Endoscopic Third Ventriculostomy vs. Ventriculoperitoneal Shunt for Obstructive Hydrocephalus: A Meta-Analysis of Randomized Controlled Trials

AIM: To conduct a meta-analysis for investigating the safety and efficacy of endoscopic third ventriculostomy (ETV) and extracranial shunting for patients with obstructive hydrocephalus. MATERIAL and METHODS: Randomized controlled trials (RCTs) of ETV and ventriculoperitoneal shunting (VPS) for obstructive hydrocephalus were analyzed systematically by using MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also perused. Postoperative infection, postoperative cerebrospinal fluid (CSF) leakage, mortality and surgical success were the main outcomes of the analysis. RESULTS: Among 841 selected studies, 6 RCTs evaluated ETV and VPS. Compared to VPS, ETV had lower postoperative infection incidence (risk ratio [RR]: 0.19, 95% confidence interval [CI]: 0.08-0.43, p=0.0001), postoperative CSF leakage (RR: 5.10, 95% CI: 1.19-21.89, p=0.03) VPS. VPS had no mortality as compared to ETV (RR 0.64, 95% CI: 0.26-1.56, p=0.32). CONCLUSION: While VPS had no mortality in comparison to ETV, the latter showed lower incidences of major complications, such as postoperative infection and CSF leakage, than those of the former for patients with obstructive hydrocephalus.