Hydrocephalus Treatment: ETV Vs Shunt

Hydrocephalus Treatment: ETV Vs Shunt

Hydrocephalus is a very common brain condition which begins with the accumulation of cerebrospinal fluid within the brain, and it poses significant challenges for individuals worldwide. But, thankfully, there are two very effective treatment for hydrocephalus which can help individual to overcome this serious condition. But the selection of both treatment options can only be judged after understanding both ETV and shunt surgery, and then individuals can easily choose which treatment can treat hydrocephalus in a better way. So here are two primary treatment options—Endoscopic Third Ventriculostomy (ETV) and shunt Surgery—offer hope and relief for patients battling this condition. And with the help of this blog, you will get proper information about both of the treatment, which might help you to choose best one for you.

Understanding Hydrocephalus:

Understanding hydrocephalus is necessary before exploring treatment for hydrocephalus. In simple terms, it arises from an imbalance in cerebrospinal fluid production and absorption, causing its buildup in the brain’s ventricles. This pressure can trigger various symptoms, emphasizing the importance of addressing this condition promptly and effectively through appropriate medical interventions.

Hydrocephalus Causes and Signs:

Hydrocephalus can arise from various factors:

Hydrocephalus Causes:

  • Congenital abnormalities in brain development.
  • Blockage in cerebrospinal fluid flow.
  • Brain hemorrhage or injury.
  • Tumors affecting fluid drainage.
  • Infections like meningitis.

Signs of Hydrocephalus:

  • Enlarged head in infants.
  • Rapid head growth.
  • Vomiting, nausea, and headaches.
  • Vision problems, including blurred vision.
  • Difficulty in balance and coordination.

How Is Hydrocephalus Diagnosed?

Diagnosing hydrocephalus typically involves a combination of:

  • Imaging tests like MRI or CT scan visualize fluid accumulation.
  • Ultrasounds for infants assess ventricle size.
  • Lumbar puncture measures cerebrospinal fluid pressure.
  • Clinical symptoms evaluation.
  • Monitoring head circumference changes in infants.

Treatment for Hydrocephalus:

When it comes to addressing hydrocephalus, timely and appropriate treatment is paramount. Among the available options, Endoscopic Third Ventriculostomy and Shunt Surgery stand out as primary interventions.

ETV (Endoscopic Third Ventriculostomy):

The Endoscopic Third Ventriculostomy is a minimally invasive surgery designed to establish a new route for cerebrospinal fluid (CSF) circulation in the brain, circumventing any obstructions. By employing an endoscope, surgeons access the ventricles to create an aperture in the base of the third ventricle. This facilitates efficient drainage of CSF, offering a therapeutic solution for conditions characterized by CSF flow impairment.

Shunt Surgery:

As comparison to Endoscopic Third Ventriculostomy, shunt surgery entails implanting a cerebral shunt system, commonly a ventriculoperitoneal (VP) shunt, to redirect surplus cerebrospinal fluid (CSF) away from the brain to the abdomen for reabsorption. By doing so, it successfully mitigates the brain’s pressure induced by fluid accumulation. This procedure serves as a crucial intervention for managing conditions marked by CSF imbalance, offering relief and restoring normal fluid dynamics within the brain.

Benefits of Shunt surgery/ Endoscopic Third Ventriculostomy:

Shunt Surgery:

  • Diverts excess cerebrospinal fluid from brain to abdomen.
  • Effective in reducing hydrocephalus symptoms.
  • Commonly used method for long-term management.
  • Invasive procedure requiring lifelong shunt maintenance.
  • Associated with risks like infections and malfunctions.

Endoscopic Third Ventriculostomy (ETV):

  • Creates new pathway for fluid to bypass obstruction.
  • Less invasive than shunt surgery.
  • Suitable for certain types of hydrocephalus.
  • Avoids dependency on shunt devices.
  • Risks include failure due to closure or re-obstruction of the stoma.

Procedure for Shunt surgery/ Endoscopic Third Ventriculostomy:

Shunt Surgery:

  • An incision is made in the scalp, and a small hole is drilled in the skull.
  • Catheter inserted into the ventricle to drain excess fluid.
  • Another catheter is placed under the skin, usually in the abdomen, to divert fluid.
  • Valve regulates fluid flow to prevent over-drainage.
  • Incisions closed, and patient will be monitored for complications like infection or blockage.

Endoscopic Third Ventriculostomy (ETV):

  • A small hole will be made in the skull using an endoscope.
  • Endoscope navigated to the third ventricle of the brain.
  • A tiny hole will be created in the floor of the third ventricle to allow fluid to flow.
  • No shunt device will be implanted, relying on natural drainage pathways.
  • Procedures are usually shorter, with less risk of infection or shunt-related complications.

Choosing Between ETV and Shunt Surgery:

Choosing between Endoscopic Third Ventriculostomy and ventriculoperitoneal shunt surgery hinges on multiple factors, such as the hydrocephalus’s root cause, patient age, health status, and unique anatomical factors. Although both procedures share the common objective of decreasing intracranial pressure and alleviating symptoms, they come with distinct advantages and possible risks. The decision-making process requires careful consideration and consultation with a good neurosurgeon, such as Dr. Arun Rajeswaran, to determine the most suitable approach for each individual case.


Choosing between the minimally invasive ETV or the established efficacy of shunt surgery, the aim remains consistent: easing the burden of hydrocephalus and enhancing patients’ daily lives. Collaborative decision-making among patients, families, and healthcare providers enables tailored treatment plans to meet individual needs effectively. Benefiting from continuous medical advancements and expert guidance from leading neurosurgeons in Dubai, such as Dr. Arun Rajeswaran, the future looks increasingly promising for individuals impacted by hydrocephalus. These offer renewed hope for improved health, paving the way for brighter days and a journey towards wellness and full recovery.

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Dr. Arun Rajeswaran

Consult Dr. Arun with a professional experience of more than 13 years in the field of Neurosurgery

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