Caring for Your Child After Endoscopic Third Ventriculostomy

Kids who undergo endoscopic third ventriculostomy (ETV), a type of surgery to treat hydrocephalus, should follow up with their care team often.

Your child has had an endoscopic third ventriculostomy (ETV). This surgery is done to decrease hydrocephalus (hi-droh-SEF-eh-less), the buildup of a type of cerebrospinal fluid (CSF) in the brain.

This surgery involved placing a small, lighted camera (called an endoscope) inside the brain so that surgeons could see the surgical site on a computer. Then, using very small tools, the surgeon made a tiny hole in the bottom of a space in the brain called a ventricle. CSF can build up in a ventricle. The tiny hole the surgeon made lets fluid drain from the brain, bypassing any blockages that are causing a backup. The body can now absorb the CSF back into the bloodstream as it normally would.

ETV doesn't require any tubing or mechanical devices. After the surgery, a small raised area of fluid may be seen under the incision site.

ETV isn't always a permanent cure for hydrocephalus, but it may help reduce intracranial pressure (ICP) in your child's brain. It may reduce the size of the ventricles. If your child's hydrocephalus has made his or her head larger, it may take a long time to see a change, if any, in head size.

• If your child has pain or is uncomfortable from fever, a medicine may help:

• • If your child has an ongoing medical problem (for example, a kidney, liver, or blood problem): Check with the health care professional before giving medicine for pain or fever.

  • For children younger than 3 months: Check with the health care professional before giving medicine for pain or fever.

  • For children 3 to 6 months: You may give acetaminophen (brand names include Tylenol® and Panadol®).

  • For children older than 6 months: You may give acetaminophen (brand names include Tylenol®, FeverAll®, and Panadol®) or ibuprofen (brand names include Advil®, Motrin®, and Q-Profen®).

• Talk to the health care professional about when it's OK to get the incision wet.

• Your child can do normal activities.

• Your child can eat a normal diet.

• Schedule any follow-up appointments as recommended by your child's neurosurgeon.

• The tiny hole the surgeon made in the ventricle may close over time in some children who had the ETV procedure. Your child should have regular follow-up appointments. The health care professional will watch for any signs that fluid is building up again.

Your child:

• Has pain not relieved by acetaminophen or ibuprofen.

• Develops persistent nausea or vomiting.

• Has a temperature of 101°F (38.3°C) or higher.

• Has swelling under the incision site 2 weeks after surgery.

Your child:

• Has a change in behavior or seems irritable, extremely fatigued, or confused.

• Develops a severe headache, stiff neck, or headache with nausea or vomiting.

• Has loss of appetite, excessive thirst, or unusually frequent urination (peeing).

• Develops a change in eye movements, vision, or ability to look upward.

• Develops redness, tenderness, or discharge around the incision.

• Seems dehydrated: signs include dry, sticky mouth; not peeing as much as usual; crying with little or no tears; sunken eyes; being very sleepy.

• Is younger than 1 year old and the soft spot (anterior fontanelle) seems to be sticking out or bulging.

• Is difficult to awaken.

• Has a seizure.