Endoscopic Third Ventriculostomy

Endoscopic third ventriculostomy is a surgical procedure that may be offered to children and adults who have been diagnosed with obstructive or non-communicating hydrocephalus.

Shunting, or using a small silicone tubing to divert the cerebrospinal fluid (CSF) to a different body cavity for reabsorption, is the most common treatment for hydrocephalus and has been used for over 40 years. While shunts may be life saving, they are man-made devices and may fail for a variety of reasons.

Endoscopic third ventriculostomy is an alternative surgical procedure that creates a bypass for the cerebrospinal fluid in the head that eliminates the need for a shunt. It is helpful only to people with hydrocephalus that is caused by a blockage of the flow of cerebrospinal fluid.

Endoscopic means that the surgery is performed with the use of an endoscope. An endoscope is a thin tube that has a strong light, a powerful magnifying lens and a passage through which tiny instruments are passed.

Third ventriculostomy refers to the area of the brain where the bypass is made. Because the most common site of blockage is the narrow pathway between the third and fourth ventricle of the brain (the aqueduct of Sylvius), the bypass is made through the thin membrane in the bottom (or floor) of the third ventricle.

The cerebrospinal fluid may then flow from the lateral to the third ventricle and from the third ventricle through the new opening to the normal fluid chambers below the base of the brain.

The cerebrospinal fluid then flows up and over the surface of the brain where it is reabsorbed into the bloodstream.

The populations who have a high success rate with this procedure include patients with:

  • Hydrocephalus in myelomeningocele
  • Hydrocephalus associated with brain tumors
  • Obstructive hydrocephalus with other causes

The patient populations who have a low probability of success with this procedure include:

  • Those with communicating hydrocephalus
  • Children under the age of 2 years with hydrocephalus
  • Patients with hydrocephalus who were previously treated with whole brain irradiation

Your child will go to the Postanesthesia Care Unit (PACU) after surgery. The surgeon will update you on how your child is doing. When you receive a call from the PACU, you may join your child.

After recovering from the immediate anesthesia effects, your child will be admitted to the hospital for 2-3 days. When your child is drinking well, has been up walking around successfully, has his / her pain under control and there is evidence that the surgery was effective, he / she will be discharged home.

Your child will have a follow up visit in neurosurgery for a wound check in 7-10 days after his / her procedure.

A cine (or motion) MRI of the brain will be part of the routine follow-up before your appointment with the neurosurgeon. This is to verify the presence of the opening made in the bottom of the third ventricle and the size of your child's ventricles for future comparison. If your child becomes ill, this helps in determining whether or not the hydrocephalus is causing problems.

You should wash your child's incision every day with a mild shampoo or soap and water. Your child may return to school or daycare 10-14 days after surgery, depending on how he / she feels.

Observe him / her for any signs of hydrocephalus; these would typically be the same symptoms that prompted the surgery. (See Shunt Malfunction for signs of hydrocephalus.)

Routine follow-up is very important for identifying and treating any problems early, before they become possibly life threatening. Call the doctor immediately if your child experiences any of the following before your next scheduled visit:

  1. Severe headache that does not stop with Tylenol and rest
  2. Excessive vomiting (when nothing stays down)
  3. Confusion or excessive sleepiness
  4. Fever over 102 degrees F
  5. Redness and / or drainage at the incision

Last Updated 07/2012