Comparison of endoscopic third ventriculostomy with or without choroid plexus cauterization in pediatric hydrocephalus: a systematic review and meta-analysis

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  • 1 Michael G. DeGroote School of Medicine, McMaster University, Hamilton;
  • 2 Faculty of Medicine, University of Toronto; and
  • 3 Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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OBJECTIVE

Pediatric hydrocephalus is a significant contributor to infant morbidity and mortality, particularly in developing countries. The mainstay of treatment has long been shunt placement for CSF diversion, but recent years have seen the rise of alternative procedures such as endoscopic third ventriculostomy (ETV), which provides similar efficacy in selected patients. The addition of choroid plexus cauterization (CPC) to ETV has been proposed to increase efficacy, but the evidence of its utility is limited. This systematic review and meta-analysis aimed to determine the efficacy and safety of ETV+CPC in comparison to ETV alone for the treatment of pediatric all-cause hydrocephalus.

METHODS

MEDLINE, Embase, Cochrane CENTRAL, ClinicalTrials.gov, and ICRCTN databases were searched from conception through to October 2018 for comparative studies including both ETV+CPC and ETV in a pediatric population. The primary outcome was success rate, defined as no secondary procedure required for CSF diversion; secondary outcomes included time to failure, mortality, and complications. Data were pooled using random-effects models of meta-analysis, and relative risk (RR) was calculated.

RESULTS

Five studies were included for final qualitative and quantitative analysis, including 2 prospective and 3 retrospective studies representing a total of 963 patients. Overall, there was no significant difference in success rates between ETV and ETV+CPC (RR 1.24, 95% CI 0.88–1.75, p = 0.21). However, a subgroup analysis including the 4 studies focusing on African cohorts demonstrated a significant benefit of ETV+CPC (RR 1.38, 95% CI 1.08–1.78, p = 0.01). There were no notable differences in complication rates among studies.

CONCLUSIONS

This systematic review and meta-analysis failed to find an overall benefit to the addition of CPC to ETV; however, a subgroup analysis showed efficacy in sub-Saharan African populations. This points to the need for future randomized clinical trials investigating the efficacy of ETV+CPC versus ETV in varied patient populations and geographic locales.

ABBREVIATIONS CENTRAL = Central Register of Controlled Trials; CI = confidence interval; CPC = choroid plexus cauterization; ETV = endoscopic third ventriculostomy; ETVSS = ETV Success Score; IVH = intraventricular hemorrhage; M-H = Mantel-Haenszel; MINORS = Methodological Index for Non-Randomized Studies; MM = myelomeningocele; NPIH = non-PIH; PIH = postinfectious hydrocephalus; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RR = relative risk; TTF = time to failure.

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Contributor Notes

Correspondence Olufemi Ajani: McMaster University, McMaster Children’s Hospital, Hamilton, Ontario, Canada. ajanio@mcmaster.ca.

INCLUDE WHEN CITING Published online July 3, 2020; DOI: 10.3171/2020.4.PEDS19720.

Y.E. and K.B. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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