Meningitis due to coccidioidomycosis invariably conveys an ominous prognosis; no documented' cures have been reported to date. The clinical course of illness depends not only on the magnitude of meningeal involvement, but also on the altered hydrodynamic flow of cerebrospinal fluid resulting from the strategic localization of the inflammatory process within the posterior cranial fossa. With the advent of amphotericin B, which has distinct fungostatic properties, a therapeutic agent became available to combat the mycotic infection so that prolongation of life has been achieved (1-3). Despite this, the onset of internal hydrocephalus, characterized by worsening headache, increased somnolence, progressive visual impairment and increased intracranial pressure, usually her~ aids the terminal phase of the illness. Prompt utilization of a mechanical shunt to circumvent the obstruction to cerebrospinal fluid flow enables the patient to survive during this critical period, and permits the initiation or continuation of amphotericin B therapy. The formation of cerebrospinal fluid within the brain, as well as its passage through the ventricular system to absorptive areas external to the brain, were recognized during the past century. Kausch noted Gartner's proposal of a physiologic method for treating hydrocephalus by creating a communication from within the ventricles of the brain to a superficial venous struc~ure within the head or neck (4). Payr described attempts to establish a shunt from the lateral ventricle to the internal jugular vein (5). ~es~ite primitive materials and techniques, amelIoratIOn of the signs and symptoms of hy~rocephalus was obtained in three of eight patients submitted to this procedure. Patency of the shunt was demonstrated at autopsy.