If you or your child is scheduled for an endoscopic third ventriculostomy (ETV), understanding the experience can help ease anxiety. ETV is a minimally invasive procedure with no implant left behind, and while your surgical team will provide specific instructions, here's a general picture of what to expect.
Before surgery Preparation is similar to other brain procedures:
- Evaluation and detailed imaging (usually MRI) to confirm that ETV is suitable and to plan the procedure, assessing the anatomy.
- Pre-operative instructions, typically including fasting beforehand and medication guidance.
- Discussion and consent — the surgeon explains the procedure, the chance of success for your situation, benefits, and risks, and answers questions.
- Site preparation — a small area of hair may be shaved or trimmed.
During surgery ETV is performed under general anesthesia (asleep). In general terms:
- The surgeon makes a small opening in the skull (a "burr hole").
- An endoscope — a thin tube with a camera and tiny instruments — is guided into the third ventricle.
- Using the camera, the surgeon creates a small opening in the floor of the third ventricle, allowing CSF to bypass the blockage.
- The endoscope is removed and the small incision is closed.
Because it's endoscopic and doesn't involve placing tubing throughout the body, ETV is often a relatively short procedure. (In infants, choroid plexus cauterization may be added — the ETV/CPC procedure.)
After surgery — in the hospital. Following the procedure:
- You'll recover and be monitored, watching for symptom improvement and any early issues.
- There may be headache or discomfort initially, managed with medication.
- Imaging may be performed to assess the result.
- The hospital stay is often relatively short, depending on recovery and the situation.
After surgery — recovery at home. Once home:
- Follow instructions on incision care and activity.
- Expect a gradual return to normal activities per your team's guidance.
- Attend follow-up appointments, which are especially important after ETV.
A key point: ETV can fail over time Unlike a shunt (which can fail at any time but is a continuously working device), an ETV relies on the new opening staying open and effective. It can close or become inadequate — sometimes soon after surgery, sometimes months or years later — causing hydrocephalus to recur. This makes two things essential:
- Ongoing follow-up, including imaging as advised.
- Knowing the warning signs of returning hydrocephalus (the same signs of raised pressure or, in babies, of infant hydrocephalus), so you can seek care promptly if symptoms come back. A failing ETV can be an emergency, just like a failing shunt.
If an ETV fails, options include a repeat ETV or placement of a shunt.
What to watch for afterward Seek medical advice for warning signs such as:
- Worsening headache, vomiting, drowsiness, or vision changes (signs of recurring raised pressure).
- In babies — bulging fontanelle, irritability, poor feeding, or sleepiness.
- Signs of infection — fever or feeling unwell — in the early period.
A reassuring note For suitable patients, ETV can be a successful, shunt-free treatment, and many people do very well. The main thing to carry forward is awareness: because the new pathway can close over time, stay engaged with follow-up and know the warning signs. As always, your surgical team is there to answer questions before and after the procedure.