Endoscopic Third Ventriculostomy vs. Ventriculoperitoneal Shunt in Aqueductal Stenosis: A Systematic Review and Meta-Analysis

Abstract

Objectives

To evaluate the evidence for Endoscopic Third Ventriculostomy vs. Ventriculoperitoneal Shunt in congenital hydrocephalus with Aqueductal Stenosis (AS). Materials and Methods: A PRISMA-based study selection is used to screen for studies, including (1) AS report cases and (2) the intervention undertaken, which can either be ETV or VPS. Furthermore, an extended criteria for quantitative analysis is added to include the following: (3) Comparing the failure rate between ETV vs VPS; (4) Infants aged < 24 months; and (5) Reporting the number of failed cases. A review of all the included studies was then summarized. Outcome Measure: ETV and VPS failure rates, specifically in infants younger than 24 months with aqueductal stenosis (AS). Results: Literatur search identified 628 studies from Pubmed, Directory of Open Access Journal (DOAJ), and manual search. Screening of the study resulted in 576 being excluded. Forty studies were screened for full article eligibility screening, resulting in 11 studies included in the systematic review and 3 in the meta-analysis. Meta-analysis indicated more failure in infant patients with AS < 24 months old who received ETV (OR 1.74, 95 % CI 0.85 – 3.58). Conclusion: This systematic review shows that ETV has a good and stable status, but in the age of infants, it indicates that ETV has a higher risk of failure than shunt despite the patient's external quality of life and long-term health status is no different between the two. Both primary and secondary ETV also do not show a significant difference in the degree of complications. As well as the technique of doing ETV is also increasingly expanding in efforts to increase the success of ETV itself. Our meta-analysis indicates a higher failure rate in ETV for infants less than two years of age with AS compared to VPS.