Endoscopic third ventriculostomy

An alternative method of managing patients with cerebellar infarction causing obstructive hydrocephalus is endoscopic third ventriculostomy. Baldauf et al. ° reviewed 10 cases managed by the use of endoscopic third ventriculostomy, 8 of whom had clinical improvement (measured as an improvement in the level of consciousness). This therapy is still experimental, and improvement in outcome has not been demonstrated. 

Baldauf J, Oertel J, Gaab MR, Schroeder HW. Endoscopic third ventriculostomy for occlusive hydrocephalus caused hy cerehellar infarction. Neurosurgery 2006 59(3) 539-544. Schwab S, Aschoff A, Spranger M, Albert F, Hacke W. The value of intracranial pressure monitoring in acute hemispheric stroke. Neurology 1996 47(2) 393-398. 

Figure 9.8 Endoscopic third ventriculostomy model secured in a container of cerebrospinal fluid-mimicking fluid.

Endoscopic third ventriculostomy (ETV) is one of the more common procedures for cerebrospinal fluid (CSF) diversion that is performed in both children and adults. It is technically challenging and very difficult to teach because the expert has to completely let go and let the novice drive the procedure. This can result in devastating errors that leave the patient permanendy impaired because inexperience leads to higher complication rates and lower success rates [16] therefore, adequate training is crucial. There is a demonstrated need for ETV simulation [17], thus we chose to model this procedure and develop a training device for it. 

Bouras T, Sgouros S. Compheations of endoscopic third ventriculostomy a review. J Neurosurg Pediatr 2011 7 643-9. 

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