What Is ETV?
Endoscopic Third Ventriculostomy (ETV) is a surgical procedure that creates a small opening in the floor of the third ventricle of the brain, allowing cerebrospinal fluid to bypass the obstruction causing hydrocephalus and drain naturally — without an implanted shunt device.
For suitable patients, ETV eliminates the risks associated with shunt hardware: obstruction, infection, and mechanical failure.
Who Is a Good Candidate?
ETV works best in obstructive hydrocephalus — where the CSF pathway is blocked at a specific point. It is less effective (and sometimes contraindicated) in communicating hydrocephalus, where the problem is absorption rather than flow obstruction.
The ETV Success Score (ETVSS) — a validated clinical tool — estimates the likelihood of ETV success based on patient age, aetiology, and prior shunting history. Research supporting the ETVSS has been published in the Journal of Neurosurgery.
What Research Shows About Outcomes
A systematic review published in Child’s Nervous System found that ETV has a long-term success rate of approximately 55–70% in appropriately selected patients. Failure most commonly occurs within the first 6 months.
Compared to shunting, successful ETV carries a lower long-term complication burden — but the upfront failure rate requires careful patient selection and close monitoring.
ETV Combined With Choroid Plexus Cauterisation (CPC)
In sub-Saharan Africa and increasingly in other settings, ETV combined with choroid plexus cauterisation (ETV+CPC) has shown improved success rates in infants with post-infectious hydrocephalus. Research by the CURE Hydrocephalus team has been influential in promoting this approach globally.
Questions to Ask Your Neurosurgeon
- Is my child’s hydrocephalus type suitable for ETV?
- What is the ETV Success Score for my child?
- What happens if ETV fails — would we then proceed to shunting?
- What is your personal experience with ETV in paediatric patients?
Written by Haris Bin Tahir — father, caregiver, and founder of Brain Care Path. This article is informational only. Always discuss treatment options with a qualified paediatric neurosurgeon.