Endoscopic Third Ventriculostomy (ETV)
ETV is an alternative way of treating certain types of hydrocephalus(HCP) where the obstruction in the ventricular system can be bypassed by creating a small hole at the base of the third ventricle and divert the CSF away from the obstruction to a a new different path, without insertion of shunt system.
The procedure is done under general anesthesia, requires very good experience form the operating team. It is done with a highly specialised equipment called Neuro-endoscope that enables the surgeon to look inside the ventricles and creates a small hole to divert the fluid into a new path.
Benefits of ETV
The advantage of this operation over a shunt is that it avoid insertion any tube implants inside the body, decrease the risks of hardware malfunctions and other complications of shunts. and the most important point, it’s a permanent solution of the obstruction problem especially in the congenital obstruction cases.
Risks and Complications
- Infection is small in compare with shunt operations. it may affects the scalp only which can be treated with simple oral antibiotics. CSF infection may lead to meningitis, which is uncommon, patient may present with headache, fever, photo phobia, neck pain, redness of the skin around the scars, nausea and vomiting.
- Failure of the procedure to achieve the target and this because the hole can close after a while due to scar tissue formation of membrane that causing obstruction and recollection of the fluid. the other cause is that the brain may not be able to absorb the CSF that’s now draining through different new pathway and then the patient will need shunt insertion.
- Uncontrollable bleeding which may lead to severe haemorrhage and death.
- Neural tissue injury: the most serious complication may cause life changing consequences in form of weakness or paralysis of legs, sphincters, sensory or sexual changes. The risk is very small and variable according to the area of the brain affected.
- Injury to the blood vessels of the brain leads to stroke with a variable neurological deficit.
- Seizure , either immediately or shortly after surgery.
- Failure to improve symptoms.
- General anesthetic complications (heart attack, stroke)
- Deep venous thrombosis/pulmonary embolism (clots in legs / lungs).
- Small risk to life.