A review of 92 consecutive shunt revisions is presented in an attempt to assess the contribution of computerized axial tomography to the long-term management of the child with shunted hydrocephalus. 20-22 percent of all cases of acute shunt malfunction presented with small ventricles, indicating that absence of ventricular enlargement should not be interpreted as demonstrating adequate shunt function. The single most useful application of computerized axial tomography in our hands is the detection of indolent shunt malfunction associated with ventriculomegaly and decline of cognitive function in the older child.