What to Expect With ETV Surgery
The best way to prepare for endoscopic third ventriculostomy (ETV) surgery is to learn as much as you can about the procedure, your medical team, and what to expect post-surgery.
The thought of having to undergo brain surgery is frightening and can be physically and emotionally taxing. That’s why it’s important to learn as much as you can about the procedure, get to know the medical professionals involved in your care, and know what to expect after surgery. The best way to prepare for involved in your care, and know what to expect after surgery ETV surgery is by thinking about what questions you want to ask your professional healthcare team, and by being prepared to answer any questions they may have for you. By spending some time preparing for your surgery, you can help ensure that you have a successful procedure and recover faster.
Your Healthcare Team
Several people are involved in the surgical process. Learn who you will meet, both prior to your surgery date and the day of your procedure.
The neurosurgeon. A neurosurgeon specializes in surgery of the brain and nervous system and will be the one performing the operation.
When you consult with your neurosurgeon, you may want to ask:
- How long the surgery will take
- What risks are involved
- How much hair they will shave
- How long should you expect to be in the hospital
- How soon you can return to your normal activities
The Physician Assistant (PA)/Nurse Practitioner. Your neurosurgeon may work with a PA or Nurse Practitioner. This person works very closely with your surgeon and will be involved in many aspects of your care. They can assist your surgeon in the Operating Room, check on you in recovery, and check on you once you move to your hospital bed.
Residents. If your surgery is being performed at an Academic Medical Institution, there will be Resident Physicians. These physicians have graduated from medical school and are getting additional specialized training. If your hospital has Residents, they will assist your surgeon in the Operating Room, check on you in recovery, and check on you once you move to your hospital bed.
The hospital staff. When you arrive at the hospital, a member of the hospital office staff will go through your paperwork with you, verifying your name, address, insurance coverage, and other information.
The Surgical team. Your surgeon, a PA, or Nurse Practitioner, or a resident will come speak with you about the procedure and ask you to sign a surgical consent to give permission for the surgery to be performed. If you are under 18 years old, a parent or guardian will need to sign the surgical consent form for you. This individual may also draw a symbol on your head indicating where on your body the surgery will be performed.
The nursing staff. A nurse will check to ensure you’re healthy enough for surgery. They will:
1. Check your blood pressure, heart rate, temperature, and breathing rate
2. Review your medical history
3. Ask about any medicines you may be taking.
TIP: It may be helpful to make a list of your medical history, allergies, and medications (a fillable PDF will open in a new window) to bring with you as a reminder.4. Ask if you have any allergies.
NOTE: This is especially important for people whose hydrocephalus is related to myelomeningoceles (also known as spina bifida). Spina Bifida patients are at risk for developing a potentially life-threatening allergy to latex.The anesthesia team. You will be asleep throughout the procedure and will wake up once it’s over. You will meet either an anesthesiologist—a doctor who specializes in anesthesia—or a certified registered nurse anesthetist (CRNA). The anesthesiologist creates the anesthesia plan and monitors you during surgery, while the CRNA will administer the anesthesia and ensure you are asleep and comfortable as the surgery is being performed.
This person will ask you about
- Your height, weight, and age
- Any previous surgeries
- Whether you or a member of your family has ever had a problem with anesthesia
The anesthetist may also ask you about any allergies you have and medications you are taking (even though you may have already discussed this with the nurse) and other questions about your health and physical condition.
Questions You Might Ask the Anesthesiologist or CRNA
You may want to ask:
- What type of anesthesia you will have
- How the anesthesia will be administered
- How will you feel as you are waking up
- If there are any side effects
Your Endoscopic Third Ventriculostomy (ETV) Surgery
Endoscopic Third Ventriculostomy (ETV) surgery is a relatively short procedure that varies slightly depending upon the anatomy inside your brain.
For more detailed information, visit ETV and ETV with CPC (choroid plexus cauterization).
Before, During, and After Surgery
When it is time for your surgery, you will be brought into the operating room. Then the surgical team will follow these steps:
1. There, you will have an intravenous (IV) line started, as well as to one or more devices to monitor you during and after surgery. These devices include:
- Electrocardiogram (EKG —which monitors your heart rate.
- Automatic blood pressure (BP) cuff—monitors your blood pressure.
- Pulse oximeter-measures the amount of oxygen in your blood.
2. Anesthesia is administered. You will be given general anesthesia either through your IV line or with a special mask placed over your nose and mouth, which will put you under anesthesia. You will feel like you are falling asleep.
3. Antiseptic is applied. Your hair will be shaved in the area the surgeon needs to perform the surgery and some antiseptic solution will be scrubbed on your head to help prevent infection. Your neurosurgeon may also scrub antiseptic solution along your chest and abdomen in case the ETV is not successful and a ventriculoperitoneal (VP) shunt needs to be placed.
5. Endoscopy is performed. An endoscope—a thin, flexible tube-like instrument used to look inside the body—is passed through the opening into the ventricle. A small camera on the tip of the endoscope projects an image of the inside of your brain onto a TV screen, allowing the neurosurgeon to see clearly and perform the surgery.
6. An opening is created. The neurosurgeon guides the endoscope through the lateral ventricle to the floor of the third ventricle and makes a small hole in the ventricular system to drain excess fluid. This opening allows the cerebrospinal fluid, or CSF, to flow more freely, potentially bypassing any blockage, allowing it to circulate and be absorbed through the normal CSF pathways.
7. The surgery is complete. The neurosurgeon removes the endoscope and closes the incision in the scalp. You may be woken up in the surgery suite by the anesthesia team. The nurse wheels you from the operating room into a recovery room.
Note: This procedure is typically only performed in children under two.
In a select group of patients, a neurosurgeon may perform Choroid plexus cauterization (also referred to as choroid plexus coagulation or CPC) during an ETV surgery. You can learn more about CPC, and considerations for performing it with ETV, here.
What to Expect After ETV Surgery
After ETV surgery is complete, you will be moved from the operating room to the recovery room.
When you wake up after surgery, expect to feel weak and tired. This is natural as your body starts to heal. Before moving you to your hospital room, a nurse will watch you closely to make sure you are recovering well.
Your nurse will assess several things:
- Your vital signs. The nurse will check your blood pressure, heart rate, breathing rate, and temperature.
- Your brain function. Expect the nurse to check your brain function by asking you some questions after you wake up from the anesthesia.
- Your mobility. The nurse will also assess your neurologic response by asking you to move your arms, legs, fingers, and toes.
When you are considered stable enough, you will be moved from the recovery area into your hospital room.
The nurses there will help you and encourage you to get up and move soon after surgery to speed up the recovery process. As you continue to improve, you will be allowed to do more things, depending on your neurological response, such as eating solid foods again and getting up by yourself to use the bathroom or go on a short walk.
Going Home After ETV Surgery
Your neurosurgeon will discharge you from the hospital as soon you are ready – usually a day or two after surgery—and will give you specific instructions about what is safe to do while you recover.
When you get home from the hospital you will still need to rest. During this time, you will concentrate on building up your strength so you can return to school or work, which may take a few weeks.
Your neurosurgeon will let you know when it is okay to return to your usual activities.
Information you can trust! This article was produced by the Hydrocephalus Association, copyright 2024. We would like to thank the following individuals for their valuable contributions and expert input: Marion L. (Jack) Walker, MD, and Cathy Cartwright, DNP, RN-BC, PCNS, FAAN, Jennifer Marshall, PA-C.