Endoscopic third ventriculostomy versus ventriculoperitoneal shunt for treating pediatric tuberculous meningitis hydrocephalus: a systematic review and meta-analysis.

Abstract

Objective: Endoscopic third ventriculostomy (ETV) is advocated as a shunt-free alternative for managing hydrocephalus to mitigate the complications associated with ventriculoperitoneal shunt (VPS). However, its efficacy in treating pediatric tuberculous meningitis-related hydrocephalus (TBMH) remains uncertain. The authors' review aimed to evaluate the safety and effectiveness of ETV compared to VPS.

Methods: The authors searched PubMed, Embase, and Cochrane for articles comparing ETV with VPS in the pediatric population. They included studies evaluated success rate, mortality, postprocedural complications, and infections. A random-effects model was used, with heterogeneity assessed with I2 and sensitivity analysis.

Results: A pooled analysis of 369 patients from 5 studies (2 randomized controlled trials and 3 observational studies), including 162 patients who underwent ETV and 207 VPS, revealed no significant difference in the success rates between ETV and VPS for TBMH (OR 0.72, 95% CI 0.45-1.14, p = 0.159, I2 = 0%). Furthermore, no significant differences in the postoperative complication (OR 0.59, 95% CI 0.08-4.17, p = 0.599, I2 = 75%), mortality (OR 0.78, 95% CI 0.23-2.65, p = 0.684, I2 = 0%), or infection (OR 0.52, 95% CI 0.09-2.87, I2 = 11%) rates were observed.

Conclusions: The authors' meta-analysis shows no significant differences in success rates, mortality risk, and incidence of complications and infections between ETV and VPS for children with TBMH. However, the broad confidence intervals and limited number of included studies introduce significant uncertainty. Therefore, while no statistically significant differences have been demonstrated, the equivalence of these treatments cannot be conclusively affirmed, and the potential for clinically significant differences remains.