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Published on: June 28, 2024
Comparison of endoscopic third ventriculostomy with or without choroid plexus cauterization in pediatric
Yosef Ellenbogen1, Karanbir Brar2, Kaiyun Yang3
11Michael G. DeGroote School of Medicine, McMaster University, Hamilton.
Insights
Endoscopic third ventriculostomy with choroid plexus cauterization (ETV+CPC) shows no overall benefit for pediatric hydrocephalus. However, ETV+CPC demonstrated efficacy in sub-Saharan African populations, warranting further research.
Area of Science:
- Neurosurgery
- Pediatric Medicine
- Medical Technology
Background:
- Pediatric hydrocephalus significantly impacts infant health, especially in developing nations.
- Shunt placement is the traditional treatment, but endoscopic third ventriculostomy (ETV) is an effective alternative for selected patients.
- The added benefit of choroid plexus cauterization (CPC) to ETV (ETV+CPC) for pediatric hydrocephalus remains unclear.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy and safety of ETV+CPC compared to ETV alone for pediatric hydrocephalus.
- To evaluate the success rate, time to failure, mortality, and complication rates of both procedures.
Main Methods:
- Searched MEDLINE, Embase, Cochrane CENTRAL, ClinicalTrials.gov, and ICRCTN databases for comparative pediatric studies.
- Included 5 studies (2 prospective, 3 retrospective) with 963 patients.
- Pooled data using random-effects models for meta-analysis to calculate relative risk (RR).
Main Results:
- No significant difference in overall success rates between ETV and ETV+CPC (RR 1.24, p=0.21).
- Subgroup analysis of African cohorts showed a significant benefit for ETV+CPC (RR 1.38, p=0.01).
- No significant differences in complication rates were observed.
Conclusions:
- ETV+CPC does not offer an overall advantage over ETV alone for pediatric hydrocephalus.
- A notable efficacy of ETV+CPC was observed in sub-Saharan African populations.
- Further randomized clinical trials are needed to investigate ETV+CPC efficacy across diverse populations and regions.
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.
