers in the treatment of hydrocephalus. In 1907, he implanted the first ventriculo-venous shunt using a vein with preserved flaps as bioprothetic valve. Unfortunately his name and scientific contributions are often unknown in the younger generation of neurosurgeons.

Methods: Reevaluation of his publications on the background of the contemporary hydrocephalus therories and therapeutic trials.

Results: Payr was born in Innsbruck in 1871, studied in Innsbruck, Wien (teachers: Billroth, von Eiselsberg and others) and Graz. He had a very broad medical education with pathology, transplantations, vascular and animal experimental surgery, which were preconditions for his later success. Since 1899 (trigeminal neuralgia) he showed special interests in neurosurgery, followed by studies of brain abscesses. After successful systematic animal studies, Payr was the first to implant a shunt from the ventricles into the sagittal sinus in Greifswald in 1907. As a catheter he used an autologous saphenous vein, and as the valve the preserved venous flaps. A collapse should be avoided by an augmentation with formalin-fixed veins. The surgical techniques and self-developed instruments confirm an extraordinary and innovative surgeon. The first patient showed significant improvement for a half year, two others were less successful. The necropsies showed patent shunts in all cases. Later on Payr preferred ventriculostomies with valveless catheters in the subarachnoid spaces, which worked in part for 9 years. In Leipzig (chair 1911–1936) he tried intracranial endoscopic operations in animals.

Conclusions: In the earty 20^th century Erwin Payr was the most important pioneer in venous shuntsfor hydrocephalus, but also in ventriculostomies using "catheters". Retrospectively his catheter material and the valve were not optimal and limited his trials. 50 years later, silicone tubes and artificial valves confirmed Payr's concept.