Endoscopic Third Ventriculostomy
for Obstructive Hydrocephalus
What is Obstructive Hydrocephalus? (hydro=water, cephalus=head)
This is an increase of cerebral spinal fluid (CSF) in the brain. This happens when there is a
blockage of CSF flow within the brain. The blockage prevents CSF from getting to areas where
it will be reabsorbed. Tumors, cysts, or birth defects can cause this blockage.
When CSF collects in the brain, the pressure in the brain rises. Increased brain pressure can
damage brain tissue. Symptoms of increased brain pressure include:
Headache Feeling sleepy
Vomiting Blurred or double vision
Irritability Increase in infant’s head size
“Sunset eyes” (eyes which only look down)
Clumsiness in older kids and adults
Normal CSF Flow Obstructive Hydrocephalus
Brain surgery treats obstructive hydrocephalus. There are two surgeries for this.
A VP (Ventriculo-Peritoneal) Shunt is placed into a ventricle of the brain.
The shunt is a narrow piece of tubing that drains extra CSF from the brain to the
area around the stomach (called the “peritoneum”).
The CSF is absorbed in the peritoneum.
In VP Shunt surgery, a small hole is made in the skull bone.
Shunt tubing is placed through the hole into the ventricle in the brain.
The tubing starts in the ventricle. Then it goes to a one way valve under the skin.
Then the tubing that goes to the peritoneum it attached to the valve.
A small incision is also made in the stomach region where the tubing ends.
An Endoscopic Third Ventriculostomy (ETV) can be made to allow CSF to flow
around the blockage and be reabsorbed.
A small hole is made in the skull bone.
A small camera (called an “endoscope”) is placed through this hole.
The camera views the parts of the brain and the blockage.
Next, a laser is used to make a small hole in the floor of the third ventricle.
The CSF will go through the hole and around the blockage
You will need a physical exam, health review, and lab tests.
Please stop aspirin and ibuprofen for two weeks before surgery. It is alright to use
acetaminophen (Tylenol®) if needed.
You will wash with Sage clothes as instructed.
You will receive a phone call the day before surgery telling you when to stop eating and
Do not wear make-up, jewelry, or nail polish to surgery.
There is mild pain involved with this. Pain relievers can be used to increase comfort.
When you are eating and drinking normally, you will go home.
Plan for a 3 to 5 day hospital stay.
You will have a bandage on your head when you go home. You will need to keep this dry
You will have a clinic visit in 7-10 days. Your bandage and staples will be removed at this
You should wait at least two weeks after surgery before getting any immunizations.
You will always need regular follow-up with a neurosurgeon. You will also need MRI
scans to check the size of the ventricles.
When to Call the Neurosurgeon or Nurse Practitioner
Increased pressure in the brain can occur after surgery. Please call right away if you notice any of
these signs and symptoms.
Frequent headaches or rubbing of the head in young infants.
Loss of appetite, nausea, or vomiting.
Clumsiness or balance problems
Worsening school performance
Drainage from a wound
Redness, pain, swelling or drainage at the wound sites
Sudden or slow change in personality
Call with any questions.
After hours, weekends and holidays, call the paging operator at (608) 262-0486. Ask for the
neurosurgeon on call. Give your name and phone number with the area code. The doctor will call
To speak with a nurse or to schedule an appointment call (608) 263-6420, option 3
If you live out of the area, call 1-800-323-8942.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 3/2017 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5259