Accessibility Tools
Hide
Dr. Marcus Zachariah, Neurosurgeon, San Diego, La Mesa, CA / Services / Brain Surgeries / Procedures / Endoscopic Third Ventriculostomy (ETV)

What is an Endoscopic Third Ventriculostomy (ETV)?

Endoscopic third ventriculostomy (EVT) is a surgical procedure employed for the treatment of children and adults diagnosed with obstructive or non-communicating hydrocephalus. Hydrocephalus is a condition characterized by excessive accumulation of cerebrospinal fluid (CSF) in and around the brain which can lead to brain damage.

CSF is the fluid that surrounds the brain and the spinal cord. It is produced by hollow spaces inside the brain called ventricles. The fluid protects your brain and spinal cord by functioning as a cushion. Usually, CSF drains out of the brain through the ventricles and into the spinal column, which is then absorbed by the body. However, if the fluid cannot drain out properly, it causes the ventricles to swell and put pressure on the brain and the skull.

Endoscopic third ventriculostomy is a surgery performed to relieve this pressure. The procedure makes an opening in the floor of the third ventricle in the brain. This allows the entrapped or accumulated cerebrospinal fluid inside the brain's ventricles to escape into its normal pathway. Endoscopic refers to the surgery being performed utilizing an endoscope - a thin, flexible fiber-optic tube with a camera, light, magnifying lens, and a port to pass tiny instruments.

Endoscopic third ventriculostomy can be an alternative to ventriculoperitoneal shunt placement for the treatment of hydrocephalus.

Indications for Endoscopic Third Ventriculostomy (ETV)

Endoscopic third ventriculostomy is mainly recommended as a treatment of choice for obstructive hydrocephalus. However, it is also indicated for the treatment of hydrocephalus secondary to:

  • Myelomeningocele
  • Encephalocele
  • Posterior fossa tumor
  • Craniosynostosis
  • Slit ventricle syndrome
  • Congenital aqueductal stenosis
  • Posterior third ventricle tumor
  • Cerebellar infarct
  • Dandy-Walker malformation
  • Vein of Galen aneurysm
  • Intraventricular hematoma
  • Syringomyelia

Preparation for Endoscopic Third Ventriculostomy (ETV)

Pre-procedure preparation for endoscopic third ventriculostomy will involve the following steps:

  • A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
  • You should refrain from alcohol or tobacco at least a week before and two weeks after surgery.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • You will be instructed to shower with an antibacterial soap the morning of surgery to help lower your risk of infection after surgery.
  • Arrange for someone to drive you home as you will not be able to drive yourself after surgery.
  • A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Endoscopic Third Ventriculostomy (ETV)

The procedure is usually performed under general anesthesia and takes about an hour to complete. In general, the procedure involves the following steps:

  • You will be placed on the operating table in a way that gives your surgeon the best access to the area of the brain to be operated on.
  • An intravenous (IV) line will be inserted into your hand or arm to administer anesthesia, medicines, and fluids.
  • Your anesthesiologist will continuously monitor your vital signs throughout the surgery.
  • A small dime-sized hole is made in the skull, normally in the front at the back of the hairline to expose the dura.
  • The dura mater (outer covering of the brain) under the skull is cut open to access the brain.
  • Your surgeon inserts an endoscope to visualize the inside of the brain and ventricles and miniature instruments are passed through the port in the endoscope to work within the ventricles.
  • The endoscope is connected to an external monitor and the powerful camera attached at the end of the endoscope delivers video images of the inside of the brain to the monitor.
  • While looking at the monitor, your surgeon performs the ETV by creating an opening in the floor of the third ventricle.
  • The excess fluid accumulated in the brain will flow through the hole and out of the brain and is absorbed by the body.
  • The scope and the instruments are withdrawn, a Gelfoam or titanium cover is used to cover the hole in the skull, and the scalp skin is closed in a standard fashion.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after endoscopic third ventriculostomy will involve the following steps:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover. Frequent neurological checks will be performed by your medical staff to assess your brain function.
  • Most patients may need to stay in the hospital for a day or two before discharge to home.
  • You may experience pain, inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
  • Application of cold and heat therapy on the operated area is also recommended to reduce inflammation and pain.
  • Antibiotics are prescribed as needed to address the risk of surgery-related infection.
  • Your diet is slowly advanced post surgery. You will start with clear liquids, then progress to having normal solid foods, as tolerated.
  • Keep your incision clean and dry for 5 days following surgery. Instructions on surgical site care and bathing will be provided.
  • Refrain from smoking for a specific period of time as it can negatively affect the healing process.
  • Refrain from strenuous activities for the first few weeks. You may resume all your normal activities including noncontact sports such as swimming and running 2 weeks after surgery. Gradual increase in activities over a period of time is recommended.
  • Walking is a good exercise and regular walking is recommended to improve strength and endurance.
  • Refrain from driving and traveling on an airplane until you receive your doctor’s consent.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Endoscopic third ventriculostomy is a relatively safe procedure; however, as with any surgery, some risks and complications may occur.

General risks of any surgery include:

  • Infection
  • Bleeding
  • Blood clots or deep vein thrombosis
  • Anesthetic/allergic reactions

Risks and complications specific to EVT include:

  • Sudden closure of the newly created pathway
  • Damage to nerves and vessels
  • Fever
  • Short-term memory loss
  • Endocrinologic irregularities
  • Altered consciousness
  • Weight gain
  • Precocious puberty
  • Gaze palsy
  • Hemiparesis

Other Brain Surgery Procedures