&NA;The reaction of periventricular tissue to shunt tubing chronically implanted in the fourth ventricle of the rat was investigated by correlative scanning and transmission electron microscopy. Sterile silicone tubing with four 0.4 mm diameter holes was inserted into the fourth ventricle of adult Sprague‐Dawley rats through an incision in the atlantooccipital membrane and the animals were killed at postoperative intervals of 5 and 8 weeks. Reactive changes that could be correlated with the extent of contact with the implant occurred in the periventricular tissue. The ependyma lining the ventricle underwent a progressive loss of cilia and microvilli, became attenuated and, in circumscribed areas, was lost entirely. A significant subependymal gliosis accompanied these changes. In regions denuded of ependyma, neurons and glia were exposed directly to the cerebrospinal fluid. Eruptions of periventricular tissue corresponding precisely to the location of holes in the implanted tubing were observed on both the vermal surface of the cerebellum and the floor of the ventricle. Evaginations from the surface of the inferior vermis and the floor of the ventricle were most prevalent at 5 and greatest at 8 weeks postimplantation, respectively. Gliosis combined with mechanical factors are believed to be responsible for development of these periventricular tissue evaginations, which may be a factor in the pathogenesis of cerebrospinal fluid shunt obstruction in treated human hydrocephalus. (Neurosurgery19:337‐345, 1986)