LAUSR

Optimized management of pediatric hydrocephalus remains the subject of debate. Ventriculoperitoneal shunt is largely considered the standard of care. However, the advancements and introduction of new cerebrospinal fluid (CSF) diversion approaches including the use of endoscopic third ventriculostomy (ETV) offer appealing alternatives that have been reported in numerous observational series. This systematic literature review was performed according to the PRISMA guidelines. Eligible studies were identified through a search of PubMed until October 2018. A random-effects model meta-analysis was conducted and the I-square was used to assess heterogeneity. Fourteen studies including 8419 patients were identified. Patients in the ETV group had a statistically significant lower risk of infection compared to shunt (OR: 0.19; 95% CI: 0.07-0.53; I2: 0%). All-cause mortality (OR: 0.77; 95% CI: 0.35-1.68; I2: 0%), postoperative CSF leak (OR: 1.53; 95% CI: 0.37-6.31; I2: 0%), and reoperation rates were similar between the 2 study groups. (OR: 0.72; 95% CI: 0.39-1.32; I2: 93.5%). Subgroup analyses for reoperation demonstrated that ETV in Africa (OR: 0.13; 95% CI: 0.03-0.48; I2: 0%) and Europe (OR: 0.39; 95% CI: 0.30-0.52; I2: 1.4%) was associated with significantly lower odds of reoperation compared to shunt, but not in USA/Canada (OR: 1.49; 95% CI: 0.85-2.63; I2: 86.2%). Metaregression analyses of age and duration of follow-up did not affect reoperation rates. ETV was associated with a statistically significant lower risk of procedure-related infection compared to shunt. All-cause mortality, CSF leak, and reoperation rates were similar between the study groups. Subgroup analysis based on the geographic region showed that ETV is associated with statistically significant lower odds for reoperation in Europe and Africa, but not in USA/Canada. Future RCTs are needed to validate the results of this study and elucidate the cause of this heterogeneity.