Alexander G Weil1, Harrison Westwick1, Shelly Wang2,3, Naif M Alotaibi2,4, Lior Elkaim5, George M Ibrahim2, Anthony C Wang6, Rojine T Ariani7, Louis Crevier1, Bethany Myers8, Aria Fallah9,10. 1. Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, QC, Canada. 2. Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada. 3. Departments of Biostatistics and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA. 4. Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 5. Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada. 6. Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA. 7. Department of Global Medicine, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA. 8. Louise M. Darling Biomedical Library, University of California Los Angeles, Los Angeles, CA, USA. 9. Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA. afallah@mednet.ucla.edu. 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. afallah@mednet.ucla.edu.
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.
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.
Entities:
Keywords:
Choroid plexus cauterization; Endoscopic third ventriculostomy; Hydrocephalus; Pediatric
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