Grey’s Anatomy Airs Episode on Congenital Hydrocephalus Performing Endoscopic Third Ventriculostomy (ETV)

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A Review: Grey’s Anatomy Airs Episode on Congenital Hydrocephalus Performing Endoscopic Third Ventriculostomy (ETV) 

On Thursday, March 29th, ABC’s Grey’s Anatomy aired the third episode of season 20, showcasing a storyline involving Malan, a young child with congenital hydrocephalus. After viewing the episode, I’m eager to share my reflections on the discussion it prompted. But before diving in, let’s recap the events of the episode.

The viewer first meets Malan when her mother, Maria-Flor, brings her into the hospital, expressing concerns that her daughter was not acting like herself. Malan was tired and not full of energy like she usually was. Her mother also noted her history of four shunt revision surgeries. Neurosurgeon Dr. Shepherd conducted a thorough neurological examination, which initially yielded no significant findings. However, she proceeded with a CT scan to assess Malan’s ventricles.

The CT scan showed enlarged ventricles and Dr. Shepherd decided to move forward with surgery, electing to do an endoscopic third ventriculostomy (ETV) instead of replacing the malfunctioning shunt. However, according to Dr. Shepherd, this option was considered risky due to the presence of a blood vessel obstructing the floor of the third ventricle, potentially hindering the success of the ETV procedure. More on this later. Nonetheless, both the medical team and Malan’s mom agreed that it was the optimal choice for Malan, considering her ongoing growth. As the episode concludes, viewers are informed of Malan’s successful ETV surgery, and following a period of recovery, she is expected to resume her normal activities.

Now that we’ve heard Malan’s story, I’d like to share my thoughts on the episode as I watched it. I must admit, I’ve been a loyal viewer of Grey’s Anatomy since season 1, and I’ve seen hydrocephalus storylines come and go over the years without much depth. Consequently, my expectations were low as I began this episode. I was surprised by the amount of detail put into Malan’s storyline. They didn’t gloss over her story like I feel had been done with hydrocephalus stories in the past. Who remembers Izzie’s teacher who was diagnosed with NPH? This storyline was so much more detailed. 

My first surprise arose when the show depicted Malan’s symptoms without exaggeration. She exhibited fatigue and a departure from her usual energetic self. She just didn’t feel like herself and her mother knew something was wrong. This resonated with me personally, as it reminded me of the times when my own parents were on high alert when I felt “off”. A shunt malfunction may not always manifest as severe symptoms like projectile vomiting or sunset eyes.  It’s important to know all of the signs and symptoms of a concern and be proactive by contacting your neurosurgeon. 

Malan’s mother shared with Dr. Shepherd that Malan has had four shunt revisions and she didn’t want her to have another surgery, but she also knew something was not right with her daughter. Side note, did anyone else catch when the resident said Malan had five shunts when he should have said she has had five shunt surgeries? It was good when Malan’s mother cleared this up when she talked about the amount of surgeries Malan has had due to her hydrocephalus! 

My second surprise came quickly when Dr. Shepherd found no abnormalities during Malan’s neurological examination. Despite this, she opted to proceed with a CT scan to check her ventricles. The writers could have easily shortened Malan’s story here by Dr. Shepherd finding something concerning in her neurological exam. Instead, they decided to show the process it may take to find out if the shunt is working or not. 

I was not surprised when later in the episode they came back to Malan’s case and her ventricles were enlarged on the CT scan. However, I was surprised when Dr. Shepherd and Dr. Beltran, the pediatric surgeon, deliberated on ETV as a potential option for Malan. While examining the scans, Dr. Shepherd indicates that Malan’s shunt will require replacement. However, when Dr. Beltran raises concerns about the potential for continued shunt disconnections due to Malan’s growth, Dr. Shepherd insists that shunt replacement is the “standard of care”. Dr. Beltran challenges this notion by proposing the option of an ETV, acknowledging that it is not suitable for every patient. Dr. Shepherd expresses skepticism regarding Malan’s candidacy for ETV, citing prior infection and arterial inflammation as limiting factors.  

Since this is a medical drama, I was not surprised when Dr. Beltran continued to push Dr. Shepherd to find a way to make it work. What surprised me was the advances in medical technology that can be used in the operating room for situations similar to Malan’s. It was still a risky surgery, as surgery is, but these medical technologies helped the doctors with a successful ETV surgery.

My last surprise came at the end of the episode when Dr. Beltran was talking with the resident on Malan’s case, she asked “Do you know who really saved Malan from severe complications today?” The resident guesses the doctors, but Dr. Beltran tells him it was the mom. She said “Malan’s mom knew something was wrong and brought her here. Whether you have a medical degree or not, you never bet against them.” At that moment, I realized that was a major point of the entire episode. The doctors trusted the mom when she said something was wrong with her daughter and did not give up until they found out what was wrong and fixed it. Parents – trust your gut. Many times my parents only had their gut feeling to go off of when bringing me to the doctors and they were never wrong.

This episode of Grey’s Anatomy finally lived up to my expectations of what a storyline on hydrocephalus should be. Malan’s case was not the biggest story of the episode, but it was well intertwined throughout the episode and contained details about not only Malan’s journey, but her mother’s as well. There were details here and there that could have been more clear, but overall I felt the writers finally understood life with hydrocephalus. 

What did you think? Do you think they could have done better with this storyline or did they do it right in your eyes? Let us know your thoughts on social media – @HydroAssoc 

Didn’t catch the episode? No worries! Head to and watch the full episode here:



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