Endoscopic Third Ventriculostomy


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Endoscopic third ventriculostomy (ETV) is a procedure used to treat hydrocephalus, as an alternative to a shunt.

The procedure was attempted years ago, before shunts were invented. A man called Dandy performed it as an open operation in the early twentieth century. But basic endoscopic attempts with primitive endoscopes even preceded this. It was always a logical way to try and treat hydrocephalus. Modern equipment to carry out ETV didn’t exist until about twenty years ago, so it is only now that surgeons are able to review the procedure, and look at success rates and possible complications.

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Endoscopic Third Ventriculostomy

  1. 1. shinecharity.org.uk info@shinecharity.org.uk 42 Park Road Peterborough PE1 2UQ 01733 555988Endoscopic Third VentriculostomyEndoscopic third ventriculostomy (ETV) is a procedure usedto treat hydrocephalus, as an alternative to a shunt.With special thanks to:- Conor Mallucci, Consultant Neurosurgeon for his help in creating this information sheet.Third ventriculostomy procedureEndoscope Third ventricle Ventriculostomy Diverted flow of CSFThe procedure was attempted years equipment to carry out ETV didn’tago, before shunts were invented. exist until about twenty years ago,A man called Dandy performed so it is only now that surgeons areit as an open operation in the able to review the procedure, andearly twentieth century. But basic look at success rates and possibleendoscopic attempts with primitive complications.endoscopes even preceded this.It was always a logical way to try Hydrocephalus is a group ofand treat hydrocephalus. Modern conditions with different causes,
  2. 2. Endoscopic Third Ventriculostomyand the treatment should naturally unfortunately this is only a solutionselect itself depending on the for less than a quarter of all patients.cause. The patients for whom ETV is goingTraditionally surgeons have used to work well are people who haveshunts to drain the cerebral spinal pure obstructions within the brainfluid (CSF) from the ventricles in the such as aqueduct stenosis, orbrain to another part of the body, patients who have tumours.and this is still the main method oftreatment. A second set of people who respond well are those who haveThird ventriculostomy, on the other had shunts for many years andhand, does the opposite to a shunt. have developed an obstructive formInstead of draining the CSF away, it of hydrocephalus. An MRI scan willkeeps it within the brain and spinal show if the patient has a blockagecord. of the CSF pathway in their brain.The neurosurgeon makes a hole The success of ETV proceduresin the thin membrane at the base depends on the experience of theof the third ventricle, which allows surgeon and most importantly, thethe fluid into the area that lines the patient who is selected.brain and the spinal cord called thesub arachnoid space. Once the If patients are carefully chosen, thefluid has drained into this space it success rate for pure obstructivecan be absorbed. hydrocephalus in new patients is around 70 per cent. The failure rateThe ETV technique is performed is highest in the first 2 to 3 months,via a hole similar to that of a shunt, and if it doesn’t work then a shuntusually at the front of the head, can be inserted.just behind the hairline, using anendoscope of between 2 and 5mm If the ETV has worked beyondin diameter. those initial few months, then it is more likely to stay working. ButThis is a beautiful technique, which it is important that patients aredrains the CSF more naturally, but aware that the procedure isn’t a
  3. 3. cure for hydrocephalus, it is an If patients are suitable for aalternative treatment. If a child third ventriculostomy, then thereor adult shows signs of raised are several advantages to thepressure i.e similar symptoms procedure over shunts. Firstly theto shunt malfunction, the infection rate, at two per cent, ispossibility of a failed ETV must very low. The other main advantagebe considered even if it is is that there are not over-drainagesome years since the original problems, which can lead toprocedure and families must headaches, because it is a naturalnot delay in seeking medical way of draining the CSF.help So while shunts still remainThere is currently an international the mainstay of hydrocephalusstudy looking at the success rates treatment, third ventriculostomyof third ventriculostomy in the under is a complementary procedureones, because it is felt that in these suitable for a group of patients,children, despite the anatomy being and remains a useful adjunct forsuitable, the success rate isn’t as patients who have shunt problemshigh as later on. or blockages later in life.This is possibly because the child’s Further informationbrain and skull is not fully formed,and the pressures generated within For further information onthe brain aren’t high enough to keep Endoscopic Third Ventriculostomythe third ventriculostomy open. please contact the Shine on 01733 555988.Many neurosurgeons tend tooffer third ventriculostomy in anychild who has purely obstructivehydrocephalus, but make theparents aware that success ratesare probably lower in newbornchildren than they are later on in life.
  4. 4. Help usShine relies on people’s generosity and support so we can help our clientswho depend on us for help and advice - people with hydrocephalus, spinabifida, their families and carers. To donate to Shine please visitwww.shinecharity.org.uk or call 01733 421329.This information has been produced by Shine’s medical advisers andapproved by Shine’s Medical Advisory Committee of senior medicalprofessionals.Shine - Registered charity no.249338To see our full range of information sheets and to find out how to donate toShine please visit www.shinecharity.org.uk