Introduction
Endoscopic third ventriculostomy ('ETV') is a treatment for obstructive (or 'non-communicating') hydrocephalus, which is where cerebrospinal fluid collects in the brain.
Cerebrospinal fluid (CSF) is produced in the ventricular system in the brain, consisting of four cavities (Two lateral ventricles, third ventricle and fourth ventricle) connected to each other via channels. The third ventricle is located in a central position above the base of the skull.
Ventricles may be enlarged when there is blockage of CSF flow (called hydrocephalus). In the case of obstructive hydrocephalus, the fluid is unable to flow properly between the ventricles, often due to a narrowing in the passage between the third and fourth ventricles (‘Cerebral Aqueduct”).
Preoperative Instructions
Before all neurosurgical procedures, including endoscopic third ventriculostomy, you should…
- Fast (i.e. no food or drink) from midnight the night before the procedure, but medications are allowed with very small sips of water.
- Stop taking any non-steroidal anti-inflammatory medication (NSAIDs) or fish oils at least one week ahead of the procedure.
- Notify the office or your doctor if you take blood thinners (such as aspirin, Plavix, prasugrel, warfarin, other blood thinners). These medications will need to be stopped a few days ahead of the procedure.
- If you develop any symptoms of infection, e.g. a cold or flu, before surgery, or if you are receiving treatment for an infection, please inform the office as soon as possible.
Procedure
An endoscopic third ventriculostomy is a procedure that involves creating a small opening in the bottom of the third ventricle so that CSF can drain to the 'basal cisterns' below, and from there into the spinal cord, and thus relieve CSF pressure.
The procedure is performed under general anaesthesia and generally takes around 60 minutes. It involves drilling a small hole (burrhole) in the skull (normally on the right side behind the hairline) to allow a small video camera (endoscope) and miniaturised surgical instruments to access the third ventricle and create a new opening in the bottom of the third ventricle. Once this is complete, the entry point in the skull is covered with a small plastic reservoir and the skin is closed.
Postoperative Instructions
Patients undergoing an endoscopic third ventriculostomy can generally expect to return home the following day. It involves one day stay in intensive care unit for monitoring. We will give you more detailed instructions about postoperative care, however, in general terms, if any of the following symptoms occur after returning home, you should seek immediate medical assistance...
- Increasing drowsiness or confusion
- Severe headaches.
- New stroke-like symptoms (weakness or numbness in arms or legs).
- Seizure.
- Redness or discharge from the incision site.
Risks
The procedure does have some associated risks. These are…
- Infection.
- Haematoma (blood clot) formation.
- Bleeding (haemorrhage) from the basilar artery.
- Injury to nearby tissue e.g. the hypothalamus, pituitary gland, fornix.
- Cerebrospinal fluid leak.
In addition, the procedure can sometimes fail due to the blockage/closure of the ventricular drainage hole (ventriculostomy) and / or the formation of membranes.
The most common complications after an ETV are bleeding and fever. Major bleeding is very uncommon. Occasionally short-term memory loss and endocrine disorders occur, but in both cases, these improve over time.
Treatment Alternatives
An alternative to the procedure is the placement of Related Information