Child's Nervous System

, Volume 32, Issue 11, pp 2119–2131 | Cite as

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

  • Alexander G. Weil
  • Harrison Westwick
  • Shelly Wang
  • Naif M. Alotaibi
  • Lior Elkaim
  • George M. Ibrahim
  • Anthony C. Wang
  • Rojine T. Ariani
  • Louis Crevier
  • Bethany Myers
  • Aria Fallah
Original Paper



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.


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.


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 %).


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.


Pediatric Hydrocephalus Endoscopic third ventriculostomy Choroid plexus cauterization 

Supplementary material

381_2016_3236_MOESM1_ESM.docx (51 kb)
ESM 1(DOCX 51 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Alexander G. Weil
    • 1
  • Harrison Westwick
    • 1
  • Shelly Wang
    • 2
    • 3
  • Naif M. Alotaibi
    • 2
    • 4
  • Lior Elkaim
    • 5
  • George M. Ibrahim
    • 2
  • Anthony C. Wang
    • 6
  • Rojine T. Ariani
    • 7
  • Louis Crevier
    • 1
  • Bethany Myers
    • 8
  • Aria Fallah
    • 9
    • 10
  1. 1.Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine HospitalUniversity of MontrealMontrealCanada
  2. 2.Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoCanada
  3. 3.Departments of Biostatistics and EpidemiologyHarvard T. H. Chan School of Public HealthBostonUSA
  4. 4.Institute of Medical Science, Faculty of MedicineUniversity of TorontoTorontoCanada
  5. 5.Faculty of MedicineUniversity of MontrealQuebecCanada
  6. 6.Department of NeurosurgeryDavid Geffen School of Medicine at University of California Los AngelesLos AngelesUSA
  7. 7.Department of Global MedicineKeck School of Medicine at University of Southern CaliforniaLos AngelesUSA
  8. 8.Louise M. Darling Biomedical LibraryUniversity of California Los AngelesLos AngelesUSA
  9. 9.Brain Research InstituteUniversity of California Los AngelesLos AngelesUSA
  10. 10.Department of Neurosurgery, David Geffen School of Medicine at UCLAMattel Children’s Hospital UCLALos AngelesUSA

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