Endoscopic Third Ventriculostomy (ETV)
What is it? Endoscopic third ventriculostomy (ETV) or Endoscopic 3rd ventriculostomy, is a surgical procedure typically used in patients who demonstrate a blockage of cerebrospinal fluid (CSF) within the ventricle system, known as “obstructive hydrocephalus”. Other patients who can benefit from ETV are those who have pure obstructions within the brain such as aqueduct stenosis, or those suffering from tumors.
How does it work and what are the benefits? It is an alternative method of treatment to a cerebral shunt, which surgeons have traditionally used to treat this condition. A shunt is used to drain the CSF from the ventricles in the brain to another part of the body. However with endoscopic third ventriculostomy technique, the CSF is kept within the brain and spinal cord instead of being drained away. The surgeon makes a single small opening (a burr hole) in the skull, and an endoscope of between 2 and 5mm in diameter is inserted. The procedure removes the blockage and allows the flow of CSF to be re-established to the basal cisterns in the brain and spinal cord (called the sub arachnoid space). It can take as little as 30 minutes (although sometimes longer).
The benefits of endoscopic third ventriculostomy include:
- Fewer smaller incisions mean less pain and scarring.
- Shorter surgery time.
- A more natural way of draining CSF means that there are no over-drainage problems, which can cause headaches.
- Less chance of infection as there are no foreign objects (shunt tubing and valve) implanted in the body.
- Quicker recover time.
- The long term complication rate is lower compared to a shunt.
It should be noted that not everyone is a candidate for ETV. The success of the procedure depends on the skill and experience of the surgeon and most importantly, the patient who is selected.