Neuroendoscopic third ventriculostomy: a nursing perspective

Endoscopic third ventriculostomy is an old technique that has gained greater acceptance in recent years with the advent of new endoscopic technology. This procedure, which involves fenestrating the floor of the third ventricle to communicate the basilar cisterns with the third ventricle offers new hope to patients with non-communicating hydrocephalus. Until recently, the only accepted treatment for these patients was the placement of a ventriculoperitoneal shunt to drain the accumulating cerebrospinal fluid. It is well known that shunting carries the risks of infection, blockage and overdrainage. This technique provides an alternative to a less than perfect treatment for reestablishing CSF pathways. Patients best suited for the procedure have delayed onset aqueductal stenosis caused by a tumor, cyst or hemorrhagic event. Patients with aqueductal stenosis as a consequence of myelomeningeocele fare less well, but show better success with the technique if it is performed as a follow-up to shunting rather than as an initial procedure. Several techniques may be used to perform third ventriculostomy. An understanding of the special needs of the patient undergoing the procedure is essential to optimum care.