School of Pharmacy, MCPHS University, Boston, MA, 02115, USA.
Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Neurosurg Rev. 2021 Jun;44(3):1227-1241. doi: 10.1007/s10143-020-01320-4. Epub 2020 May 31.
Treatment options for hydrocephalus include endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS). Some ambiguity remains regarding indications, safety, and efficacy for these procedures in different clinical scenarios. The objective of the present study was to pool the available evidence to compare outcomes among patients with hydrocephalus undergoing ETV versus VPS. A systematic search of the literature was conducted via PubMed, EMBASE, and Cochrane Library through 11/29/2018 to identify studies evaluating failure and complication rates, following ETV or VPS. Pooled effect estimates were calculated using random effects. Heterogeneity was assessed by the Cochrane Q test and the I value. Heterogeneity sources were explored through subgroup analyses and meta-regression. Twenty-three studies (five randomized control trials (RCTs) and 18 observational studies) were meta-analyzed. Comparing ETV to VPS, failure rate was not statistically significantly different with a pooled relative risk (RR) of 1.48, 95%CI (0.85, 2.59) for RCTs and 1.17 (0.89, 1.53) for cohort studies; P-interaction: 0.44. Complication rates were not statistically significantly different between ETV and VPS in RCTs (RR: 1.34, 95%CI: 0.50, 3.59) but were statistically significant for prospective cohort studies (RR: 0.47, 95%CI: 0.30, 0.78); P-interaction: 0.07. Length of hospital stay was no different, when comparing ETV and VPS. These results remained unchanged when stratifying by intervention type and when regressing on age when possible. No significant differences in failure rate were observed between ETV and VPS. ETV was found to have lower complication rates than VPS in prospective cohort studies but not in RCTs. Further research is needed to identify the specific patient populations who may be better suited for one intervention versus another.
脑积水的治疗选择包括内镜第三脑室造瘘术（ETV）和脑室-腹腔分流术（VPS）。在不同的临床情况下，这些手术的适应证、安全性和疗效仍存在一些不确定性。本研究的目的是汇集现有证据，比较接受 ETV 与 VPS 治疗的脑积水患者的结局。通过 11 月 29 日在 PubMed、EMBASE 和 Cochrane Library 进行系统文献检索，以确定评估 ETV 或 VPS 后失败和并发症发生率的研究。使用随机效应计算汇总效应估计值。通过 Cochrane Q 检验和 I ² 值评估异质性。通过亚组分析和 meta 回归探索异质性来源。对 23 项研究（5 项随机对照试验（RCT）和 18 项观察性研究）进行了 meta 分析。与 VPS 相比，ETV 的失败率无统计学差异，RCT 的汇总相对风险（RR）为 1.48，95%CI（0.85，2.59），队列研究的 RR 为 1.17（0.89，1.53）；P 交互作用：0.44。RCT 中 ETV 和 VPS 的并发症发生率无统计学差异（RR：1.34，95%CI：0.50，3.59），但前瞻性队列研究的 RR 有统计学意义（RR：0.47，95%CI：0.30，0.78）；P 交互作用：0.07。比较 ETV 和 VPS 时，住院时间无差异。当按干预类型分层和可能时按年龄回归时，结果保持不变。在 ETV 和 VPS 之间未观察到失败率的显著差异。在前瞻性队列研究中，与 VPS 相比，ETV 的并发症发生率较低，但在 RCT 中则不然。需要进一步的研究来确定哪些特定的患者人群可能更适合一种干预措施而不是另一种干预措施。
