Endoscopic Third Ventriculostomy (ETV)
Endoscopic third ventriculostomy (ETV) is a shunt-free surgical method in which a small opening is created with an endoscope in the floor of the third ventricle to provide an alternative pathway for accumulating cerebrospinal fluid. It is used in selected cases of obstructive hydrocephalus.
마지막 업데이트: 2026-06-09
Definition
ETV is an endoscopic procedure that creates a new pathway bypassing an obstruction when the flow of cerebrospinal fluid is blocked. The surgeon advances a thin endoscope from the lateral ventricle into the third ventricle and creates a small hole (stoma) in the floor of the ventricle. This opening allows the fluid to reach the basal cisterns and rejoin the normal absorption pathways. The method differs from shunt systems in that it leaves no permanent device.
Indications
ETV is considered particularly in cases of obstructive hydrocephalus where CSF flow is blocked at a point; a typical example is obstruction due to aqueductal stenosis or a posterior fossa tumor. Suitability relies on assessing the level of obstruction on imaging and the anatomy of the third ventricle. The likelihood of success may be lower in communicating hydrocephalus from impaired absorption and in very young infants; patient selection markedly affects the outcome.
Procedure
The procedure is usually performed under general anesthesia. A small hole (burr hole) is made in the skull and the endoscope is guided through the lateral ventricle into the third ventricle. The floor of the ventricle (usually the tuber cinereum region) is perforated with a blunt tip and the created stoma is carefully widened. The surgeon confirms the cisternal space beneath the opening and the passage of fluid under direct vision. The nearby vascular and neural structures are closely monitored; after the procedure the endoscope is withdrawn and the small incision is closed.
Advantages and Limitations
Reported potential advantages include leaving no permanent foreign device and thereby avoiding the risks of shunt infection and mechanical malfunction. In appropriately selected cases the patient may avoid lifelong shunt dependence. However, the method is not suitable for every type of hydrocephalus and requires a specific anatomical corridor and experience. The stoma may close over time and the procedure may need to be repeated or converted to a shunt; in some cases a shunt may be a more reliable option.
Recovery and Risks
Recovery time varies by patient; many patients mobilize quickly and the hospital stay may be relatively short. Possible risks include bleeding, injury to vascular or neural structures adjacent to the floor of the third ventricle, CSF leak, infection, hormonal effects, and recurrence of symptoms due to closure of the stoma. Reappearance of symptoms requires urgent evaluation. No outcome is guaranteed; the decision is made individually by considering the patient's clinical status together with imaging findings.
참고 문헌
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:525-530.
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:453-454.
- Kulkarni AV, et al. Endoscopic third ventriculostomy success score (ETVSS). J Pediatr. 2009.
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