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Meta-Analysis
. 2025 Apr 1;48(1):343.
doi: 10.1007/s10143-025-03471-8.

The impact of neuroendoscopic drainage in intraventricular hemorrhage: an updated meta-analysis

Frederico de Lima Gibbon  1   2 , Rafaela Jucá Lindner  3 , Matheus Rech  4 , Guilherme Gago  1   2 , Lucca Biolcati Palavani  5 , Gabriel Semione  6 , Felipe Salvagni Pereira  7 , Antônio Delacy Martini Vial  1 , Feres Chaddad-Neto  8   9
Affiliations
Meta-Analysis

The impact of neuroendoscopic drainage in intraventricular hemorrhage: an updated meta-analysis

Frederico de Lima Gibbon et al. Neurosurg Rev. .

Abstract

External ventricular drainage (EVD) is a mainstay for intraventricular hemorrhage (IVH) treatment, improving ventricular clearance and reducing mortality but with suboptimal complications and morbidity. Meanwhile, several studies have shown that neuroendoscopic drainage (NED) provides superior results and is a promising therapy. Thus, we aimed to compare NED and EVD in patients with IVH. A systematic literature review was conducted using Embase, PubMed, and Cochrane databases. The primary outcome was shunt dependency. Secondary outcomes were infection, length of intensive care unit (ICU) and hospital stay, mortality, and functional outcome. Inclusion criteria: studies comparing NED and EVD with predefined outcomes. Exclusion criteria: age < five years. Statistical analysis was performed using RStudio 2024.04.1 + 748. Sensitivity analysis was performed with subgroup analysis. The risk of bias was assessed using ROBINS-I and RoB-2. Of 234 potential articles, 17 met our criteria, involving 1043 patients, with 495 undergoing NED and 548 receiving only EVD. Patients who underwent NED had lower odds of shunt dependency (OR 0.17; 95% CI 0.12,0.25; p < 0.001), infection (OR 0.29; 95% CI 0.16,0.53; p < 0.001), and mortality at one month (OR 0.44; 95% CI 0.20,0.96; p = 0.039) and six months (OR 0.31; 95% CI 0.16,0.58; p < 0.001), shorter hospital (MD -6.02; 95% CI -9.58,-2.45; p < 0.001) and ICU stay (MD -6.64; 95% CI -10.46,-2.83; p < 0.001), and better functional outcomes according to Glasgow Outcome Scale (MD -0.65; 95% CI -0.98,-0.32; p < 0.001) and modified Rankin Scale (MD -1.25; 95% CI -1.90,-0.60; p < 0.001) compared to patients who underwent EVD. To confirm the robustness of the results, we performed sensitivity analyses with subgroups of the RCT, which also showed significant superiority of NED over EVD. Our results suggest that NED has a positive impact on patients with IVH and may be a breakthrough intervention in this scenario.

Keywords: Endoscopic brainwashing; Intraventricular hemorrhage; Meta-analysis; Neuroendoscopic surgery; Shunt dependency; Systematic review; Ventricular lavage.

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Conflict of interest statement

Declarations. Ethics approval: This study is a systematic review and did not require the approval of the Ethics Committee of the Federal University of São Paulo. Competing interests: The authors declare no competing interests.

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