Is an ETV an Option After Shunt Failure?

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By Jenna Koschnitzky, PhD
National Director of Research Programs, Hydrocephalus Association

Is an ETV an option after shunt failure? A study recently published out of the United Kingdom reviewed studies that reported on the effectiveness of endoscopic third ventriculostomy (ETV) after shunt failure in children. The study, by lead author Dr. Mueez Waqar, combined and analyzed the results from 15 studies looking at children under 18 years old. All of the children had previously had a shunt placed for hydrocephalus (primary shunt) and were in shunt failure at the time of the ETV procedure (secondary ETV).

Based on the available data, the authors came to several conclusions.

Overall, in 68.2% of the patients, the secondary ETV effectively treated the hydrocephalus. The average follow-up time in the reviewed studies was 37 months.

Another interesting finding was that, patients who are initially poor candidates for a primary ETV, may have better success rates with a secondary ETV. This includes patients with posthemorrhagic or postinfectious hydrocephalus and those with a chiari malformation or spina bifida. The reason for this is still unclear. It may be due to the narrowing of the pathway between the third and fourth ventricles that can occur after shunt placement.

The authors also recommend complete removal of the existing shunt if it can be done safely.

However, there are many factors to consider with your doctor when considering an ETV procedure for those patients with a failing shunt.

Secondary ETV can be a more challenging surgery due to changes in the ventricular system after long-term shunting. Patients with slit ventricles should be carefully considered, as navigating the narrowed ventricles can be very challenging.

Although secondary ETV worked in 68.2% of the patients studied, it did not work in 31.8% of the patients. That is not an insignificant number of individuals. These patients had to undergo another surgery to divert cerebrospinal fluid.

It is also likely that the patients in each study were already determined to be ‘good candidates’ for secondary ETV. Therefore, these results may not be accurate for the general population.

The authors state that there are many questions remaining as to the appropriate post-surgical care for patients with secondary ETVs and the risk of sudden death after a secondary ETV.

To read the study abstract and access the full text, click here.



7 Comments for : Is an ETV an Option After Shunt Failure?
    • Lanna
    • October 29, 2018

    My 18 yo son has a shunt that is having intermittent issues – this is not the first time this has happened for us. We would like to find a neurosurgeon that does etv to see if this is an option for us. Our son has yet to show the typical signs of shunt failure, so we need a great doc that listens! Any recommendations?

    • janet miller
    • March 16, 2018

    I had two back to back shunt surgeries and both failed immediately. I was placed in an assisted living facility because I was unable to walk and didn’t have any memory and little conversational skills. Then, friends found a surgeon who could do an ETV and the results were nothing short of miraculous. It has given me back my life and a future. Granted I get a yearly MRI to make sure the “fluid is freely flowing” and am alert for signals that the opening made in the ventricle is closing (stumbles, and personality changes to temper) but I think they are miraculous. No infections, headaches or other shunt related woes. With an ETV, there is little to lose but a future to gain.

      • Lori
      • April 28, 2018

      Hi Janet
      I am happy about your success with etv. May I ask your age and who performed the surgery. My son has been shunted since birth. Had an extension put in because of his age. But his headaches are back I live in Rhode Island. Any input I would be grateful
      Thank you

      • Nina
      • May 9, 2018

      Did you have your shunt removed after the ETV? If you still have your shunt, do you experience pain, complications, etc?

      • Agnes Santiago Suarez
      • July 5, 2018

      That’s awesome Janet!! I had an EYV and it failed in less than 2 years. Doctors had no choice but to shunt me again.

      • Reply

        My first ETV failed after 6 years and I had a redo of the ETV. That was in 2008. So fingers crossed that is continues to hold. I have a MRI every year just to be sure. Agnes, why did your medical team go with a shunt for the redo?

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