• World Neurosurg · Sep 2019

    Review Meta Analysis

    Endoscopic Third Ventriculostomy versus Ventriculoperitoneal Shunt in Patients with Obstructive Hydrocephalus: A Meta-Analysis of Randomized Controlled Trials.

    • Liang Lu, Hongwu Chen, Shaotao Weng, and Yimin Xu.
    • Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, PR China.
    • World Neurosurg. 2019 Sep 1; 129: 334-340.

    ObjectiveEndoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) are 2 surgical methods used for the treatment of obstructive hydrocephalus. However, the efficacy and safety of these 2 procedures are unknown. Therefore we conducted a meta-analysis to compare the safety and efficiency of ETV and VPS in patients with obstructive hydrocephalus.MethodsIn January 2019, a comprehensive search strategy of 3 electronic databases was initiated. A systematic search from database inception to December 30, 2018, on clinical outcome, safety, and efficiency of ETV and VPS in the treatment of obstructive hydrocephalus was conducted. The following electronic databases were searched: PubMed, Embase, and Cochrane Library for related randomized controlled trials (RCTs). Main outcomes included postoperative hematoma, postoperative infection, postoperative cerebrospinal fluid leakage, blockage rate, and mortality.ResultsOf the 546 studies identified, 4 RCTs involving 250 patients met our inclusion criteria. The pooled results show that ETV was associated with lower incidence of postoperative infection (risk ratio [RR] 0.09, 95% confidence interval [CI]: 0.02-0.32, P = 0.0002); postoperative hematoma (RR 0.26, 95% CI: 0.08-0.88, P = 0.03); and blockage rate (RR 0.28, 95% CI: 0.13-0.60, P = 0.001) compared with VPS. Compared with VPS, ETV had no significant effect on incidence rate of postoperative cerebrospinal fluid leakage (RR 2.00, 95% CI: 0.30-13.16, P = 0.47) and mortality rates (RR 0.19, 95% CI: 0.03-1.09, P = 0.06), but there have been no deaths in patients treated with ETV.ConclusionsOn the basis of the meta-analysis of RCTs evaluating ETV and VPS, the incidence of complications and mortality was higher with the VPS procedure, and therefore greater benefits can be achieved using ETV.Copyright © 2019. Published by Elsevier Inc.

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