Endoscopic third ventriculostomy

Endoscopic Third Ventriculostomy (ETV) is a neurosurgical procedure used to treat hydrocephalus, a condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain. This minimally invasive surgery creates a new pathway for CSF flow, bypassing obstructions or narrowing within the ventricular system.

Indications

ETV is primarily indicated for patients with obstructive or non-communicating hydrocephalus, where the flow of CSF is blocked along one or more points in the ventricular system. Common causes include aqueductal stenosis, tumors within the ventricular system, and cysts. It is less effective in treating communicating hydrocephalus, where CSF flow is blocked outside the ventricular system.

Procedure

Performed under general anesthesia, ETV involves the use of an endoscope, a flexible tube with a camera and light at the end, which is inserted into the brain through a small hole in the skull. The surgeon navigates the endoscope through the ventricular system to the floor of the third ventricle, where a small hole is created to allow CSF to flow directly into the basal cisterns, bypassing the obstruction.

Risks and Complications

As with any surgical procedure, ETV carries risks, including infection, bleeding, and damage to surrounding brain tissue. Specific complications related to ETV may include failure of the ventriculostomy to remain open, leading to the need for additional surgery, and the potential for short-term memory problems, given the close proximity of the third ventricle to memory-related structures.

Outcomes

Success rates for ETV vary depending on the underlying cause of hydrocephalus and the patient's age, with higher success rates observed in older children and adults with aqueductal stenosis. In general, ETV is considered a safe and effective alternative to ventriculoperitoneal shunt placement, which requires the implantation of a mechanical device to divert CSF from the ventricles to the abdominal cavity.

Follow-up

Postoperative care includes regular neuroimaging studies, such as MRI, to monitor the patency of the ventriculostomy and the overall volume of CSF within the brain. Patients may also require neuropsychological testing to assess for any changes in cognitive function.