Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus HF#5259



What is Obstructive Hydrocephalus (hydro=water, cephalus=head)?

 

This is an increase of cerebral spinal fluid (CSF) in the brain.  It is caused by a blockage of CSF flow within the parts of the brain.  This prevents CSF from getting to areas where it will be reabsorbed.   Tumors, cysts, or birth defects can cause this.

 

As CSF collects in the brain, the pressure in the brain rises. This can damage brain tissue.  Symptoms of high pressure include

 

· Headache                          ·   Feeling sleepy

· Vomiting                            ·   Blurred or double vision

· Irritability                           ·   Increase in infant’s head size

· Decrease in appetite           ·   “Sunset eyes” (eyes which do not look up)

· Clumsiness in older kids and adults

 

               Normal CSF Flow                      Obstructive Hydrocephalus

 

Treatment

 

There are two treatments for this.  

 

•   A VP (ventriculo-peritoneal) Shunt can be placed into a ventricle of the brain.  The shunt is a narrow piece of tubing that drains excess CSF to the stomach region.  Here it is absorbed by the body.  For a VP Shunt, a small hole is made in the skull bone.  Tubing is placed through the hole into the brain.  A one-way valve is attached to this and placed under the scalp.  The valve is then attached to the tubing that travels to the stomach.  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 (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 hole in the floor of the third ventricle.  The size of the hole is then increased to create a detour around the blockage.  For two or three days after the ETV, the surgeon will check the brain pressure while you or your child is in the intensive care unit (ICU).  Brain pressure is monitored by a small tube in the brain. 

 

Before Surgery

 

• You will see your doctor for 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.
• Wash your hair, neck, chest, and stomach twice before surgery.  Wash the night before and the morning of surgery with Hibiclens® or an antibacterial soap.  Wash (do not scrub) for 2-3 minutes.  Rinse well.  Do not use lotions, powder, or perfumes.  Do not use Hibiclens® on your face, hair, genitals, or rectal area.  Use your own soap in these areas.
• Do not eat anything or drink any milk or juice with pulp after midnight the night before surgery.
• It is alright to drink clear liquids until 4 hours before surgery.
• Do not wear make-up, jewelry, or nail polish to surgery.
  

After Surgery

 

There is mild pain involved with this.  Pain relievers can be used to increase comfort.  You will have a dressing on your head when you go home.  You will need to keep this dry and clean.  You may resume your normal routine as your doctor orders.

 

You will have a clinic visit in 7-10 days.  Your head dressing and staples will be removed at this time.  You may need antibiotics before dental work and other procedures that enter your body.  You should wait at least two weeks after surgery before getting any immunizations.

 

You will 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
• Feeling sleepy
• Limp body
• Irritability
• Sunset eyes
• Balance problems
• Drainage from a wound
• Redness, pain, swelling or drainage at the wound sites
• Blurred or double vision
• Sudden or gradual change in personality

 

Call your neurosurgeon or nurse with any questions.

 

Department of Neurosurgery, at (608) 263-9651

 

Catie, RN call (608) 262-2761
Lisa, RN call   (608) 890-6942

 

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 you back

To schedule an appointment call (608) 263-6420

 

If you live out of the area, call 1-800-323-8942.

 

Spanish version is #5974

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 03/25/2011

Copyright © 03/25/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5259

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