Endoscopic Third Ventriculostomy doctors in India

Endoscopic Third Ventriculostomy Surgery

What Is Endoscopic Third Ventriculostomy (ETV)?

Endoscopic third ventriculostomy (ETV) is a brain surgery used to treat a condition called hydrocephalus, when too much fluid (called cerebrospinal fluid or CSF) builds up inside the brain’s ventricles (fluid-filled spaces). This buildup increases pressure inside the skull, causing headaches, nausea, balance problems, vision issues, and other serious symptoms.

In ETV, a surgeon uses a thin endoscope, a tiny tube with a camera and light, inserted through a small opening in the skull to create a small hole in the floor of the third ventricle (a fluid-filled chamber in the brain). This new opening allows the excess fluid to flow out to areas around the brain where it can be absorbed normally.

Endoscopic third ventriculostomy is a minimally invasive surgery, meaning it uses very small instruments and causes less tissue damage compared with traditional open brain surgery. It helps restore normal fluid flow and reduces pressure inside the brain.

Purpose & Benefits of Endoscopic Third Ventriculostomy

● Helps treat hydrocephalus by improving fluid drainage

● Reduces pressure inside the skull

● Improves symptoms like headache, vomiting, balance problems, and vision issues

● Avoids use of lifelong shunt devices in many patients

● Less invasive compared with traditional brain surgery

● Shorter hospital stay and faster recovery for many patients

Who May Need Endoscopic Third Ventriculostomy?

ETV may be recommended for patients with:

● Obstructive (non-communicating) hydrocephalus, when fluid flow is blocked inside the ventricles

● Conditions like aqueductal stenosis, where a narrow passage blocks fluid flow

● Some cases of tumors or cysts blocking fluid paths

● Repeated shunt malfunction

● Patients when a shunt (drainage tube) is not ideal or has failed

Your neurosurgeon will perform tests like MRI or CT scans to confirm the type and cause of hydrocephalus and decide if ETV is a good option.

Types of Endoscopic Third Ventriculostomy

Although the name refers to one main method, the procedure may vary slightly based on the patient’s anatomy:

1. Standard ETV

A small endoscope is passed into the third ventricle through a tiny opening in the skull, and a hole is made in the floor of the ventricle to allow fluid flow.

2. ETV with Foramen of Monro Access

In some cases, the surgeon needs to pass through a nearby opening (Foramen of Monro) to reach the third ventricle safely based on the patient’s anatomy.

3. ETV with Choroid Plexus Coagulation (CPC)

In some young children, ETV may be combined with coagulation of the choroid plexus (a source of fluid production) to improve outcomes.

Your neurosurgeon will decide the best technique based on your scans, condition, and age.

Endoscopic Third Ventriculostomy Procedure: Step-by-Step

1. Your neurosurgeon reviews your medical history, symptoms, and imaging tests (MRI/CT).

2. Blood tests and anaesthesia evaluation are done.

3. You may be asked to stop certain medications before surgery.

4. You are taken to the operating room.

5. General anaesthesia is given so you are asleep and pain-free during surgery.

6. A small incision is made in the scalp.

7. A tiny opening (burr hole) is made in the skull.

8. The surgeon gently passes the endoscope into the brain’s ventricular system to reach the third ventricle.

9. A small hole is carefully made in the floor of the third ventricle.

10. This new opening allows cerebrospinal fluid to bypass the blockage and flow into areas where it can be absorbed.

11. The endoscope is removed.

12. The surgeon closes the skull opening and scalp incision with sutures or staples.

The entire surgery usually takes 1–2 hours, depending on complexity and patient age.

Recovery & Aftercare

After surgery:

Hospital Stay

● Most patients stay in the hospital for a few days for monitoring and care.

● Your vital signs, neurological status, and wound will be checked regularly.

Pain & Comfort

● A mild headache or soreness near the incision site is common and managed with pain medicines.

Activities

● Avoid strenuous lifting and heavy physical activity for a few weeks.

● Your surgeon will advise when normal activities can be resumed.

Follow-Up

● You will have follow-up visits to check healing and ensure the new pathway for fluid flow remains open.

● Imaging tests (MRI/CT) may be repeated to evaluate results.

Most patients notice reduced symptoms, like fewer headaches and better balance, after the pressure normalises.

Risks & Possible Complications

Endoscopic third ventriculostomy is generally safe, but like all brain surgeries, it carries some risks:

● Bleeding inside the brain

● Infection

● CSF leak

● Injury to nearby brain structures

● Failure of the new opening to remain open (may need future procedures)

● Rare risk of dizziness or cognitive changes

Your neurosurgeon will explain the possible risks and how they are managed. Careful follow-up helps detect problems early.

Endoscopic Third Ventriculostomy vs Shunt Surgery

Endoscopic Third Ventriculostomy (ETV)

● Creates a natural pathway for fluid flow

● No permanent implanted device in many cases

● Less hardware to maintain or revise

● Best suited for obstructive hydrocephalus

Ventriculoperitoneal (VP) Shunt

● Uses a tube (shunt) and a valve to drain excess fluid to the abdomen

● Remains in place long-term

● May require future surgeries to fix or revise the shunt

Both treatments help reduce fluid pressure in the brain. Your neurosurgeon will recommend the best option based on your condition and tests.