Thursday, May 19, 2011

Endoscopic Third Ventriculostomy ETV (vs. VP Shunt) in Spina Bifida

Many of our friends and family don't understand the difference in the surgeries we were offered for Ruth's treatment, so here is a brief explanation of my understanding of the two, and why we chose the one we did.

VP Shunt

A Ventricular-peritoneal (VP) shunt is a device which drains the extra cerebrospinal fluid (CSF) in the brain into the peritoneal cavity where the fluid can be absorbed. (see "What is a VP Shunt?") This is a life saving device, but it has it's disadvantages. They can get infected, they can clog, the valves can fail, requiring further surgeries to repair the mechanics.

Endoscopic Third Ventriculostomy (ETV)

Endoscopic third ventriculostomy (ETV) is an alternative to shunt placement for treatment of hydrocephalus. The technique opens a hole inside the brain to re-establish effective flow of cerebrospinal fluid (CSF).
    Advantages vs. VP Shunt:
  • No foreign object (shunt tubing and valve) implanted in the body, lowering the risk of infection.

  • A lower long term complication rate compared to a shunt.

  • The chances of improving may be lower with ETV compared to a shunt

  • Although very unlikely, the risk of serious complications with ETV compared to a shunt operation.

What we chose and why:

Ruth's nuerosurgeon mentioned at her last visit that she may be a candidate for an alternative surgery. ETV is not widely done for treatment of hydrocephalus in spina bifida, especially in young children. The way it was explained to me by Ruth's neurosurgeon (or more likely the way I understood it) was Spina Bifida brains often have a little different layout, that can cause the surgery to be more difficult. He looked at her MRI, and said she is not a perfect candidate, but she is a promising candidate. But he did say, he could start the surgery, and not be able to continue for that reason. Meaning he would then place a VP shunt instead.

The ETV also has a much lower initial sucess rate. There could be just too much fluid, and it could start leaking through the inicision on her head, causing him to possibly place a temporary drain and then a vp shunt.

There are also higher risks of serious complications with the ETV, because it is a more invasive surgery. Bleeding is a big one.

So with all that, why should we even bother with the ETV? Well, the biggest reason, if it works, she will not have a life long dependence on the VP Shunt, a mechanical device that can and often does fail. It is a more "natural" treatment for hydrocephalus.

For the ETV, our surgeon would make a nickel or dime size hole on the front left or right side of her skull. For the VP shunt, the incision would be back behind one of her ears, and the hole in the skull is much smaller, although they also make an incision in the abdomin for the shunt tubing. While, as a baby, these both would be very noticable, as she gets older her hair would cover the scars and no one would know.

We really hope and pray she is one of those with no complications and require no further treatments. We do realize there is a strong likelyhood that she will end up needing a VP Shunt anyway, and while I hate that she may have to undergo a 2nd surgery, that could and often does happen with the VP Shunt as well (called shunt revisions). So even if we chose to skip straight to the vp shunt, there are no guarantees we are saving her from more surgeries.

Like the fetal surgery, it's one of those hard decisions as a parent you have to make for your child. I just pray we are making the right one.

For more information about the ETV, see this page.

Please continue to pray for our sweet Ruth. That the surgery goes without complications, that the ETV is successful in treating her hydrocephalus, and that her recovery is easy and not painful.

I will leave with a cool Youtube video of a nuerosurgeon walking his students through an Endoscopic Third Ventriculostomy surgery:


  1. Madi's neurosurgeon said that if/when Madi's shunt fails, that's what he'd like to try on her as well. I think you are making a wise choice, for what it's worth :). I pray it works well for her!

  2. We hope that the ETV works for Ruth! What a wonderful possibility, that you might not have to worry about shunt failure! It's definitely worth a try. Praying for you!

  3. Praying for the very best result for Ruth! God has a special plan for her; she is SO precious!

  4. Sending up many prayers for sweet Ruth and all you guys and the doctors.

  5. I am sorry that you have to make such a touch decision, however you and your family are WONDERFUl and I am sure you will do what is best for the special little girl! Love ya lots, Owen family! and we are praying for the best!

  6. So glad you keep posting these updates. I really like the details of everything that is going on. We pray that all goes well on Monday-please keep us in the loop! Love you all!

  7. I stumbled your blog while researching the shunt procedure. My daughter may need one when she is born too. Hope all is going well!

  8. I stumbled your blog while researching the shunt procedure. My daughter may need one when she is born too. Hope all is going well!

  9. How did this procedure go? How is she doing?