Ahmed Ikhlas, Choudry Usama, Nathani Karim Rizwan, Basit Abdul, Akhtar Khan Saad, Nasir Roua, Haque Minza, Noor Ahmed, Pasha Muhammad Saad, Arif Aabiya, Akhunzada Naveed Zaman, Godfrey Oswin
Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan.
Department Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom.
Surg Neurol Int. 2025 May 30;16:205. doi: 10.25259/SNI_1111_2024. eCollection 2025.
The objective of this research article is to compare endoscopic treatment versus shunting procedures for failed endoscopic third ventriculostomies (ETVs) in pediatric patients with hydrocephalus.
We did a systematic review based on preferred reporting items for systematic reviews and meta-analyses guidelines on Studies involving pediatric patients (aged 0-18 years) diagnosed with hydrocephalus, reporting on the use of repeat ETV (Re-ETV) or Ventriculoperitoneal shunting (VPS) as a treatment option following failed ETV. Comparative studies, including randomized controlled trials, cohort studies, and any prospective studies, are included. Studies published in the English language conducted between 2001 and 2023 are included.
Forty articles were selected for full-text review. Out of which nine articles that clearly addressed the topic of Re-ETV and/or VPS placement after failure of primary ETV were deemed suitable for analysis. A data set of 663 patients was analyzed. Re-ETV was done in 220 patients (33.18%) and VPS Placement was done in 443 patients (66.81%). The primary ETV failure rates ranged from 16.6 to 60.89%. There was a higher failure rate of Re-ETV (74.98%) compared to VPS (22.26%) indicating that VPS is generally more successful as a secondary intervention. The presence of hemorrhage during primary ETV suggested more benefit from VPS placement rather than Re-ETV ( < 0.05).
Our systematic review suggests that VPS placement is the more prevalent choice after primary ETV failure, likely due to its higher overall success rate and the nature of complications. The wide variability in failure rates and follow-up durations suggests that treatment outcomes can differ greatly between patients and studies. Decisions regarding secondary interventions should be individualized, considering patient-specific factors such as age, complications, and timing of intervention.
本研究文章的目的是比较小儿脑积水患者内镜下第三脑室造瘘术（ETV）失败后内镜治疗与分流手术的效果。
我们根据系统评价和Meta分析的首选报告项目，对涉及诊断为脑积水的小儿患者（0至18岁）的研究进行了系统评价，报告了ETV失败后重复ETV（Re-ETV）或脑室腹腔分流术（VPS）作为治疗选择的情况。纳入比较研究，包括随机对照试验、队列研究和任何前瞻性研究。纳入2001年至2023年发表的英文研究。
选择了40篇文章进行全文审查。其中9篇文章明确涉及原发性ETV失败后Re-ETV和/或VPS置入的主题，被认为适合分析。分析了663例患者的数据集。220例患者（33.18%）进行了Re-ETV，443例患者（66.81%）进行了VPS置入。原发性ETV失败率在16.6%至60.89%之间。与VPS（22.26%）相比，Re-ETV的失败率更高（74.98%），这表明VPS作为二次干预通常更成功。原发性ETV期间出血的患者接受VPS置入而非Re-ETV可能更有益（<0.05）。
我们的系统评价表明，原发性ETV失败后，VPS置入是更普遍的选择，可能是由于其总体成功率较高以及并发症的性质。失败率和随访时间的广泛差异表明，不同患者和研究之间的治疗结果可能有很大差异。关于二次干预的决策应个体化，考虑患者的具体因素，如年龄、并发症和干预时机。
