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PubMed This is a summary of 7 peer-reviewed journal articles Updated
Neurosurgery · Long-standing Overt Ventriculomegaly in Adults

Does Surgery Fully Reverse LOVA Symptoms in Adults?

At a Glance

LOVA surgery may improve or stabilize symptoms, but it does not reliably reverse every problem. Walking often responds best, while memory and urinary recovery vary. Symptoms can return months or years later if the fluid pathway closes or a shunt malfunctions, so long-term monitoring is essential.

In this answer

4 sections

01

Is Surgery Always the Answer?

02

How Specific Symptoms Respond

03

ETV vs. Shunting: Understanding the Options

04

Brain Scans and Long-Term Monitoring

Surgery may improve or stabilize symptoms of Long-standing Overt Ventriculomegaly in Adults (LOVA), but it does not reliably reverse every symptom. “Improvement” means a symptom gets noticeably better, while “stabilization” means the surgery halts its progression so it stops getting worse. The degree of recovery depends heavily on the specific symptom, how long you have had it, and other individual health factors.

Is Surgery Always the Answer?

Not everyone with enlarged ventricles needs surgery. Treatment decisions depend on whether your symptoms are progressing and if there is evidence of impaired cerebrospinal fluid (CSF) circulation [1]. Before proceeding with surgery, your doctor will also want to rule out other possible causes for your memory or walking issues, such as sleep apnea, medication side effects, or other neurologic conditions.

How Specific Symptoms Respond

LOVA affects individuals differently, and symptom recovery happens at different rates. Because most research on LOVA comes from observational studies of specific surgical groups, percentages should be viewed as general trends rather than guaranteed outcomes for any one person.

  • Walking and Balance (Gait): Gait difficulties often show the strongest response to surgery. In one study tracking 40 adults with LOVA over an average of six years, all patients reported some improvement in their gait and balance [2]. Objective improvements in walking speed can begin early and continue over several months [3].
  • Urinary Symptoms: Issues like urinary urgency improve moderately. In the same 40-person study, 60% of patients reported improvements in their urinary symptoms [2].
  • Memory and Cognitive Deficits: Cognitive recovery is less predictable. Research indicates that just over half of patients (about 52.5% in the 40-patient study) experience subjective memory improvements [2]. Recovery may be influenced by cognitive reserve—a measure of your baseline intellectual function before symptoms worsened [4]. While some memory and spatial skills can improve immediately after surgery, some deficits may persist [4]. The duration of your symptoms, age, and mood can also influence your cognitive recovery.

ETV vs. Shunting: Understanding the Options

The goal of surgery is to improve CSF circulation. Broad analyses suggest that over 80% of treated patients experience overall improvement or a halt in symptom progression, though this does not mean complete reversal of all damage [5][6].

There are two main surgical options:

  • Endoscopic Third Ventriculostomy (ETV): Creates an alternate internal pathway for fluid to bypass the blockage.
  • Ventriculoperitoneal (VP) Shunt: Diverts fluid through a tube and valve system into the abdomen.

While broad analyses suggest both procedures have roughly similar overall success rates for LOVA, the choice depends on your specific anatomy, CSF absorption, and surgeon experience [5][6]. Studies generally report higher complication rates for VP shunts (such as over-drainage, infection, or mechanical malfunction) compared to ETV, but ETV is not anatomically suitable for every patient [5][6]. Both surgeries carry risks, including bleeding, infection, and failure to improve symptoms.

Brain Scans and Long-Term Monitoring

If you look at your follow-up MRIs, your ventricles may still look enlarged. In many LOVA patients, clinical symptoms improve even when there is no major measurable reduction in ventricle size [7]. Therefore, MRI findings are interpreted together with your symptoms and neurologic examination; unchanged ventricular size alone does not prove the surgery failed.

However, late surgical failure can occur. Between 10% and 18% of patients may require a second surgery months or years later because the ETV closes or the shunt malfunctions [2][6].

Warning Signs of Late Failure

Because of the risk of delayed failure, continuous, long-term monitoring by your neurosurgical team is critical. Contact your surgical team immediately or seek emergency care if you or your family notice any of the following red flags:

  • New or worsening headaches
  • Repeated vomiting
  • Increasing sleepiness, lethargy, or confusion
  • Rapid worsening of your gait or memory
  • New visual changes
  • Fever, or redness/drainage along a shunt tract

Common questions in this guide

Can surgery completely reverse symptoms caused by LOVA?
Not always. Surgery may improve symptoms or stop them from getting worse, but recovery depends on the type of symptom, how long it has been present, and other health factors. Some problems, especially memory and thinking difficulties, may persist.
Which LOVA symptoms are most likely to improve after surgery?
Walking and balance problems often show the strongest improvement, and walking speed may improve early and continue to improve over several months. Urinary urgency improves in some people. Memory and thinking problems are less predictable and may depend on age, mood, symptom duration, and baseline thinking ability.
How do doctors decide between endoscopic third ventriculostomy and a VP shunt for LOVA?
Both procedures aim to improve cerebrospinal fluid flow and have similar overall improvement rates in broad studies. The choice depends on brain anatomy, how well the body absorbs fluid, and the surgeon’s experience. VP shunts may have more complications such as over-drainage, infection, or mechanical failure, while endoscopic third ventriculostomy is not suitable for everyone.
Can symptoms improve even when my ventricles still look enlarged on an MRI?
Yes. Many people improve without a major reduction in ventricle size. Doctors interpret the scan together with symptoms and a neurologic examination, so unchanged ventricles alone do not prove that surgery failed.
When can LOVA surgery fail, and what warning signs should I watch for?
Late failure can happen months or years after surgery if an endoscopic third ventriculostomy closes or a VP shunt becomes blocked or stops working. New or worsening headaches, repeated vomiting, increasing sleepiness or confusion, rapidly worsening walking or memory, new vision changes, fever, or redness or drainage along a shunt path require immediate contact with the surgical team or emergency care.
How soon might I notice improvement after LOVA surgery?
Walking speed can begin improving early and continue to improve over several months. Some memory and spatial skills may improve soon after surgery, but other thinking problems can persist, so recovery timing differs from person to person.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What baseline tests for my memory and walking will we use to accurately measure my recovery?
  2. 2.Have we ruled out other potential causes for my memory and walking symptoms?
  3. 3.Based on my specific MRI and fluid flow, am I a better candidate for an ETV or a VP shunt, and why?
  4. 4.If my symptoms improve but my ventricles stay enlarged on follow-up MRIs, how will we monitor whether the surgery is still functioning?
  5. 5.What specific warning signs should my family and I watch for that might indicate the ETV or shunt is failing?

Questions For You

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Related questions

Does a Tectal Glioma Need Cancer Treatment or Fluid Bypass?How Can Adults Have Aqueductal Stenosis Without Symptoms?How Common Is Aqueductal Stenosis? Incidence RatesHow Is the ETV Success Score Calculated for Hydrocephalus?What Does an Evans Index Over 0.3 Mean on an MRI?When Is a CINE MRI Considered for Aqueductal Stenosis?What Is L1 Syndrome in Babies With Aqueductal Stenosis?Aqueductal Webbing vs. Narrowing: What's the Difference?Why Can ETV Failure Become a Sudden Medical Emergency?Why Combine CPC With ETV in Infants With Hydrocephalus?

References

References (7)
  1. 1

    Surgical treatment of long-standing overt ventriculomegaly in adults (LOVA).

    Ved R, Leach P, Patel C

    Acta neurochirurgica 2017; (159(1)):71-79 doi:10.1007/s00701-016-2998-7.

    PMID: 27807671
  2. 2

    Long-standing Overt Ventriculomegaly in Adults and Endoscopic Third Ventriculostomy, the Perfect Treatment for the Proper Diagnosis.

    Bianchi F, Ducoli G, Moriconi F, et al.

    World neurosurgery 2021; (149()):104-110 doi:10.1016/j.wneu.2021.02.016.

    PMID: 33578027
  3. 3

    Cognitive and gait outcomes after primary endoscopic third ventriculostomy in adults with chronic obstructive hydrocephalus.

    Zwimpfer TJ, Salterio N, Williams MA, et al.

    Journal of neurosurgery 2022; (136(3)):887-894 doi:10.3171/2021.3.JNS203424.

    PMID: 34534954
  4. 4

    Cognitive improvement after endoscopic third ventriculostomy surgery in long-standing overt ventriculomegaly in adults.

    Campanella F, Piccolo D, Sebastianutto G, et al.

    Journal of neurosurgery 2025; (142(3)):875-883 doi:10.3171/2024.6.JNS232969.

    PMID: 39393104
  5. 5

    Long-Standing Overt Ventriculomegaly in Adults: A Systematic Review and Meta-Analysis of Endoscopic Third Ventriculostomy Versus Ventriculoperitoneal Shunt as First-Line Treatment.

    Gillespie CS, Fang WYS, Lee KS, et al.

    World neurosurgery 2023; (174()):213-220.e2 doi:10.1016/j.wneu.2023.03.064.

    PMID: 36958719
  6. 6

    Clinical and surgical outcome of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in patients with Long-Standing Overt Ventriculomegaly in Adults (LOVA): a systematic review.

    Montemurro N

    Neurological research 2024; (46(1)):81-88 doi:10.1080/01616412.2023.2257461.

    PMID: 37722694
  7. 7

    Long-Standing Overt Ventriculomegaly in Adults (LOVA): Diagnostic Aspects, CSF Dynamics with Lumbar Infusion Test and Treatment Options in a Consecutive Series with Long-Term Follow-Up.

    Tuniz F, Fabbro S, Piccolo D, et al.

    World neurosurgery 2021; (156()):e30-e40 doi:10.1016/j.wneu.2021.08.068.

    PMID: 34425295

This page is for informational purposes only and does not constitute medical advice. Discuss your symptom changes, MRI findings, surgical options, risks, and follow-up plan with your neurosurgical team.

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