Surgical management of non-communicating hydrocephalus in patients: meta-analysis and comparison of endoscopic third ventriculostomy and ventriculoperitoneal shunt

Abstract

Objective: We performed a meta-analysis of reported series of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) for non-communicating hydrocephalus to determine whether comparisons between the outcomes in ETV and VPS approaches are valid.

Methods: Online databases were searched for articles reporting quantifiable outcome data published between 1990 and 2014 pertaining to the surgical treatment of non-communicating hydrocephalus, with no language restrictions. Eight articles meeting predetermined criteria were included. Data were pooled for 5 surgical outcome measures.

Results: Our literature search identified 5 prospective cohort studies and 3 retrospective cohort studies with a cumulative number of 652 patients that compared the ETV with VPS for non-communicating hydrocephalus. Analysis of outcomes favored the approach of ETV in terms of duration of surgery (P < 0.00001), incidence of major complications (RR 0.35, 95% CI: 0.24-0.52), and reoperation rate (OR 0.22, 95% CI: 0.12-0.40), whereas it did not favor either approach in terms of length of stay in hospital (P = 0.052) and improvement of symptoms (P = 0.18, OR 0.71, 95% CI: 0.44-1.16).

Conclusion: ETV and VPS have therapeutic equivalence for non-communicating hydrocephalus, whereas ETV can result in lower surgery time, incidence of postoperative complication, and reoperation rate of hydrocephalus.