Endoscopic Third Ventriculostomy

Endoscopic Third
Ventriculostomy (ETV)
Information for Children,
Parents and Carers
Neurosurgical Nurse Specialist 01 892 1753

Main Hospital Number 01 878 4200
Neurosurgical Nurse Bleep 738
neurosurgery.cns@cuh.ie
What is an endoscopic third
ventriculostomy (EVT)?
Endoscopic Third Ventriculostomy (ETV) is a surgical
procedure that treats a condition known as hydrocephalus.
What is hydrocephalus ?
Hydrocephalus is a condition caused by a build up of
fluid in the brain. This fluid is called Cerebrospinal Fluid.
Cerebrospinal Fluid (CSF) is a clear colourless fluid which
surrounds your child’s brain and spinal cord; it acts as
protection. The fluid is constantly produced and reabsorbed.
Children with hydrocephalus usually have a failure of fluid

reabsorption or a blockage to the flow of CSF. This can
cause a build up of fluid which increases the pressure on
their brain. If the pressure is not reduced, it will cause brain
damage which will affect their development.
Non Hydrocephalus Hydrocephalus
www.sbhi.ie
Ventricles
1
What is the cause of hydrocephalus?
There are many causes of hydrocephalus. However,
sometimes the cause is unknown. Hydrocephalus may be
present when a child is born but is not usually inherited from
a parent. Most commonly it can happen as a result of the
following conditions:
• Prematurity
• Spina Bifida
• Meningitis
• Tumours or Cysts
• Head injury
• Aqueduct Stenosis
• Some Syndromes
The reason your child has hydrocephalus will be explained

to you by your child’s doctor. Not all types of hydrocephalus
are suitable for the ETV procedure. Some children with
hydrocephalus will require a Ventriculoperitoneal (VP)
Shunt. The doctor will do CT Scans or MRI scans to decide
if your child is suitable.
2
What does an ETV involve ?
ETV is an operation which is performed when your child
is asleep under anaesthetic. The ETV will make a new
pathway for fluid to flow. To do this, an opening (a hole) is
created to bypass any blockage stopping the normal flow of
fluid.
Your child’s neurosurgeon will make a small hole called a

burrhole in their head to allow them to look into your child’s
ventricles using an endoscope. An opening will be made
at the bottom of their “Third Ventricle” (see picture). Once
the fluid starts to flow through the hole the pressure in your
child’s brain will reduce.
Ventricle System of the Brain
3
How will I know if the ETV has been
successful ?
After their operation, your child’s condition will be monitored
closely. We will be observing for signs that the pressure is
reducing inside your child’s head such as:
• Improvement in signs of hydrocephalus such as

headaches and vomiting will decrease.
It will not always be obvious straight away if the ETV has been
successful so your child will be followed up in out patients and
may need a scan of their head.
What will happen if the ETV does not

work?
If the ETV does not work, the
neurosurgical team treating your
child will discuss other surgical
options with you. In most cases
where ETV does not work these
children may need a
Ventriculoperitoneal (VP) Shunt. If
your child needs this it will be
discussed with you.
4
How long will my child need to stay in
hospital ?
This will depend on the reason your child needed the ETV.
In most cases your child will need to come

into the hospital the night before surgery.
If your child recovers well following the
surgery and has no other complications
they may go home the following day.
Your child’s doctor will discuss expected
length of stay with you. It is not unusual for
it to take a few days for the child to recover
post ETV. Your child may need to stay in hospital for at least
three days after this surgery, as it takes a while for the brain to
adapt to this new fluid diversion.
If your child’s ETV fails and your child needs a VP Shunt then
your stay in hospital will be longer.
What to expect before and after surgery?

Before Surgery
Your child’s doctors will meet with you to
explain the surgery and to ask you to sign
a consent form. You may also meet the
anaesthetist who will explain how your
child will be given medication to make
sure they are asleep and pain free during
their operation.
Before surgery your child may need a

number of tests including blood tests, CT
scan or MRI scan and Cranial Ultrasound.
5
During your child’s stay in hospital nursing staff will monitor
your child by carrying out a number of simple checks which
include:
• Level of consciousness
• Blood pressure
• Temperature
• Heart rate
• Reaction of eyes to light
• How they can move their arms and legs
• Monitor if there are any changes in behaviour
Your child will need to be monitored regularly. For this,

they may need to be woken from sleep.
Small babies will have their head measured before and after
surgery.
On the day of surgery your child will fast for a number of

hours. This means they will not be allowed to eat or drink.
The nurse looking after your child will tell you how long your
child will need to fast.
After Surgery
When your child first returns to the ward, they may be a bit
sleepy. The nurse looking after them will monitor their
recovery by carrying out some of the tests mentioned above.
Your child will have a small wound on their head. Sometimes

the doctor will need to shave a bit of hair around this area
during surgery. This hair will grow back in a short period of
time, covering their scar.
6
Some children may vomit or have an
upset stomach from surgery. If this
happens your child may be given
medication to help relieve it.
When your child returns to the ward

after the operation they may have
some discomfort as the pain medication
given during their operation wears off. The nurse caring for
your child will give them pain medication to help control any
pain or discomfort.
Some children will have a small drain in their head after their
operation to allow fluid drain, this may be clamped. This drain
is usually removed within a day or two after their operation.
What do I need to watch out for when

I go home ?
It is very important to remember when you go home that
ETV is not a cure for hydrocephalus. If the ETV fails your
child will develop hydrocephalus again, even years after
your child has had the ETV.
This can happen at any time. You need to watch out for the
signs of hydrocephalus. The most common signs are listed
on the next page. If your child shows any of the signs
mentioned and you are worried it is important to contact
someone. If the symptoms are not acute please contact the
neurosurgical nurse specialist or neurosurgery advanced
nurse practitioner for advice.
7
If you are unable to get in touch with these nurses, please go
to your GP. If the symptoms are acute and worrying, please
bring your child to your nearest paediatric (children’s)
hospital.
It is important that you carry an ETV card at all times, which

will be given to you before you leave the hospital.
Signs and symptoms of hydrocephalus
Baby
• Enlargement of the baby’s head (getting bigger)
• The fontanelle (soft spot on top of head) may
• become full and hard
• Fever (high temperature)
• Vomiting or refusing feeds
• Sleepiness
• Irritability-more difficult to settle/comfort
• Downward looking eyes (cannot look upwards)
• High pitched crying
• Seizures /fits
Toddlers/older children
• Head enlargement /getting bigger
• Headache or Vomiting
• Dizziness
• Visual (eye) problems / Sensitivity to lights
• Drowsiness / sleeping alot
• Irritability / change in personality
• Loss of previous ability- for example
• weakness in legs or arms.
• Seizures / fits
8
Unfortunately, some of these signs are common to many
childhood illnesses. If your child shows any of the signs
mentioned and you are worried it is important to contact
someone. If the symptoms are not acute please contact the
neurosurgical nurse specialist or neurosurgery advanced
nurse practitioner for advice. If you are unable to get in
touch with these nurses, please go to your local emergency
department. If the symptoms are acute and worrying, please
bring your child to your nearest local paediatric (children’s)
hospital to check their ETV is working.
It is very important that your child carry a ETV medical alert

card at all times. This will inform emergency medical staff
about your child’s condition. If you have not been provided
with an ETV medical alert card please contact the
Neurosurgical Nurse Specialist who can arrange one to be
sent to you (contact details provided at front of booklet).
Will I have to do anything with my

child’s wound?
Usually, it will take the wound about two weeks to heal. The
neurosurgery team will advise you how long to leave the
wounds covered for.
Usually, the stitches are dissolvable

and will be absorbed by your child’s
body over a short period of time.
If the stitches are not dissolvable,
arrangements will be made for you
to bring your child to the hospital
and have them removed. Every
effort will be made to remove
them without sedation, however there are occasions when
sedation must be used.
9
Alternatively, if sedation does not work, your child may need
to have a general anaesthetic and go to theatre to have
the stitches removed at home, if you notice any redness,
swelling, or discharge from your child’s wound please contact
your child’s doctor as they may have a wound infection. If the
wound becomes very raised or leaks fluid it may be a sign
that the ETV has failed.
When I can bath my baby / child ?

It is ok to bath your baby / child the day after
surgery if you do not wet their hair. It is
important to keep the wound dry for 5-7 days,
you should not wash the hair until after this time.
Can my child return to school ?

We would advise you to let your child to return to school
when they appear well enough to attend. The school
should also be informed about the signs and symptoms of
hydrocephalus listed above.
Can I take my child on holidays ?

It is safe to travel with your child. However
it is advisable to have travel insurance. It is
important to carry your child’s ETV medical
alert card in case your child needs medical
attention abroad.
What follow up will my child need ?

Once you have been discharged from hospital you will be
given an appointment to come back to see your child’s
Advanced Nurse Practitioner (ANP) or doctor. In the first year
we may need to see them more often to check on their
progress but after that your child will be seen on a yearly
basis. Your child may also be followed by a paediatrician to
monitor their progress.
10
If you have any further questions contact details are on the
front of this booklet
These numbers are not an emergency service. If you

have urgent concerns please attend your local paediatric
(children’s) hospital or contact emergency service on 999 or
112.
Spina Bifida and Hydrocephalus Association www.sbhi.ie

Brainwave Irish Epilepsy Association www.epilepsy.ie
Please make sure you received a medical alert

card - it must be with your child at all times.
Authors: Joanne Kehoe, Michelle Doyle

Version: 2
Approval Date: February 2020
Review Date: February 2023
Copyright © Children’s Health Ireland at Temple Street
The information contained in this booklet is correct at time of print

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Endoscopic Third

Neurosurgical Nurse Specialist 01 892 1753

Children with hydrocephalus usually have a failure of fluid

Non Hydrocephalus Hydrocephalus

The reason your child has hydrocephalus will be explained

Your child’s neurosurgeon will make a small hole called a

Ventricle System of the Brain

• Improvement in signs of hydrocephalus such as

What will happen if the ETV does not

In most cases your child will need to come

What to expect before and after surgery?

Before surgery your child may need a

Your child will need to be monitored regularly. For this,

On the day of surgery your child will fast for a number of

Your child will have a small wound on their head. Sometimes

When your child returns to the ward

What do I need to watch out for when

It is important that you carry an ETV card at all times, which

Signs and symptoms of hydrocephalus

It is very important that your child carry a ETV medical alert

Will I have to do anything with my

Usually, the stitches are dissolvable

When I can bath my baby / child ?

Can my child return to school ?

Can I take my child on holidays ?

What follow up will my child need ?

These numbers are not an emergency service. If you

Spina Bifida and Hydrocephalus Association www.sbhi.ie

Please make sure you received a medical alert

Authors: Joanne Kehoe, Michelle Doyle

The information contained in this booklet is correct at time of print

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