# Endovascular balloon usage in endoscopic third ventriculostomy for hydrocephalus during a national shortage: case series and technical note

## TL;DR

This paper discusses using alternative balloons during brain surgery for hydrocephalus when the usual device is unavailable.

## Contribution

The study demonstrates the viability of using cardiac and neurovascular balloons as alternatives to the Neuroballoon in endoscopic third ventriculostomy.

## Key findings

- The Scepter balloon was effective but presented technical challenges due to its pliability.
- The Cardiac TREK balloon was both effective and easier to manage endoscopically at a lower cost.
- Non-neuroendoscopic balloons can be used successfully for ETV dilation during Neuroballoon shortages.

## Abstract

Endoscopic third ventriculostomy (ETV) is a well-established surgical technique for treating hydrocephalus. Many providers have transitioned to utilizing the specialized Neuroballoon for the stoma dilation in ETV; however, these devices are intermittently unavailable during supply chain shortages. We present the experience of employing cardiac angioplasty and neurovascular balloons as substitutes for the Neuroballoon in 3 patients. The scepter balloon (Microvention), priced at $1800 compared to the standard $300 Neuroballoon (Integra), proved effective, but its pliability presented technical challenges. The substantial cost differential compared to a Neuroballoon ($300) raises economic considerations. The Cardiac TREK balloon (Abbott) was similarly effective, while also being easier to manage endoscopically and cheaper at $158. These experiences support the viability of non-neuroendoscopic specialized balloons as alternatives for ETV dilation of the floor of tuber cinereum.