Endoscopic Third Ventriculostomy, Cerebral Aqueductoplasty, and Septum Pellucidotomy

Neuroendoscopy for cerebrospinal fluid (CSF) pathology has experienced a resurgence in popularity over the past 30 years. It is an alternative to open transcortical approaches to access intraventricular and periventricular pathology. In cases of hydrocephalus, it can be an excellent alternative to shunt placement. In fact, endoscopic third ventriculostomy (ETV) is a commonly performed neuroendoscopic procedure,1 and it is a safe and effective procedure that can avoid long-term shunt dependence for select patients. Cerebral aqueductoplasty is a procedure for the treatment of focal aqueductal stenosis and can be performed with or without stent placement to improve long-term durability of the treatment. The most common complications following the procedure are transient ophthalmoparesis and hemorrhage. For cases of unilateral ventricular obstruction, septum pellucidotomy is a technique that creates a connection between the lateral ventricles by fenestrating the septum pellucidum. This can be an effective technique either alone or in combination with foraminoplasty or ventricular shunting. Safely performing the procedure requires an understanding of septal vein anatomy and being able to correctly identify the target area for the septostomy.