Efficacy and safety of endoscopic third ventriculostomy and choroid plexus cauterization for infantile hydrocephalus: a systematic review and meta-analysis.
OBJECTIVE
Endoscopic third ventriculostomy/choroid plexus cauterization (ETV/CPC) has gained popularity in its treatment of infantile hydrocephalus over the past decade. In this manuscript, we perform a systematic review and meta-analysis to determine the efficacy and safety of ETV/CPC, and to compare the procedural outcomes between North American and sub-Saharan African cohorts.


METHODS
Systematic review was performed using four electronic databases and bibliographies of relevant articles, with no language or date restrictions. Cohort studies of participants undergoing ETV/CPC that reported outcome were included using MOOSE guidelines. The outcome was time to repeat CSF diversion or death. Forest plots were created for pooled mean and its 95 % CI of outcome and morbidity.


RESULTS
Of 78 citations, 11 retrospective reviews (with 524 total participants) were eligible. Efficacy was achieved in 63 % participants at follow-up periods between 6 months and 8 years. Adverse events and mortality was reported in 3.7 and 0.4 % of participants, respectively. Publication bias was detected with respect to efficacy and morbidity of the procedure. A large discrepancy in success was identified between ETV/CPC in six studies from sub-Saharan Africa (71 %), compared to three studies from North America (49 %).


CONCLUSIONS
The reported success of ETV/CPC for infantile hydrocephalus is higher in sub-Saharan Africa than developed nations. Large long-term prospective multi-center observational studies addressing patient-important outcomes are required to further evaluate the efficacy and safety of this re-emerging procedure.
Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, QC, Canada.
Alexander G
AG
Weil
Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, QC, Canada.
Harrison
H
Westwick
Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.|Departments of Biostatistics and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Shelly
S
Wang
Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.|Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Naif M
NM
Alotaibi
Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
Lior
L
Elkaim
Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
George M
GM
Ibrahim
Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA.
Anthony C
AC
Wang
Department of Global Medicine, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.
Rojine T
RT
Ariani
Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, QC, Canada.
Louis
L
Crevier
Louise M. Darling Biomedical Library, University of California Los Angeles, Los Angeles, CA, USA.
Bethany
B
Myers
Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA. afallah@mednet.ucla.edu.|Department of Neurosurgery, David Geffen School of Medicine at UCLA, Mattel Children's Hospital UCLA, 300 Stein Plaza, Suite 525, Los Angeles, CA, 90095-6901, USA. afallah@mednet.ucla.edu.
Aria
A
Fallah
D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020542:Third Ventricle / Q000601:surgery*; D014696:Ventriculostomy / Q000379:methods*
Choroid plexus cauterization; Endoscopic third ventriculostomy; Hydrocephalus; Pediatric