Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric patients with post-infective hydrocephalus: A meta-analysis of randomized controlled trials

Background: Although studies on the safety and efficacy of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) have been conducted, the safety and efficacy for treating post infective hydrocephalus (PIH) in pediatric patients have not been investigated using meta-analysis and thus remain controversial. Therefore, we conducted a meta-analysis to assess the safety and efficacy of ETV and VPS for PIH treatment and determine whether ETV is more appropriate than VPS for treating PIH in PP. Methods: We searched Pubmed, Embase, Web of Science, and the Cochrane Library databases up to January 2022. The quality of studies was assessed using the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials. A fixed-effect model was used for pooling analysis, and heterogeneity was assessed using I2. Results: Three randomized controlled trials involving 200 patients out of a total 254 identified studies were included. No significant differences were found between ETV and VPS in postoperative success rate (risk ratio RR: 0.89; 95% confidence interval CI: 0.72-1.10; p = 0.27), postoperative infection rate (RR: 0.68; 95% CI: 0.21-2.22; p = 0.52), postoperative blockage rate (RR: 0.90; 95% CI: 0.40-2.00; p = 0.80), complication rates (RR: 1.29; 95% CI: 0.45-3.71; p = 0.63), or mortality (RR: 1.31; 95% CI: 0.47-3.65; p = 0.60). However, patients who underwent VPS showed lower postoperative cerebrospinal fluid leakage than those who underwent ETV (RR: 9.00; 95% CI: 1.18-68.45; p = 0.03). Conclusions: VPS may be more beneficial for the treatment of PIH in pediatric patients.