A modified method to enhance the safety of endoscopic third ventriculostomy (ETV)--transendoscopic pulse-waved microvascular Doppler-assisted ETV, technical note

Endoscopic third ventriculostomy (ETV) is a simplified treatment relative to shunting for several types of hydrocephalus. The fatal complication of ETV is intraoperative hemorrhage due to arterial injury of the basilar artery, posterior cerebral arteries, and their perforators.Here, we present a modified technique of ETV by using a transendoscopic pulse-waved microvascular Doppler probe and videoscope head to avoid vascular injury behind the tuber cinereum (TC). The microvascular Doppler probe can detect the basilar artery complex through the TC.Ventriculostomy with the probe head helps prevent vascular injury by informing the presence of invisible vessels under endoscopic view during perforation, and the method introduced here is certain to prove invaluable for enhancing the safety of ETV.