title: Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 4: Cerebrospinal fluid shunt or endoscopic third ventriculostomy for the treatment of hydrocephalus in children.
abstract: OBJECTIVE
  The objective of this systematic review was to examine the existing literature comparing CSF shunts and endoscopic third ventriculostomy (ETV) for the treatment of pediatric hydrocephalus and to make evidence-based recommendations regarding the selection of surgical technique for this condition.
  
  
  METHODS
  Both the US National Library of Medicine and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words specifically chosen to identify published articles detailing the use of CSF shunts and ETV for the treatment of pediatric hydrocephalus. Articles meeting specific criteria that had been determined a priori were examined, and data were abstracted and compiled in evidentiary tables. These data were then analyzed by the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force to consider treatment recommendations based on the evidence.
  
  
  RESULTS
  Of the 122 articles identified using optimized search parameters, 52 were recalled for full-text review. One additional article, originally not retrieved in the search, was also reviewed. Fourteen articles met all study criteria and contained comparative data on CSF shunts and ETV. In total, 6 articles (1 Class II and 5 Class III) were accepted for inclusion in the evidentiary table; 8 articles were excluded for various reasons. The tabulated evidence supported the evaluation of CSF shunts versus ETV.
  
  
  CONCLUSIONS
  Cerebrospinal fluid shunts and ETV demonstrated equivalent outcomes in the clinical etiologies studied.
  
  
  CONCLUSIONS
  Both CSF shunts and ETV are options in the treatment of pediatric hydrocephalus.
  
  
  METHODS
  Level II, moderate clinical certainty.
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
authors.forename: David D
authors.initials: DD
authors.lastname: Limbrick
authors.forename: Lissa C
authors.initials: LC
authors.lastname: Baird
authors.affiliation: Department of Neurosurgery, University of Tennessee Health Science Center|5Le Bonheur Children's Hospital, Memphis, Tennessee;
authors.forename: Paul
authors.initials: P
authors.lastname: Klimo
authors.affiliation: Division of Pediatric Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah
authors.forename: Jay
authors.initials: J
authors.lastname: Riva-Cambrin
authors.affiliation: Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Flannery
mesh_terms: D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D019317:Evidence-Based Medicine; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D020542:Third Ventricle / Q000601:surgery*; D014481:United States; D014696:Ventriculostomy / Q000379:methods
keywords: AANS = American Association of Neurological Surgeons; CNS = Congress of Neurological Surgeons; CPC = choroid plexus cauterization; ETV = endoscopic third ventriculostomy; VP = ventriculoperitoneal; cerebrospinal fluid; endoscopic third ventriculostomy; hydrocephalus; practice guidelines; shunt; ventriculoperitoneal