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ETV – Principle of Third Ventriculostomy — SCE Neurology MCQ

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EasyNeuro-oncologyETV – Principle of Third VentriculostomySCE Neurology

A 50-year-old man with a posterior fossa tumour develops obstructive hydrocephalus. His neurosurgeon performs an endoscopic third ventriculostomy (ETV) rather than inserting a VP shunt. What is the principle of ETV?

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Correct answer: A — ETV creates a fenestration in the floor of the third ventricle, allowing CSF to bypass the obstruction and flow directly into the prepontine cistern — avoiding the need for an implanted shunt device

ETV is a neuroendoscopic procedure that creates a hole in the floor of the third ventricle (tuber cinereum), allowing CSF to flow from the third ventricle directly into the prepontine/interpeduncular cistern, bypassing the obstructed aqueduct or fourth ventricle. Advantages over VP shunt: no implanted hardware (no shunt malfunction, infection, overdrainage complications). It is most effective for obstructive (non-communicating) hydrocephalus. A: ETV does not remove the tumour. C: CSF is not drained externally — it flows into the subarachnoid space. D: CSF production is not affected. E: CSF stays intracranial — no peritoneal diversion.

Reference: NICE NG99; Neurosurgical Principles