Health Library

Endoscopic Third Ventriculostomy

Endoscopic third ventriculostomy is a surgical procedure offered to 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 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 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. Because 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) after surgery. Your doctor will update you on how your child is doing and you can join your child in the PACU.

After your child is awake and alert, they will go to their hospital room. Children typically stay in the hospital for 2-3 days and can go home once the doctor feels the surgery was effective and they are:

• Drinking well
• Able to get out of bed and walk around safely
• Managing their pain

Your child will need to see the doctor in 7-10 days after the procedure to have their wound checked. They will also need to have a motion MRI of the brain before this visit. This x-ray allows the doctor to check the opening made during surgery.

Caring for Your Child After Procedure

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 they feel.

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 vomiting (when nothing stays down)
• Confusion or excessive sleepiness
• Fever over 102 degrees F
• Redness and / or drainage at the incision