Title: Endoscopic Third Ventriculostomy And Choroid Plexus Cauterization Versus Ventriculoperitoneal Shunt In Treatment Of Pediatric Hydrocephalus: A Systematic Review And Meta-analysis
Authors: Muhammad Hassan Waseem, Zain ul Abideen, Sania Aimen, Justin Chen, Jamir Pitton Rissardo, Brandon Lucke-Wold
Conference: 2025 CNS Annual Meeting, Los Angeles, CA
Introduction
Endoscopic third ventriculostomy with choroid plexus cauterization (EVT/CPC) and ventriculoperitoneal shunt (VPS) are common surgical procedures to treat pediatric hydrocephalus. The combined EVT/CPC has emerged as an effective alternative to VPS.
Objectives
This study aims to compare the efficacy and safety of combined ETV and CPC with VPS for pediatric hydrocephalus treatment.
Methods
PubMed, ScienceDirect, and the Cochrane Library were searched from inception till October 2024. The PRISMA guidelines were followed. The Risk Ratios (RRs) with 95% Confidence interval (CI) were pooled under the random effects model using the Review Manager 5.4.1 for the dichotomous outcomes. The primary outcome was success rate. Secondary endpoints were postoperative complications, infections, mortality, reoperation, and failure rate. The quality of studies was assessed through the Newcastle Ottawa Scale and the Cochrane RoB 2.0 tool. The Leave-one-out sensitivity analysis was performed to investigate the cause of heterogeneity. Publication bias was assessed visually through funnel plots and statistically through Egger’s regression test.
Results
Eight studies, including 604 patients, were included in this meta-analysis. The success rate was comparable between the ETV/CPC and VPS groups (RR= 0.96; 95%CI: [0.86,1.08]; p=0.53; I2=22%). The postoperative complications rate (RR= 0.67; 95%CI: [0.44,1.03]; p= 0.07; I2=0%) and the failure rate (RR=0.91; 95%CI: [0.48,1.71]; p=0.77; I2=61%) decreased in the EVT/CPC group but the results were statistically insignificant. Other outcomes including infections (RR=0.58; 95%CI:[0.24,1.40]; p=0.23; I2=14%), mortality (RR= 1.14; 95%CI:[0.47,2.73]; p= 0.77; I2= 0%), and reoperation rate (RR= 0.71; 95%CI:[0.14,3.75]; p= 0.69; I2=76%) were also comparable between the 2 arms.
Conclusions
Endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) shows a comparable success rate to ventriculoperitoneal shunt (VPS) in treating pediatric hydrocephalus, with no significant differences in postoperative complications, infections, mortality, or reoperation rates. Despite slight reductions in complications and failure rate with ETV/CPC, these findings were not statistically significant.
Citation
Waseem MH, Abideen Z, Aimen S, Chen J, Pitton Rissardo J, Lucke-Wold B. Endoscopic Third Ventriculostomy And Choroid Plexus Cauterization Versus Ventriculoperitoneal Shunt In Treatment Of Pediatric Hydrocephalus: A Systematic Review And Meta-analysis. CNS Annual Meeting 2025;2025:6585. https://www.cns.org/poster-search?id=6585
Figure. Forest plots comparing ETV+CPC and VP shunt in pediatric hydrocephalus for success rate, postoperative complications, and infection outcomes.
Figure. Forest plots comparing ETV+CPC and VP shunt in pediatric hydrocephalus for mortality, reoperation, and failure rates.