Endoscopic Third Ventriculostomy
Endoscopic third ventriculostomy is a surgical procedure that may be offered to children and adults who have been diagnosed with obstructive or non-communicating hydrocephalus.
Shunting, or using a small silicone tubing to divert the cerebro-spinal fluid to a different body cavity for reabsorption, is the most common treatment for hydrocephalus and has been used for more than 40 years. While shunts may be life saving, they are man-made devices and may fail for a variety of reasons.
Endoscopic third ventriculostomy is an alternative surgical procedure that creates a bypass for the cerebro-spinal fluid in the head that eliminates the need for a shunt. It is helpful only to people with hydrocephalus that is caused by a blockage of the flow of cerebro-spinal fluid.
Endoscopic means that the surgery is performed with the use of an endoscope, which is a thin tube that has a strong light, a powerful magnifying lends and a passage through which tiny instruments are passed.
Third ventriculostomy refers to the area of the brain where the bypass is made. Because the most common site of blockage is the narrow pathway between the third and fourth ventricle of the brain (the aqueduct of Sylvius), the bypass is made through the thin membrane in the bottom, or floor, of the third ventricle.
The cerebro-spinal fluid may then flow from the lateral to the third ventricle and from the third ventricle through the new opening to the normal fluid chambers below the base of the brain.
The cerebro-spinal fluid then flows up and over the surface of the brain where it is reabsorbed into the bloodstream.
Who might benefit from an endoscopic third ventriculostomy?
The populations who have a high success rate with this procedure including patients with:
- Hydrocephalus in myelomeningocele.
- Hydrocephalus associated with brain tumors.
- Obstructive hydrocephalus with other causes.
The patient populations who have a low probability of success with this procedure include:
- Those with communicating hydrocephalus.
- Children under the age of two with hydrocephalus.
- Patients with hydrocephalus who were previously treated with whole brain irradiation.