Endoscopic third ventriculostomy (ETV) to treat hydrocephalus

What is an endoscopic third ventriculostomy (ETV)?

An endoscopic third ventriculostomy (ETV) is an operation, done by our neurosurgical team, under a general anaesthetic. It treats some types of hydrocephalus by making a small hole in the bottom of the third ventricle to improve the flow of cerebrospinal fluid (the fluid in your brain and spinal cord).

How is the operation done?

Your child will be put under a general anaesthetic so they are asleep and do not feel the surgery.

First the surgeon will make a small hole in their skull. Through this hole, they pass camera with light (called an endoscope) in to the third ventricle. Then a hole is made in the bottom of the third ventricle. The cerebral spinal fluid then flows through this hole and circulates to the area around the brain where it can be reabsorbed. The wounds are closed with dissolvable stitches.

The anaesthetic staff will make sure your child has pain relief is woken up in post-anaesthesia care unit and returned to the ward when they are ready.

How does the ETV stay open?

The flow of the cerebrospinal fluid through the ETV stops it from healing over and closing. However, they do heal over in a small number of children. If this happens then your child may need a different treatment such as a shunt.

How will we know if the ETV did not work?

If the hole made during the operation heals over then the cerebrospinal fluid will begin to build up inside the ventricles again. If this happens then the symptoms of hydrocephalus will come back.

If you have any concerns, then please contact our service.

What are the benefits of an ETV?

If successful an ETV can treat hydrocephalus without the patient needing a device such as a shunt. This reduces the risks and complications associated with shunts.

Why has my child not been offered ETV when they have hydrocephalus?

An ETV can only treat hydrocephalus that has been caused by reduced flow of cerebrospinal fluid between the third and fourth ventricles. If hydrocephalous is caused by a different problem, then an ETV will not be an appropriate treatment.

Because this operation is less successful in babies, sometimes it is not recommended.

How long will my child be in hospital?

All children recover at there own pace. Once your child is recovered from surgery and pain free, eating and drinking as normal, with wounds healing well, then they will be prepared for discharge. This is usually 1 or 2 days after surgery.

What happen after discharge?

All children will be seen in our outpatient clinics after neurosurgical procedure. Ongoing follow-up appointments will be with the nurse lead from the hydrocephalus clinics. If you have any concerns after your child has been discharged, please contact our service directly by calling Ward 5 or the clinical nurse specialist team.

How do I care for the wounds after the operation?

The wound stitches should be white and absorbable. The wound should be kept dry for 7 days. After 7 days you can wash around the wound and their hair. Only use mild shampoo until the stitches are all gone. Other products may coat the stitches and stop them from dissolving.

When can my child go back to school?

Each child recovers at there own rate, often children are back to their normal selves within 1 or 2 weeks. Once the wounds have healed well and your child is returning to their normal activities, they can go back to school or nursery.

Can my child do sports and physical activities again?

Once the wounds are fully healed they can return to normal activity.

Please do not do any swimming activities until all wounds are fully healed.