Concierge neurosurgery · UK
Endoscopic third ventriculostomy, the keyhole alternative to a shunt.
For the right obstructive hydrocephalus, ETV creates an internal CSF bypass and leaves no hardware behind — 60 to 70% of well-selected patients stay shunt-free long-term. Selection is everything.
Why patients choose us
- 01
A consultant neurosurgeon, in a proper theatre
Not a general list and not a training case. A named paediatric or adult neurosurgeon at an SBNS/BPNS unit, with intra-operative neuroendoscopy and full ICU cover.
- 02
Selection before surgery, honestly
ETV works brilliantly in the right patient and fails in the wrong one. We use the ETV Success Score and imaging to say who benefits — and who is better served by a shunt.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private ETV costs in the UK.
Indicative ranges across our partner neurosurgical units. Send the details and we quote firm figures across two or three options.
In short
A straightforward adult ETV in our network: £14,000–£22,000, home in three to five nights.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| ETV — adult, straightforward | £14,000–£22,000 | 60–90 min | 3–5 nights |
| ETV — paediatric, straightforward | £16,000–£26,000 | 60–90 min | 3–5 nights |
| ETV plus choroid plexus cauterisation | £18,000–£30,000 | 90–120 min | 3–5 nights |
| Redo ETV (stoma closure) | £15,000–£24,000 | 60–90 min | 3–5 nights |
| Pre-operative MRI (CSF flow protocol) | £650–£1,100 | 45 min | 24–48 h |
| Neurosurgical consultation only | £300–£600 | 45 min | Same visit |
Prices vary by unit, by which neurosurgeon does the case, by whether choroid plexus cauterisation is added, and by ICU length of stay. We come back with a firm quote within one working day.
The problem
The right operation for the right hydrocephalus.
ETV is transformative when the anatomy is right and disappointing when it is not. The commonest error is offering it to the wrong patient — usually one with communicating or post-haemorrhagic hydrocephalus.
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Is it really obstructive?
A CSF-flow MRI confirms where the blockage sits. ETV works for obstruction, not for communicating hydrocephalus.
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ETV or shunt?
The ETV Success Score gives an honest probability of shunt-free survival before you consent to anything.
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Who will follow you up?
A named neurosurgeon for the three-month MRI and for any late failure years later — the long game matters more than the operation.
The journey
From enquiry to the three-month MRI — what happens, in order.
One neurosurgeon from first message through ICU discharge to the follow-up scan.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
Theatre and neuro-ICU
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. Symptoms, imaging so far, and whether a shunt has ever been placed or considered.
- 02
Before
We come back with a recommendation
Within one working day: whether ETV is likely to succeed, whether a shunt is a better fit, and an indicative price. ETV Success Score used in paediatrics.
- 03
Before
We arrange the appointment
Usually within one to two weeks. Anticoagulants are reviewed with the team and pre-operative MRI is booked if not already done.
- 04
On the day
Arrival at the neurosurgical unit
Admission, consent and a chat with the neurosurgeon and anaesthetist. General anaesthetic — no sedation-only option for this procedure.
- 05
On the day
The procedure itself
60 to 90 minutes in a neurosurgical theatre. A single burr hole, rigid or flexible neuroendoscope, blunt fenestration of the third ventricular floor and Liliequist’s membrane.
- 06
On the day
Overnight on the neuro ICU
24 to 48 hours of hourly GCS observations, electrolyte checks for SIADH, and a wound review. Most patients then move to the ward.
- 07
After
Recovery and stoma-patency MRI
Home in three to five days. A CSF-flow MRI at three months confirms the stoma is open. Family taught the signs of late failure.
Typical end-to-end: 2–3 weeks from enquiry to theatre. Stoma-patency MRI: 3 months.
When it helps
When ETV is the right operation.
The indications where ETV shines, plus the red flag that means a same-day neurosurgical assessment rather than an appointment.
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Aqueductal stenosis
The classic ETV indication — a blocked cerebral aqueduct with dilated lateral and third ventricles and a normal fourth. Best success rates of any group.
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Tectal glioma-related hydrocephalus
A low-grade tumour of the tectal plate blocking CSF flow. ETV treats the hydrocephalus without touching the tumour itself.
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Post-posterior-fossa-tumour hydrocephalus
Once the tumour is resected, ETV is often preferred to a shunt for residual obstructive hydrocephalus.
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Chiari-related hydrocephalus
Selected cases where a Chiari malformation is driving obstructive hydrocephalus at the fourth ventricular outlet.
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Shunt malfunction — the right patient
A previously shunted patient with obstructive anatomy may be shunt-free after ETV, avoiding lifelong hardware.
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Occasional normal-pressure hydrocephalus
A small, carefully selected group of NPH patients — evidence is mixed and shunting remains the mainstream option.
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Congenital obstructive hydrocephalus
Infants and children with obstructive anatomy — often combined with choroid plexus cauterisation to improve success.
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Red flag: sudden late failure
A previously well ETV patient with new headache, vomiting or drowsiness must be assessed same-day — the stoma can close abruptly, years on.
Procedure options
ETV is not one operation.
What each option on the table actually involves — and which fits which anatomy.
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ETV — rigid neuroendoscope
Storz or Wolf rigid endoscope through a single right frontal burr hole. The standard technique for a favourable anatomy.
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ETV — flexible neuroendoscope
Flexible scope for awkward anatomy — a narrow foramen of Monro, or when a second window (septostomy) is needed.
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ETV plus CPC
ETV combined with choroid plexus cauterisation. Improves shunt-free survival in infants, particularly under one year (CURE Uganda experience).
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Redo ETV
For late stoma closure — often technically straightforward if the original tract is preserved, and worth trying before a shunt.
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Septostomy at the same sitting
A window through the septum pellucidum to connect asymmetric ventricles — added when only one side is dilated.
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Biopsy at the same sitting
A tumour of the pineal region or third ventricle can be biopsied through the same endoscope during the ETV.
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Ventriculoperitoneal shunt (alternative)
The alternative when ETV is unlikely to succeed — communicating hydrocephalus, infants under six months, prior haemorrhage or infection.
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Consultation only
An honest discussion of whether ETV, a shunt or watchful waiting fits best — no obligation.
Our vetted UK network
A small panel of neurosurgeons, we picked them.
Consultant paediatric and adult neurosurgeons at SBNS/BPNS units in London, Cambridge, Oxford, Bristol, Manchester and Edinburgh. Introductions are made privately, once we understand the case.
Selection criteria
How we choose every neurosurgeon in our network.
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Consultant paediatric or adult neurosurgeons at SBNS/BPNS units
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ETV Success Score used routinely in paediatric decision-making
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Neuro-ICU cover for the first 24 to 48 hours post-operatively
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Long-term follow-up with CSF-flow MRI and family education for late failure
Safety and recovery
What to expect afterwards — honestly.
ETV is generally safe in experienced hands, but the risks are not the same as a routine day case. Basilar artery injury, hypothalamic disturbance and late stoma closure all deserve a proper conversation before consent.
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A general anaesthetic, always
ETV is not a sedation procedure. A neuro-anaesthetist manages ventilation, blood pressure and intra-operative CSF loss throughout.
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Basilar artery injury is rare but catastrophic
The basilar artery sits directly beneath the third ventricular floor. Injury is under 1% in experienced hands but can be fatal — one reason surgeon experience matters more than anything else.
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Memory and hypothalamic dysfunction
Injury to the fornix or hypothalamus during scope passage can cause short-term memory disturbance, appetite changes or endocrine problems. Usually transient, occasionally permanent.
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CSF leak and meningitis
A small risk of CSF leak from the burr-hole wound and meningitis in the first two weeks. Fever, neck stiffness or clear fluid from the wound needs same-day review.
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SIADH and hyponatraemia
A transient drop in sodium from the syndrome of inappropriate ADH release is common in the first 48 hours — the reason for the neuro-ICU electrolyte checks.
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Cumulative stoma closure
The most important number: 20 to 30% of ETV stomas close over five years. Success does not mean cured — it means monitored.
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No hardware, no shunt infection
The great advantage over a shunt: there is nothing inside you to infect, block or migrate. No lifelong hardware means no shunt revision surgery.
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Late failure can be sudden
Unlike a slowly failing shunt, a closing ETV stoma can decompensate quickly. Patient and family education about the warning signs is essential.
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Red flags
New headache, vomiting, drowsiness, double vision or a seizure in an ETV patient — days, months or years later — is an emergency, not a clinic booking.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever technique was used, the note the neurosurgeon sends you keeps to the same shape.
A quiet reminder
Neurosurgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication and ETV Success Score
Why ETV was chosen — aqueductal stenosis, tectal glioma, post-tumour hydrocephalus — and, in paediatrics, the calculated ETVSS.
- 02 Technique
Approach, scope and fenestration
Whether a rigid or flexible endoscope was used, the burr-hole site, the fenestration point on the third ventricular floor, and whether Liliequist’s membrane was opened.
- 03 Findings
Anatomy, CPC and any biopsy
Notes on the ventricular anatomy, whether choroid plexus cauterisation or septostomy were added, and the results of any endoscopic biopsy taken through the same tract.
- 04 Impression
ICU plan, MRI schedule and late-failure counselling
Read this first: how long in ICU, when the three-month stoma-patency MRI is booked, and what warning signs of late failure should trigger same-day review.
Recognised by major UK insurers
Cover for ETV varies by insurer and by indication — usually funded when medically indicated for obstructive hydrocephalus. We confirm cover before booking.
Frequently asked
Everything families ask about ETV.
Quick answers on selection, success rates, ICU stay and what to watch for years later.
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What is an endoscopic third ventriculostomy?
ETV is a keyhole neurosurgical procedure that creates a small window in the floor of the third ventricle so cerebrospinal fluid can bypass a blockage and drain internally into the interpeduncular cistern. It is the main alternative to a ventriculoperitoneal shunt for obstructive (non-communicating) hydrocephalus.
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Who is a good candidate for ETV rather than a shunt?
ETV works best in obstructive hydrocephalus with clear blockage — aqueductal stenosis, tectal gliomas, post-tumour hydrocephalus in the posterior fossa, and selected Chiari cases. In children, decisions use the ETV Success Score (age, aetiology, previous shunt). It works poorly in post-haemorrhagic or post-infective hydrocephalus, in communicating hydrocephalus, and in infants under six months.
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How successful is ETV?
In appropriately selected patients — particularly aqueductal stenosis in older children and adults — around 60 to 70% remain shunt-free long-term. In infants under one year, combining ETV with choroid plexus cauterisation (ETV+CPC) improves shunt-free survival substantially, as shown by the CURE Uganda experience.
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How much does a private ETV cost in the UK?
Roughly £14,000–£22,000 for a straightforward adult ETV, £16,000–£26,000 in paediatrics, and £18,000–£30,000 when combined with choroid plexus cauterisation. A pre-operative CSF-flow MRI is £650–£1,100. We confirm a firm figure within one working day.
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What are the risks of ETV?
The most feared complication is basilar artery injury — rare (under 1%) but potentially catastrophic. Others include memory or hypothalamic dysfunction from forniceal injury, CSF leak, meningitis, transient SIADH with hyponatraemia, and, most importantly, cumulative stoma closure — 20 to 30% of stomas close over five years.
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How long is the hospital stay and recovery?
Most patients spend 24 to 48 hours on the neuro-ICU for GCS and electrolyte monitoring, then move to the ward and go home within three to five days. Return to normal activity is usually within two to four weeks, guided by the neurosurgeon.
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Why is a follow-up MRI needed at three months?
A CSF-flow MRI at around three months confirms the stoma is patent — a flow void through the fenestration means it is working. It also gives a baseline for later comparison if symptoms return.
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What should we watch for years after the procedure?
Late stoma closure can happen years after a successful ETV, and can decompensate quickly. New headache, vomiting, drowsiness, double vision or seizure in an ETV patient is an emergency and needs same-day neurosurgical assessment — not a clinic appointment.
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