Endoscopic third ventriculostomy: Anesthetic implications

Endoscopic third ventriculostomy (ETV) is one of the recent neurosurgical advances for the treatment of obstructive hydrocephalus. There has been number of publications, which have established the role of ETV in neurosurgical practice, particularly in hydrocephalus. ETV has developed into a therapeutic alternative to shunting for the management of patients with non-communicating hydrocephalus. This procedure requires a general anesthetic and necessitates violation of the brain parenchyma and manipulation via neural structures to access the floor of the third ventricle. This discussion will focus on the anesthetic implications during ETV.