When Your Child Needs an Endoscopic Third Ventriculostomy

Endoscopic third ventriculostomy (ETV) is a type of brain surgery. It treats hydrocephalus. This condition is when cerebrospinal fluid (CSF) builds up in the brain. CSF surrounds the brain and spinal cord and acts as a cushion. The brain normally has a certain level of CSF in it. Too much of this fluid can cause undue pressure on the brain. This can cause brain damage.

During ETV, a healthcare provider puts a thin, flexible tube called an endoscope into your child’s brain. The endoscope has a camera on the end of it. It sends images to a screen, so the provider can see inside your child’s brain. Through the endoscope, the provider makes a hole in the bottom of the third ventricle in the brain. A ventricle is a space in the brain filled with CSF. Making the hole lets CSF flow more freely between your child’s brain and the space outside the brain.

Why is ETV done?

ETV is sometimes done in place of a ventriculoperitoneal (VP) shunt. A VP shunt is another way to treat hydrocephalus. It uses a tube (catheter) to carry CSF out of the brain to the lining of the abdomen (peritoneum). This tube runs just under the skin. A small valve in the tube helps control the flow of CSF from the brain.

Compared to a VP shunt, ETV may have a lower risk for long-term health problems. But ETV is not always an option. It’s used mainly to treat a certain type of hydrocephalus. That is when it is caused by a blockage in the brain. The block leads to a buildup of CSF in the ventricles. ETV is also done only in children older than age 2.

What happens before ETV?

Your child’s healthcare provider will ask about your child’s health. They will also give your child a physical exam. Your child may also need some tests, such as blood work and imaging tests.

Tell your healthcare provider about all the medicines your child takes. That includes prescriptions, over-the-counter medicines, and supplements. Also, tell your provider if your child has any allergies.

Your child may be directed not to eat or drink anything for a certain time before the procedure.

What happens during ETV?

ETV is done in a hospital. It takes about 1 to 2 hours. During the procedure:

• Your child is given medicine to help them relax and not feel pain. A small area of hair on their head may be shaved.

• Your child’s healthcare provider makes a small cut on the right side of your child’s head just behind the hairline. They then make a small hole in the skull. This is called a burr hole.

• The healthcare provider puts the endoscope through the burr hole into your child’s brain. Using the images on the screen, the provider finds the third ventricle.

• The provider uses special tools to make a small hole in the bottom of the third ventricle.

• The provider removes the endoscope and closes up the burr hole on the side of your child’s head.

What happens after ETV?

After ETV, your child will be taken to a recovery room. Healthcare providers will closely watch your child’s heart rate, blood pressure, and temperature. They will also check your child’s brain function. Your child will be asked some questions and told to move different parts of their body, like their limbs, fingers, and toes. Your child may also have imaging tests to check that the procedure worked. A brain CT or MRI might be repeated to make sure the procedure was successful.

Your child will be able to go home within 1 to 2 days. When at home, make sure your child follows all care instructions from the healthcare provider. Your child will have to limit their activity for a while as their body heals.

Keep all follow-up visits with your child’s healthcare provider to make sure your child is healing well. Your child will need to see their provider regularly for imaging tests. They will also be checked for developmental delays as they grow up. Talk with your child’s healthcare provider if you have any questions or concerns.

Risks of ETV

All procedures have risks. The risks of ETV include:

• Fever

• Infection

• Bleeding

• CSF leakage

• Muscle weakness

• Short-term memory loss

• Problems with thinking or understanding

• Damage to nerves or parts of the brain

• Sudden closure of the hole made in the third ventricle

• Another surgery, such as putting in a shunt, if ETV does not work