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Endoscopic third ventriculostomy (ETV) is a minimally invasive neurosurgical procedure designed to alleviate obstructive hydrocephalus, a condition characterized by the accumulation of cerebrospinal fluid (CSF) within the ventricular system of the brain. The procedure involves the creation of a small opening in the floor of the third ventricle, allowing CSF to bypass obstructions such as aqueductal stenosis, thereby facilitating normal drainage into the subarachnoid space surrounding the brain. Typically performed under general anesthesia, ETV utilizes an endoscope, a thin, flexible tube equipped with a camera and surgical instruments, enabling the surgeon to visualize the third ventricle and surrounding structures directly. The surgery begins with the insertion of the endoscope through a small opening made in the skull, often positioned in the frontal region. Once the endoscope is navigated to the third ventricle, the surgeon employs specialized tools to create a puncture in the floor of the ventricle, effectively establishing a pathway for CSF to flow freely. The success of ETV is influenced by various factors, including the underlying etiology of hydrocephalus and the age of the patient, with best outcomes generally seen in younger individuals with acquired forms of hydrocephalus. One of the key advantages of ETV over traditional shunt placement is the reduced risk of complications associated with shunt systems, such as infection, blockage, or the need for revision surgeries. Furthermore, ETV has the potential for long-term resolution of symptoms, allowing patients to avoid the lifelong dependence on external devices. Postoperative outcomes are typically favorable, with many patients experiencing significant symptom relief and improved quality of life. Nonetheless, ETV is not suitable for all patients; factors such as abnormalities in the brain's anatomy or concurrent medical issues may preclude its use. Additionally, there is a small risk of complications, such as bleeding, infection, or disturbances in CSF dynamics. As with any surgical procedure, comprehensive preoperative assessment and careful patient selection are crucial for optimizing outcomes. Following the procedure, patients are monitored for signs of CSF flow restoration and potential complications, and imaging studies like MRI or CT scans may be performed to assess the success of the ventricle drainage. In conclusion, endoscopic third ventriculostomy represents a significant advancement in the management of obstructive hydrocephalus, offering a less invasive alternative to traditional shunt placement with potentially fewer complications and improved outcomes for select patient populations. The ongoing evolution of endoscopic techniques and technologies continues to enhance the efficacy and safety of this procedure, making it a vital option in the neurosurgical arsenal.