While implantation of a ventriculoperitoneal shunt (VPS) is the usual treatment for myelomeningocele-associated hydrocephalus (MAH), infection and shunt dysfunction can complicate the procedure. As a result, endoscopic third ventriculostomy (ETV) has been recommended as an option, with or without choroid plexus coagulation (CPC). A study determined how successful, technical, and complication rates of ETV with or without CPC were in MAH patients. Case series, cohort studies, and randomized controlled trials reporting success, technical failure, or complication rates were searched by Researchers in the PubMed, Scopus, and Cochrane Central Register of Controlled Trials databases from inception to June 2020. The estimates for these outcome measures were determined using random-effects analysis. The Newcastle-Ottawa Scale was used to assess study quality and bias risk.

The study includes thirteen trials with 325 patients who underwent ETV or ETV+CPC. The pooled estimate of the success rate (95% CI 44% –68%, I= 78%) was 56% (95% CI 44% –68 %, I2= 78%), whereas the technical failure rate was 2% (95% CI 0% –6%, I2=32%) using random-effects models. Due to the type of surgical intervention (ETV vs. ETV+CPC, p<0.001). Random-effects analysis of 9 studies with 117 patients who received ETV alone revealed a success rate of 48% (95% CI 0.39–0.57, I2=0%), while analysis of 4 studies with 166 patients who received ETV+CPC revealed a success rate of 75% (95% CI 67%–82%, I2=21%). Mild/moderate, severe, and fatal complication rates were estimated to be 0 (95% CI 0% –4%, I2=0%), 2% (95% CI 0% –10%, I2=52%), and 0 (95% CI 0% –1%, I2=0%), respectively. ETV+CPC was linked to a greater MAH success rate than ETV alone in a meta-analysis of published research. ETV, with or without CPC, proved technically viable and safe for this patient population.

 

Reference:thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/aop/article-10.3171-2021.11.PEDS21505/article-10.3171-2021.11.PEDS21505.xml