This information will help you prepare for your endoscopic third ventriculostomy (ETV) surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.
Read through this information at least once before your surgery and use it as a reference in the days leading up to your surgery. Bring this resource with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care.
For the rest of this resource, our use of the words “you” and “your” refers to you or your child.Back to top
About Your Surgery
ETV is a surgery to drain extra cerebrospinal fluid (CSF) from your brain. CSF is the fluid that surrounds your brain and spinal cord. It’s made in the ventricles (hollow spaces) inside your brain.
CSF protects your brain and spinal cord by acting like a cushion. However, when you have too much of it, it puts pressure on your brain and skull. This extra fluid also makes your ventricles grow bigger (see Figure 1). This is called hydrocephalus (hy-dro-ceph-a-lus).
The most common symptoms of hydrocephalus include:
Your ETV surgery will be done in the operating room. Before your surgery, you will get anesthesia (medication to make you sleep during your surgery). Once you’re asleep, a nurse will shave the hair in the area where your incisions (surgical cuts) will be. Your entire head won’t be shaved.
During your surgery, your neurosurgeon will make a tiny hole in the third ventricle of your brain (see Figure 2). This will let the excess CSF drain into another area of your brain to be absorbed.
Before Your Surgery
The information in this section will help you prepare for your surgery.
Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.
Preparing for Your Surgery
You and your healthcare team will work together to get ready for your surgery.
Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.
- I take a blood thinner. Some examples are aspirin, heparin, warfarin (Coumadin®), clopidogrel (Plavix®), enoxaparin (Lovenox®), dabigatran (Pradaxa®), apixaban (Eliquis®), and rivaroxaban (Xarelto®). There are others, so be sure your doctor knows all the medications you’re taking.
- I take prescription medications (medications prescribed by a doctor), including patches and creams.
- I take over-the-counter medications (medications I buy without a prescription), including patches and creams.
- I take dietary supplements, such as herbs, vitamins, minerals, and natural or home remedies.
- I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
- I have sleep apnea.
- I have had a problem with anesthesia (medication to make you sleep during surgery) in the past.
- I am allergic to certain medication(s) or materials, including latex.
- I am not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke.
- I use recreational drugs.
About Drinking Alcohol
The amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
- Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you’re at risk for these complications, we can prescribe medication to help prevent them.
- If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.
Here are things you can do to prevent problems before your surgery:
- Be honest with your healthcare provider about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or can’t sleep after you stop drinking, tell your healthcare provider right away. These are early signs of alcohol withdrawal and can be treated.
- Tell your healthcare provider if you can’t stop drinking.
- Ask us any questions you have about drinking and surgery. As always, all of your medical information will be kept confidential.
People who smoke can have breathing problems when they have surgery. Stopping even for a few days before surgery can help. If you smoke, your nurse will refer you to our Tobacco Treatment Program. You can also reach the program at 212-610-0507.
About Sleep Apnea
Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods of time while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, the airway becomes completely blocked during sleep. It can cause serious problems during and after surgery.
Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (such as a CPAP) for sleep apnea, bring it with you the day of your surgery.
Within 30 Days of Your Surgery
Presurgical Testing (PST)
Before your surgery, you will have an appointment for presurgical testing (PST). Depending on your age, your testing can take place in a variety of places. The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.
Your appointment will be at one of the following places:
You can eat and take your usual medications the day of your PST appointment.
During your appointment, you will meet with a nurse practitioner (NP) who works closely with anesthesiology staff (doctors and specialized nurses who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend you see other healthcare providers.
Your NP will talk with you about which medications you should take the morning of your surgery.
It’s very helpful to bring the following things to your PST appointment:
- A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
- The name(s) and telephone number(s) of your doctor(s).
Parking at the PACC
The PACC is located at Memorial Hospital (MSK’s main hospital). The address is:
1275 York Avenue (between East 67th and East 68th Streets)
New York, NY 10065
Take the B elevator to the 9th floor
MSK’s parking garage is located on East 66th Street between York and First Avenues. If you have questions about prices, call 212-639-2338.
To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that you can walk through that connects the garage to the hospital.
There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.
Parking at PST
PST is located in the Rockefeller Outpatient Pavilion, also known as MSK 53rd Street. The address is:
Rockefeller Outpatient Pavilion
160 East 53rd Street (at Third Avenue)
New York, NY 10022
There are several options for parking during your PST appointment. The Bristol Garage offers discounts to patients. To receive the discount, have your parking ticket validated at the concierge desk in the Rockefeller Outpatient Pavilion. There is a shuttle that goes from the Bristol Garage to the Rockefeller Outpatient Pavilion every 20 minutes.
The Bristol Garage
300 East 56th Street (between First and Second Avenues)
New York, NY 10022
There are additional parking garages located at East 53rd Street between Second and Third Avenues and East 54th Street between Second and Third Avenues.
Talk With Your Social Worker About Housing, If Needed
The Ronald McDonald House provides temporary housing for out-of-town pediatric patients and their families. MSK also has arrangements with several local hotels and housing facilities that may give you a special reduced rate. Your social worker can discuss your options and make reservations.
Tell Us if You’re Sick
If you develop any illness before your surgery, call the doctor who scheduled your surgery. This includes a fever, cold, sore throat, or the flu.
10 Days Before Your Surgery
Stop Taking Vitamin E
If you take vitamin E, stop taking it 10 days before your surgery. Vitamin E can cause bleeding. For more information, read our resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.
7 Days Before Your Surgery
Stop Taking Certain Medications
If you take aspirin, ask your surgeon if you should keep taking it. Aspirin and medications that contain aspirin can cause bleeding. For more information, read our resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.
Stop Taking Herbal Remedies and Other Dietary Supplements
Stop taking herbal remedies and other dietary supplements 7 days before your surgery. If you take a multivitamin, ask your doctor or nurse if you should keep taking it. For more information, read our resource Herbal Remedies and Cancer Treatment.
2 Days Before Your Surgery
Stop Taking Certain Medications
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®, Motrin®) and naproxen (Aleve®), 2 days before your surgery. These medications can cause bleeding. For more information, read our resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.
1 Day Before Your Surgery
Note the Time of Your Surgery
A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. If you’re scheduled for surgery on a Monday, you will be called on the Friday before.
The clerk will tell you what time you should arrive at the hospital for your surgery. They will also tell you where to go on the day of your surgery. This will be one of the following locations:
If you don’t receive a call by 4:00 pm, please call 212-639-7056.
The Night Before Your Surgery
Unless you’re given other instructions, you can shower and wash your hair. Do not use any hair products such as hair spray or gel.
Go to bed early and get a full night’s sleep.
Instructions for eating and drinking before your surgery
Do not eat or drink anything after a certain time on the night before your surgery. This exact time is based on your age and any other medical problems that you may have. Your NP will talk with you about what you can and cannot eat before surgery.
If you do not follow the instructions you are given, your surgery may be cancelled.
The Morning of Your Surgery
Take Your Medications
If your doctor or NP instructed you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.
Starting 2 hours before your surgery, do not take any medications.
Do not eat or drink anything the morning of your surgery. This includes water, hard candy, and gum. Take any medication as instructed with a sip of water.
Things to Remember
- Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
- Remove nail polish and nail wraps.
- Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Leave valuable items (such as credit cards, jewelry, or your checkbook) at home.
- Before you’re taken into the operating room, you will need to remove your hearing aids, dentures, prosthetic device(s), wig, and religious articles.
- Wear something comfortable and loose-fitting.
- If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
What to Bring
- Your breathing machine for sleep apnea (such as your CPAP), if you have one.
- Your portable music player, if you choose. However, someone will need to hold it for you when you go into surgery.
- Your cell phone and charger.
- A case for your personal items (such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles), if you have one.
- This resource. Your healthcare team will use this resource to teach you how to care for yourself after your surgery.
Where to Park
For information about parking at Memorial Hospital, read the “Parking at the PACC” section.
Once You’re in the Hospital
You will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar names may be having surgery on the same day.
Get Dressed for Surgery
When it’s time to change for surgery, you will get a hospital gown, robe, and nonskid socks to wear.
Meet With Your Nurse
You will meet with your nurse before surgery. Tell your nurse the dose of any medications (including patches and creams) you took after midnight and the time you took them.
Meet With Your Anesthesiologist
Your anesthesiologist will:
- Review your medical history with you.
- Talk with you about your comfort and safety during your surgery.
- Talk with you about the kind of anesthesia you will receive.
- Answer questions you have about your anesthesia.
Prepare For Your Surgery
You will either walk into the operating room or be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help blood flow in your legs.
Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line, MediPort®, or central line, and you will fall asleep.
Once you’re asleep, your surgery will begin. You won’t feel any pain during your surgery.Back to top
After Your Surgery
The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hospital. You will learn how to safely recover from your surgery. Write down any questions you have and be sure to ask your doctor or nurse.
What to Expect
When you wake up after your surgery, you will be in the Post Anesthesia Recovery Unit (PACU).
You may have a mask over your face that will give you air and help you wake up after surgery. You will be attached to machines that will monitor your body temperature, heart rate, blood pressure, and oxygen level. You may also have dressings (bandages) over your incisions.
It’s normal to feel very tired after surgery. Your PACU nurse will make sure you’re comfortable and answer any of your questions.
Once you’re awake and your pain is under control, you will be taken to your hospital room. Depending on your age and condition, you may be taken to the Pediatric Intensive Care Unit (PICU), the Adult Intensive Care Unit (ICU), or the Neurology Advanced Care Unit (NACU) for close observation and monitoring.
Read our resource Call! Don't Fall! for Pediatric Patients for information about how to avoid falling and stay safe while you’re in the hospital.
After 24 hours, you will be taken to the pediatric or neurology floor for continued care. If you have a bandage over your incision, your doctor will take it off around this time. After the bandage is removed, your incision(s) will be left uncovered.
While you’re in the hospital, you will frequently be asked to move your arms, fingers, toes and legs. Your nurse will check your pupils with a flashlight and ask questions such as “What is your name?”
Commonly Asked Questions
Will I have any pain?
You may have a mild headache or feel discomfort from your incision for the first few days after your surgery. Your nurse will give you pain medication. Please tell your nurse if the medication isn’t helping your pain.
You may have a sore throat after your surgery. This is caused by the breathing tube that was used during your surgery. You will be given cool liquids to drink and lozenges to suck on to help with the discomfort.
How long will I be in the hospital?
Most people stay in the hospital 1 night, but this will depend on your recovery.
Parents can call the inpatient unit at any time. Ask your nurse for the phone number. Because of privacy concerns, staff will only give information to parents or spouses. Please tell friends and other relatives not to call the inpatient unit for information.
When will I be able to eat and drink?
You will be given ice chips to eat after your surgery. You will start with a liquid diet and then progress to solid food.
When will my sutures or staples be removed?
The sutures or staples in your incision will be removed 7 to 10 days after your surgery. They may need to stay in longer if you have had this surgery before. Your doctor or NP will remove them during your follow-up visit at the clinic.
How do I care for my incision?
- Check your incision daily for any signs of redness, swelling, or drainage.
- Keep your incision clean and dry for 5 days after your surgery. Don’t shower for 5 days after your surgery.
When can I shower?
- Your doctor or nurse will tell you when it’s safe to shower after your surgery.
- Keep your incision dry for 5 days following your surgery. If your doctor or nurse says it’s okay to shower before then, wear a shower cap to keep your incision dry.
- When you wash your hair, use a gentle shampoo, such as baby shampoo.
- Don’t let your incision soak in water. Avoid baths, hot tubs, and swimming pools for at least 2 weeks after your surgery.
- Don’t use a hair dryer, creams, ointments, or hair products on your incision until it’s completely healed. This takes about 6 weeks.
When can I go back to work?
Your doctor will tell you when you can go back to work. This depends on your age, type of work, medical condition, and other factors.
When can I go back to school?
You can go back to school as soon as you feel ready. Tell your school nurse that you have an ETV.
When can I go back to my normal activities?
You can participate in all noncontact sports (such as swimming and running), exercise, and go to the gym 2 weeks after your surgery. You can’t participate in any contact (collision) sports (such as football, boxing and wresting) until your neurosurgeon says it’s okay. Remember to wear a helmet to decrease the risk of head injury, if needed. Ask your neurosurgeon for specific guidelines on wearing a helmet.
When can I swim?
Don’t swim for at least 2 weeks after your surgery. If your incision needs more time to heal, you may need to wait longer. Your doctor or NP will tell you when it’s okay to swim at your first follow-up appointment after your surgery.
When can I travel?
Don’t travel on an airplane until your doctor says it’s okay.
What follow-up care will I receive?
You will have regular visits with your neurologist, neurosurgeon, or both. They will monitor the function of your ETV over time.
Do I need to take any precautions when I have an MRI?
No. The magnet in the MRI scanner will not affect your ETV.
What other precautions do I need to take?
You should always wear a MedicAlert® bracelet or necklace stating that you have hydrocephalus with an ETV. If you’re ever seriously ill or hurt and need medical help, it will inform emergency services workers about your ETV.
You can buy a MedicAlert bracelet or necklace at most drug stores. For more information, visit the MedicAlert website at www.medicalert.com.
You should also carry a wallet card at all times that states you have hydrocephalus with an ETV. Your nurse will give you a wallet card to fill out.
When should I call my doctor or NP?
Call your doctor or NP if you’re having any of the following signs and symptoms that your ETV isn’t working properly or you have an infection:
These warning signs can appear quickly. If any of these signs or symptoms develop, call your doctor or NP immediately.
Back to top
If you cannot wake your child, call 911 or go to the nearest emergency room immediately.
If you have any questions or concerns, please talk with your doctor or nurse. You can reach them Monday through Friday from 9:00 am to 5:00 pm at 212-639-7056.
After 5:00 pm, during the weekend, and on holidays, please call 212-639-2000 and ask for the pediatric neurosurgery fellow on call.Back to top
This section contains a list of support services available at MSK, as well as the resources that were referred to throughout this guide. These resources will help you prepare for your surgery and recover safely. Write down any questions you have and be sure to ask your doctor or nurse.
- Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E
- Herbal Remedies and Cancer Treatment
- Information for Family and Friends for the Day of Surgery
- Call! Don't Fall! for Pediatric Patients
Call if you have any questions about anesthesia.
Blood Donor Room
Call for more information if you’re interested in donating blood or platelets.
Bobst International Center
MSK welcomes patients from around the world. If you’re an international patient, call for help arranging your care.
At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.
Many people find that counseling helps them. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed.
Integrative Medicine Service
Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.
Patient and Caregiver Support Program
You may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient and Caregiver Support Program, you’re able to speak with former patients and caregivers.
Call if you have any questions about preauthorization with your insurance company. This is also called preapproval.
Patient Representative Office
Call if you have questions about the Health Care Proxy form or if you have concerns about your care.
Perioperative Nurse Liaison
Call if you have questions about MSK releasing any information while you’re having surgery.
Private Duty Nursing Office
You may request private nurses or companions. Call for more information.
Resources for Life After Cancer (RLAC) Program
At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also help refer you to community agencies and programs, as well as financial resources if you’re eligible.
Tobacco Treatment Program
If you want to quit smoking, MSK has specialists who can help. Call for more information.
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.
American Cancer Society (ACS)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.
275 Seventh Avenue (Between West 25th & 26th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.
Cancer Support Community
Provides support and education to people affected by cancer.
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.
LGBT Cancer Project
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.
National Cancer Legal Services Network
Free cancer legal advocacy program.
National LGBT Cancer Network
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.
Lists Patient Assistance Programs for brand and generic name medications.
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.
Patient Advocate Foundation
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.