Children & families · Conditions
Endoscopic third ventriculostomy (ETV)
For selected children with a blocked fluid pathway, an alternative to a shunt using a small camera.
What is it?
ETV is an operation for some types of hydrocephalus, usually where the fluid pathway inside the brain is blocked. A new opening is made so that fluid can bypass the blockage.
What symptoms does hydrocephalus cause?
The symptoms are those of hydrocephalus: in babies a growing head and full soft spot; in older children headaches, vomiting, drowsiness or vision changes.
How is it assessed?
An MRI scan shows where the blockage is. Whether ETV is suitable depends on the cause of the hydrocephalus and your child's age, and this is discussed with you.
What are the treatment options?
The main alternatives are ETV or a shunt. Each has benefits and risks, which are explained so you can decide together.
- Fluid (CSF) is made in the ventricles. Here the narrow channel between the third and fourth ventricles (the aqueduct) is blocked, so fluid builds up.
- Through a small opening in the skull (a burr hole), a thin camera called an endoscope is guided into the ventricles and through the foramen of Monro into the third ventricle.
- A small opening is made in the thin floor of the third ventricle, between the mammillary bodies and the infundibulum.
- Fluid can now leave the ventricles through the new opening and flow into the prepontine cistern in front of the brainstem, bypassing the blockage.
- The endoscope is removed. Fluid continues to circulate around the brain and spinal cord, where it is absorbed naturally.
When might surgery be considered?
ETV may be offered when the fluid pathway is blocked and your child is likely to benefit. Using a small camera (endoscope) passed through a small opening in the skull, a new pathway is made in the floor of the third ventricle. If it works, your child avoids an implanted shunt.
What to expect from recovery and follow-up
Most children go home within a few days. Follow-up visits and scans check that the new pathway is working. ETV can fail early or later (sometimes years afterwards); success depends on the child’s age and the cause of the hydrocephalus, and some children later need a shunt.
When to seek urgent help
If your child is very drowsy, difficult to wake, has a seizure, repeated vomiting or a severe headache, go to the nearest emergency unit or call 10177. If your child is under our care, also call the hospital switchboard and ask for Dr Labuschagne (Netcare Unitas Hospital 012 677 8000; Nelson Mandela Children's Hospital 010 133 0600).
This page is general information for parents and caregivers. Your child's doctor will advise on what applies to your child.