Endoscopic Third Ventricullostomy
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What is it?
ETV is an abbreviation that stands for endoscopic third ventriculostomy. An ETV is a highly specialized treatment performed by Rochester Neurosurgery Partners for hydrocephalus (extra fluid in the brain causing pressure). This treatment can be an alternative to the placement of a shunt (see ventriculoperitoneal shunt) but is only performed in a select group of patients. This technique uses cameras navigated through the brain to create a small hole which relieves the increased pressure. The procedure is most common performed for patients with aqueductal stenosis; a blockage that prevents the outflow of cerebrospinal fluid (water that bathes the brain).
What is its goal?
The goal of an ETV is to divert the flow of cerebrospinal fluid and decrease pressure in the brain. There are several benefits of an ETV versus a ventriculoperitoneal shunt. Compared to a shunt, there are no implanted foreign bodies, fewer incisions and an overall lower long term complication rate. This means there is less discomfort, a lower infection rate, and less time in the hospital.
How is it done?
The patient goes to sleep with general anesthesia. A small dime-sized hole in the skull, usually in the front behind the hairline. Next a small camera is inserted and navigated to the part of the brain that holds cerebrospinal fluid. An opening is made through normal brain tissue which allows this fluid to drain and get reabsorbed by the body. This opening does not normally result in any harmful permanent effects. Once the flow is diverted, a titanium cover is placed over the hole in the skull and the skin is closed. The procedure usually takes less than one hour to complete
What are the risks?
The most common complications after an ETV are fever and bleeding. The light from the camera and heat from the instruments can heat the fluid in the brain causing a fever which usually resolves within a few hours. Sometimes when the brain is perforated to allow diversion of cerebrospinal fluid, blood vessels are damaged causing bleeding. The chances of a catastrophic bleed are very low. Other potential complications after ETV are short-term memory loss or endocrinologic disorders which occur infrequently and usually get better over time.
What is the success rate?
With good patient selection, an ETV can be very effective treatment for hydrocephalus. For patients with obstructive hydrocephalus, some studies show that 70% get better. This treatment does not prevent the future use of a shunt if the ETV fails to cure the hydrocephalus.
How long will I stay in the hospital?
Patients usually are able to go home the next day after surgery.
What is special about the way we deliver this treatment?
Rochester Neurosurgery Partners use the most up-to-date technology to perform these operations. A high-definition camera is used which allows excellent visualization of brain structures and assures that the procedure is performed correctly.