Endoscopic third ventriculostomy versus ventriculoperitoneal shunt insertion for the management of pediatric hydrocephalus in African centers – A systematic review and meta-analysis

Abstract

Background: Ventriculoperitoneal shunt (VPS) insertion and endoscopic third ventriculostomy (ETV) are common surgical procedures used to treat pediatric hydrocephalus. There have been numerous studies comparing ETV and VPS, but none from an African perspective. In this study, we sought to compare outcomes from African neurosurgical centers and review the associated complications. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in conducting this study. PubMed, Google Scholar, and African Journal Online were searched. Data on treatment successes and failures for ETV and VPS were pooled together and analyzed with a binary meta-analysis. A clinically successful outcome was defined as no significant event or complication occurring after surgery and during follow-up (e.g., infection, failure, CSF leak, malfunction, and mortality). Seven studies fully satisfied the eligibility criteria and were used in this review. Results: There was no statistically significant difference between the outcomes of ETV and VPS (OR- 0.27; 95% CI −0.39–0.94, P = 0.42). After reviewing the rates of complications of ETV and VPS from the identified studies, four were recurrent. The infection rates of ETV versus VPS were 0.02% versus 0.1%. The mortality rates were 0.01% versus 0.05%. The reoperation rates were 0.05% versus 0.3%, while the rates of ETV failure and shunt malfunction were 0.2% versus 0.2%. Conclusion: This study concludes that there is no significant difference between the outcomes of ETV and VPS insertion.

Outcomes of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in the treatment of paediatric hydrocephalus: Systematic review and meta-analysis

“…In summary, our study’s findings align with those of previous research in the field. A Jesuyajolu et al study [ 16 ] similarly observed no significant difference between VPS and ETV treatments, although they noted a slightly higher mortality risk of 0.05% in VPS compared to 0.01%. Sheik et al study [ 17 ], which involved 100 patients treated with either VPS or ETV, suggested that VPS might carry a higher risk of long-term complications.…”

Endoscopic Third Ventriculostomy in the Pediatric Patient

“…ETV was associated with a statistically significant lower risk of procedure-related infection compared to shunt [21]. It is generally accepted that true differences exist regarding complication rates among centers or among individual neurosurgeons, according to their personal experience [59,65,66].…”

Endoscopic Third Ventriculostomy for the Management of Obstructive Hydrocephalus in Pregnancy: A Case Report and Review of the Literature

“…Recent comparisons between these interventions in adult and pediatric populations have shown that ETV has lower complication rates, particularly in postoperative infections and hematomas, although no differences were noted in mortality or postoperative success rates. 7,8 In pregnant patients, ETV appears to offer several advantages over shunt placement. First, it eliminates the need for foreign body implantation, reducing the risk of infection.…”

“…ETV offers an alternative CSF flow pathway, establishing communication between the third ventricle and adjacent compartments near the brainstem. 6 7 8 This procedure demands precision in identifying anatomical landmarks such as the foramen of Monro and the basilar artery to prevent complications such as hemorrhage and neurological injury. Moreover, factors such as ventricular thickening or scarring may impede stoma creation and diminish ETV success rates.…”

“…Recent comparisons between these interventions in adult and pediatric populations have shown that ETV has lower complication rates, particularly in postoperative infections and hematomas, although no differences were noted in mortality or postoperative success rates. 7 8 …”