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Endoscopic third ventriculostomy (ETV) is a minimally invasive procedure that uses an endoscope to treat obstructive hydrocephalus, a condition caused by excess build-up of cerebrospinal fluid (CSF), a protective layer found around the brain and spinal cord in the brain.
Obstructive hydrocephalus (also known as non-communicating hydrocephalus) occurs when the fluid is unable to flow properly between the ventricles. This usually happens due to a narrowing of the passage between the ventricles.
The endoscope is used to create an alternate pathway for CSF to flow from the brain downwards to the spine, because the normal pathway through the aqueduct is blocked.
Why do you need an endoscopic third ventriculostomy?
An ETV is considered the treatment of choice for patients diagnosed to have obstructive hydrocephalus, which is caused by blockage in the normal pathways of CSF flow. This leads to excessive CSF in the brain. It is usually caused by congenital or acquired aqueduct stenosis or tumour.
The general benefits of an endoscopic third ventriculostomy are:
It is a minimally invasive procedure.
It eliminates the need of placing a shunt, which is a small silicone tube that carries cerebrospinal fluid to a different body cavity for reabsorption.
Endoscopic third ventriculostomy success rate
The success rate for an ETV depends on factors such as:
Age of the patient
Cause of hydrocephalus
For some patients, the success rate may be up to 90%. However, for some, the chances for success may be lower in children under the age of 2.
What are the risks and complications of an endoscopic third ventriculostomy?
Short-term memory loss and endocrine abnormalities may also occur, although both recover with time.
How do you prepare for an endoscopic third ventriculostomy?
You are generally recommended to:
Not have solid foods for 6 hours before surgery (clear fluids are allowed up to 2 hours before surgery)
Inform your doctor of allergies to any medicine
Inform your doctor of your current medications, especially blood thinners, which must be stopped a few days before the procedure
What can you expect in an endoscopic third ventriculostomy?
Estimated duration
The procedure generally takes around 1 hour.
During the procedure
The endoscope is inserted into the ventricular system, then directed into the third ventricle, where an opening is created in the floor of the third ventricle. This allows the CSF to flow directly to the basal cisterns, bypassing the obstruction in the aqueduct area. The endoscope is then removed and the burr-hole and scalp incision is closed.
After the procedure
You will be taken to the recovery room post-surgery. Once you're awake and the pain is under control, you'll be transferred to your hospital room and will stay there for a night for monitoring.
Care and recovery after endoscopic third ventriculostomy
Since the procedure is minimally invasive, you may expect to:
Go home within 1 – 2 days, depending on your recovery and clinical symptoms
Resume daily activities within a couple of days
Return to work and exercise after 2 weeks
Some postoperative care instructions include:
Keeping your incision clean and dry and check for any signs of redness, swelling, or fluid leakage
Visit your doctor 7 – 10 days after your surgery for suture removal
Contact your doctor immediately if you have the following signs and symptoms:
