Endoscopic Third Ventriculostomy

What is endoscopic third ventriculostomy?

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?

Risks associated with the procedure may include:

• Bleeding from damage to the arteries
• Fever
• Formation of a haematoma (blood clot)
• Neural injuries (e.g. thalamus, fornix, hypothalamus, mid-brain)
• Leakage of cerebrospinal fluid

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:

• Severe headaches
• Increased drowsiness
• Weakness or numbness in arms or legs
• Double vision
• Redness or discharge from the site of incision
• Fluid leakage from the scalp incision