Evaluation of Outcome of Endoscopic Third Ventriculostomy and Ventricular Shunt in Paediatric Congenital Obstructive Hydrocephalus: A Systematic Review and Meta-Analysis

Abstract

Abstract Background Hydrocephalus is one of the most common paediatric neurological diseases. The mainstay of the treatment of hydrocephalus has long been a shunt placement for CSF diversion, but recent years have seen the rise of alternative procedures such as endoscopic third Ventriculostomy (ETV), which provides similar efficacy in selected patients. However, there is a controversy regarding the outcome, efficacy and safety of these two surgical methods. Aim and Objectives The aim of this study is to evaluate the outcome and the safety of both endoscopic third ventriculostomy and ventricular shunt in treatment of congenital obstructive hydrocephalus in paediatric population. Subjects and Methods A systematic review and Meta-Analysis were conducted including database (PubMed and Cochrane Central Register of Controlled Trials databases). Literature search between 2000 and 2021 was performed in accordance with PRISMA guidelines. Eligible studies were included if they including paediatric patients (<18 years old) with congenital obstructive hydrocephalus treated with either ETV or ventriculoperitoneal shunt. Results Both procedures (ETV and VP shunt) proved to be effective clinically and radiographically with mean success rate. The pooled analysis indicated no statistically significant difference between the two interventions in terms of success (OR = 1.02, 95% CI [0.80, 1.29], Test for overall effect: Z = 0.14, (P = 0.89). The I2 value was 85%, indicating substantial heterogeneity. ETV tends to have lower complication rates but the difference did not reach statistical significance (OR = 0.66, 95% CI [0.42, 1.03], test for overall effect: Z = 1.83(P = 0.07) with no evidence of heterogeneity among the included studies (I² = 0%). Conclusion Both ETV and VPS are effective in treating congenital obstructive hydrocephalus, but their success and complication rates vary based on patient characteristics, age and the type of hydrocephalus. ETV tends to have lower complication rates compared to VPS however, both procedures require long-term follow up.