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Endoscopic Third Ventriculostomy

Endoscopic third ventriculostomy is a surgical procedure used to treat children and adults diagnosed with obstructive or non-communicating hydrocephalus.

Shunting, or using a small silicone tube to carry the cerebrospinal fluid (CSF) to a different body cavity for reabsorption, is the most common treatment for hydrocephalus. While shunts may be lifesaving, they are synthetic 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 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 an opening where tiny instruments are passed.

Third ventriculostomy refers to the area of the brain where the bypass is made. The most common site of blockage is the narrow pathway between the third and fourth ventricle of the brain. 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.

Success Rates

This procedure has a high success for patients with:

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

Patients who have low success rate 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.

After the Procedure

Your child will recover in Post Anesthesia Care Unit (PACU) or Pediatric ICU (PICU) after surgery. Your doctor will update you on how your child is doing and staff will let you know when you can join your child in the PACU or ICU room.

Children typically stay in the hospital for two to three days and can go home once the surgeon feels the surgery was effective and when:

• They are eating and drinking well.
• They are able to get out of bed and walk around safely.
• Pain is managed on oral medicine.

Your child will need to be seen in the neurosurgery clinic about two weeks after surgery to have their wound checked. Per doctor preference, they may need an MRI or CT prior to this visit to assess the CSF spaces. Follow-up scans at the three month mark will assess if the hole made in surgery is still open.

Caring for Your Child After Procedure

Wash your child's incision every day with Johnson's® baby shampoo and water. Your child may return to school or daycare after cleared at post op visit.

Watch your child for any signs of hydrocephalus (the same symptoms that prompted the surgery). See Shunt Malfunction for signs of hydrocephalus.

Call Your Child's Doctor If:

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

• Severe headache that does not stop with Tylenol and rest.
• Excessive throwing up (when nothing stays down).
• Confusion or excessive sleepiness.
• Fever over 102 degrees Fahrenheit.
• Redness and / or drainage at the incision.