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

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.