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Efficacy and safety of endoscopic third ventriculostomy and choroid plexus cauterization for infantile hydrocephalus: a systematic review and meta-analysis

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Abstract

Purpose

Endoscopic third ventriculostomy/choroid plexus cauterization (ETV/CPC) has gained popularity in its treatment of infantile hydrocephalus over the past decade. In this manuscript, we perform a systematic review and meta-analysis to determine the efficacy and safety of ETV/CPC, and to compare the procedural outcomes between North American and sub-Saharan African cohorts.

Methods

Systematic review was performed using four electronic databases and bibliographies of relevant articles, with no language or date restrictions. Cohort studies of participants undergoing ETV/CPC that reported outcome were included using MOOSE guidelines. The outcome was time to repeat CSF diversion or death. Forest plots were created for pooled mean and its 95 % CI of outcome and morbidity.

Results

Of 78 citations, 11 retrospective reviews (with 524 total participants) were eligible. Efficacy was achieved in 63 % participants at follow-up periods between 6 months and 8 years. Adverse events and mortality was reported in 3.7 and 0.4 % of participants, respectively. Publication bias was detected with respect to efficacy and morbidity of the procedure. A large discrepancy in success was identified between ETV/CPC in six studies from sub-Saharan Africa (71 %), compared to three studies from North America (49 %).

Conclusions

The reported success of ETV/CPC for infantile hydrocephalus is higher in sub-Saharan Africa than developed nations. Large long-term prospective multi-center observational studies addressing patient-important outcomes are required to further evaluate the efficacy and safety of this re-emerging procedure.

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Author information

Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, QC, Canada

    Alexander G. Weil, Harrison Westwick & Louis Crevier

  2. Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Shelly Wang, Naif M. Alotaibi & George M. Ibrahim

  3. Departments of Biostatistics and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA

    Shelly Wang

  4. Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Naif M. Alotaibi

  5. Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada

    Lior Elkaim

  6. Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA

    Anthony C. Wang

  7. Department of Global Medicine, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA

    Rojine T. Ariani

  8. Louise M. Darling Biomedical Library, University of California Los Angeles, Los Angeles, CA, USA

    Bethany Myers

  9. Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA

    Aria Fallah

  10. Department of Neurosurgery, David Geffen School of Medicine at UCLA, Mattel Children’s Hospital UCLA, 300 Stein Plaza, Suite 525, Los Angeles, CA, 90095-6901, USA

    Aria Fallah

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  1. Alexander G. Weil
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  11. Aria Fallah
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Corresponding author

Correspondence to Aria Fallah.

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All authors have no conflicts of interest to disclose.

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Weil, A.G., Westwick, H., Wang, S. et al. Efficacy and safety of endoscopic third ventriculostomy and choroid plexus cauterization for infantile hydrocephalus: a systematic review and meta-analysis. Childs Nerv Syst 32, 2119–2131 (2016). https://doi.org/10.1007/s00381-016-3236-6

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  • DOI: https://doi.org/10.1007/s00381-016-3236-6

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