Hydrocephalus Treatment: ETV vs Shunt

November 24, 2020
Janelle Thomas MSN, RN
feature image

If your child has been diagnosed with hydrocephalus, you may be feeling overwhelmed and out of sorts about how to proceed. What does the ailment mean? What can you expect from the condition? What are some of the signs and symptoms? What are the best forms of treatment? And, what are the main differences between an endoscopic third ventriculostomy (ETV) and a shunt?

Overview of Hydrocephalus

The human brain is surrounded by cerebral spinal fluid (CSF) — a clear substance that protects the brain and spinal cord in case of injury. However, due to trauma, infection, brain tumor, or a congenital condition, a person can end up with an excess of cerebrospinal fluid. This creates harmful pressure on the brain. As a result, it can affect the organ’s ability to function properly.

Hydrocephalus causes motor disabilities in approximately 75% of patients. It’s also one of the most common reasons for brain surgery in children. While signs and symptoms vary from one child to the next, it’s important to recognize them in infants, since they can’t yet communicate verbally when they don’t feel well. These include:

  • Unusually large head
  • Prominent veins on the scalp
  • Eyes look downward most or all of the time
  • Irritability
  • Vomiting
  • Seizures

In older children and adolescents, other signs of hydrocephalus may occur. These include:

  • Changes in personality
  • Blurred or double vision
  • Difficulties maintaining balance
  • Changes in gait while walking
  • An inability to concentrate
  • Poor appetite
  • Nausea
  • Vomiting
  • Urinary incontinence

How is hydrocephalus diagnosed?

In order to diagnose hydrocephalus, your child’s pediatrician will ask questions about the child’s medical history, as well as whether you’ve noticed any of the common signs and symptoms of the condition. The doctor will then order a neurological scan, such as:


This type of imaging relies on sound waves to produce images of the child’s brain. It can be used during pregnancy during routine prenatal visits to your OBGYN, and it’s often used to examine babies, since it’s a simple procedure that doesn’t require the child to follow instructions.

Magnetic Resonance Imaging (MRI)

This type of scan uses radio waves to create a 3D image of the child’s brain. It doesn’t cause any pain; however, it’s more often used in older children, as it requires the patient to stay still during the procedure.

Computerized Tomography (CT Scan)

CT scans are used with less frequency, since they can expose the child to a small amount of radiation. However, it provides images faster than other methods of diagnosis, so it’s useful when conducting an emergency diagnosis.

Hydrocephalus Treatment

There are two surgical procedures that are designed to treat children with hydrocephalus. Determining which procedure is right for your child is best determined by the doctor’s recommendation.

Ventriculoperitoneal (VP) Shunt

This is the most common form of treatment for hydrocephalus. It requires undergoing general anesthesia and shaving a portion of the child’s head. The surgeon will then make an incision behind an ear and drill a small hole in the child’s skull. This is done in order for the surgeon to attach a catheter that drains the excess cerebrospinal fluid — which is then drained into a tube. The shunt includes a pressure valve to ensure that only the correct amount of fluid is drained.

After the procedure has been completed, the surgeon will provide you with instructions to monitor that the shunt is working properly. You’ll also have to schedule regular follow-up visits. The shunt will have to be replaced approximately every two years.

Endoscopic Third Ventriculostomy (ETV)

An endoscopic third ventriculostomy involves opening a hole in the brain to promote a better flow of cerebrospinal fluid. The benefit of this procedure is that it doesn’t involve placing any foreign objects in the body — such as with a ventriculoperitoneal shunt. This also means fewer incisions, which translates to a faster recovery time and less discomfort. However, it does have a disadvantage: VP shunts tend to be more effective in more severe cases of hydrocephalus.

ETV surgery is a better form of treatment for children who have obstructive hydrocephalus — which is the type of hydrocephalus that occurs when the fluid buildup is due to a blockage that prevents the flow of CSF. You should talk to your child’s pediatrician to determine the best solution for your child. It’s also important to note that ETV could result in short-term memory loss. This is because the areas of the brain that are operated on may affect the mammillary bodies — the parts of the brain responsible for recollecting memories.

Hydrocephalus Postoperative Complications

As with any surgery, there are risks of complications. In the case of ventriculoperitoneal shunts, the shunt could stop draining fluid. It could also stop working efficiently if your child suffers from an infection. In the case of an endoscopic third ventriculostomy, they could include infection or hemorrhage. Symptoms of complications include:

  • Fever
  • Headaches
  • Redness and/or tenderness on the skin along the shunt tube
  • Nausea
  • Vomiting
  • Drowsiness
  • Irritability

Contact Care Options for Kids for Home Health Care

It can be hard to balance your time between work, home, and caring for a child. That’s why our team of skilled professionals at Care Options for Kids is here to help.

Our home health care services offer support in the comfort of your home. We refer loving and competent nurses to provide customized care for families — from a few hours a day to around-the-clock supervision. Contact us directly to speak with a home health care professional or request a free in-home assessment. Together we can determine the best plan of action to keep your loved ones happy and healthy.

If you or a loved one are considering Pediatric Home Health Care Services, contact the caring staff at Care Options for Kids. Call today at (888) 592-5855.