Hydrocephalus can be treated by undergoing a surgical procedure called Endoscopic Third Ventriculostomy (ETV) or Endoscopic Third Ventriculostomy/Choroid Plexus Cauterization (ETV/CPC). The ETV/CPC procedure is only available to infants.
The success rate for ETV or ETV/CPC depends upon patient factors such as age, cause of hydrocephalus, and whether there is scarring in the fluid space below the floor of the third ventricle. For some patients, the chance for success of the ETV may be up to 90%; however, for others, ETV – with the addition of CPC for infants – may not be recommended because the chances for success are sufficiently low. Your neurosurgeon should be able to provide you with a reliable estimate of the likelihood for success in your particular situation prior to the operation.
The most common complication with these two procedures is closure of the pathway that is surgically created with ETV and infection.
Sudden Pathway Closure with ETV and ETV/CPC
Sudden closure of the pathway created using Endoscopic Third Ventriculostomy (ETV) can be sudden and life-threatening. Pathway closure occurs in 20 to 50% of patients within five years of the procedure with the great majority of treatment failures occurring within the first six months of the operation. Although late failures can occur, they are rare, and the ongoing risk of treatment failure over subsequent years is much less than that for patients with shunt-dependence.
It’s critical that parents and patients understand that ETV is not a permanent cure for hydrocephalus. Candid communication with your physician regarding the definition of success is important when considering ETV.
Infection with ETV and ETV/CPC
Infection occurs in up to less than one percent of those treated surgically with ETV or ETV/CPC procedures.
Fever and Bleeding with ETV and ETV/CPC
With new technologies the risks of ETV have been minimized, however there are still potential complications including fever and bleeding. Attempts to perforate or create an opening in the ventricular floor can lead to bleeding, as can damage to ventricular walls or perforation of the basilar artery. Large bleeds due to vessel injury under the third ventricle can be catastrophic, but they are rare.
Other complications from ETV include short-term memory loss, since the procedure may affect the hypothalamus and the areas of the mammillary body which are responsible for memory. This is typically a temporary complication. Endocrinologic irregularities can occur following ETV and ETV/CPC as a result of the small opening in the area of the third ventricle which is responsible for some hormonal function. This complication is also often short lived.