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Endoscopic Third Ventriculostomy at NYU Winthrop Hospital

A minimally invasive treatment bringing hope to families with children with hydrocephalus

At NYU Winthrop, the most advanced technologies and treatment protocols are used to treat patients with hydrocephalus. This includes endoscopic third ventriculostomy (ETV), which has become a safe and effective alternative to ventricular shunt replacement to drain excessive amounts of cerebrospinal fluid (CSF).

The goal of treatment in hydrocephalic patients is to decrease and prevent brain damage by draining the collected CSF to reduce the intracranial pressure. While specific treatment depends on the child’s age, overall health and medical history, as well as the cause, type and extent of the condition, surgery is usually the treatment of choice. If possible, the obstruction is removed, and the hydrocephalus is resolved. Frequently, however, a direct method is not available to open obstructed CSF pathways, and a bypass – or diversion – must be created to allow for the fluid’s normal flow.

To achieve this, a shunt – the traditional approach to treating hydrocephalus – may be placed in the brain to drain and redirect the extra fluid from the ventricles to another part of the body such as the abdomen. However since a shunt is a foreign body, potential complications include infection, bleeding and malfunction, as well as over or under-draining.

With the significant advances in endoscopes, fiberoptic imaging and other specialized instruments, endoscopic third ventriculostomy is now commonly being used instead of ventricular shunt replacement.

The ETV Procedure

ETV is an internal bypass procedure that involves passing a slim-tubed endoscope with a tiny camera at the tip through a tiny burr hole in the skull. The microcamera is connected to a TV monitor that clearly displays the brain as the endoscope is navigated from the top of the skull through the brain to the base of the third ventricle. A small hole is then made in the thin membrane of the ventricle floor, which allows the accumulated fluid to bypass the obstruction and flow into the subarachroid space. This establishes normal CSF circulation within the brain and spinal cord.

The success of ETV depends on patient selection and the cause of the hydrocephalic condition. If the patient is chosen carefully, the success rate can be as high as 85 percent. When the cause is an infection or a bleed in the brain, success is about 50 percent. Once a third ventriculostomy functions and the hydrocephalus is relieved, there is usually no need for further surgery. This compares favorably to the use of shunts, since about 70 percent fail within a 10 year period, with a hydrocephalic child potentially needing five to six shunts inserted before reaching adulthood. What’s more the risk of ETV is low, with few potential side effects. There is no over drainage, no blockage, very little risk of infection, and most important, no implanted foreign material to cause future problems.