Endoscopic third ventriculostomy (ETV)
Surgical procedure used to treat hydrocephalus, a condition in which there is an excessive accumulation of cerebrospinal fluid (CSF) in the brain. Hydrocephalus can be caused by various factors, such as congenital malformations, infections, tumors, or trauma. It can lead to serious neurological symptoms, such as headaches, nausea, vomiting, seizures, vision problems, and cognitive impairment. If left untreated, hydrocephalus can be life-threatening.
The traditional treatment for hydrocephalus is shunt surgery, which involves inserting a tube (shunt) into the brain to drain the excess CSF into another part of the body, usually the abdomen or the heart. However, shunt surgery has several drawbacks, such as the risk of infection, malfunction, blockage, or displacement of the shunt, which may require further surgery. Moreover, shunt surgery may not be effective in all cases of hydrocephalus, especially when the cause is a blockage in the ventricular system that cannot be bypassed by a shunt.
ETV is a less invasive alternative to shunt surgery, which involves creating a new opening in the third ventricle of the brain to allow the CSF to flow out of the ventricular system and into the surrounding brain tissue, where it can be absorbed. The procedure is performed using an endoscope, a long, thin, flexible tube with a light source and a camera at the tip. The endoscope is inserted through a small incision in the scalp and guided to the third ventricle through a narrow corridor between the brain structures.
Once the endoscope reaches the third ventricle, the surgeon uses a small tool, such as a laser or a radiofrequency probe, to create a small hole in the floor of the ventricle. The hole is usually about 5-6 mm in diameter, and its location depends on the individual anatomy of the patient and the cause of the hydrocephalus. The surgeon may also use a stent or a catheter to keep the opening patent and allow the CSF to flow freely.
The advantages of ETV over shunt surgery are several
First, Endoscopic third ventriculostomy does not require the placement of a foreign object in the brain, which reduces the risk of infection, malfunction, and long-term complications. Second, ETV can be performed under local or general anesthesia, and the recovery time is usually shorter than that of shunt surgery. Third, ETV can provide long-lasting relief from hydrocephalus, especially if the underlying cause is a blockage that can be removed by the endoscope. Finally, ETV can be repeated if necessary, unlike shunt surgery, which may have limited options for revision. Dr.arunrajeswaran is specialist in Endoscopic third ventriculostomy in abu dhabhi.
However,
ETV also has some limitations and risks that should be considered. The success rate of ETV varies depending on the cause and severity of the hydrocephalus, the experience and skill of the surgeon, and other factors. Some studies report a success rate of over 80%, while others report a lower rate of 50-70%. The success of ETV also depends on the absence of other brain abnormalities or complications that may affect the CSF circulation or absorption.
The risks of ETV include bleeding, infection, CSF leakage, brain damage, and other complications that may require further surgery or medical intervention. The most common complication of ETV is a temporary increase in the intracranial pressure (ICP) after the procedure, which may cause headaches, nausea, vomiting, or seizures. However, this usually resolves within a few days, and the ICP returns to normal. Rarely, ETV may cause a permanent neurological deficit, such as weakness, paralysis, or loss of vision, although this