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Updated: Oct 5, 2025
Author Spotlight: A Single-Entry Point Endoscopic Intraventricular Approach for Third Ventriculostomy and Pineal Biopsy
Published on: June 28, 2024
Endoscopic third ventriculostomy with or without choroid plexus coagulation for myelomeningocele-associated
Abdelsimar T Omar1,2,3, Adrian I Espiritu4,5,6, Julian Spears1,2
11Division of Neurosurgery, Department of Surgery, University of Toronto.
Objective:
While ventriculoperitoneal shunt (VPS) insertion is the standard treatment for myelomeningocele-associated hydrocephalus (MAH), it can be complicated by infection and shunt malfunction. As such, endoscopic third ventriculostomy (ETV), with or without choroid plexus coagulation (CPC), has been proposed as an alternative. The aim of this review was to determine the success, technical failure, and complication rates of ETV with or without CPC in patients with MAH.
Methods:
PubMed, Scopus, and Cochrane Central Register of Controlled Trials databases were searched from inception to June 2020 for case series, cohort studies, or randomized controlled trials reporting success, technical failure, or complication rates. Random-effects analysis was performed to determine the estimates for these outcome measures. Studies were evaluated using the Newcastle-Ottawa Scale for quality and risk of bias.
Results:
Thirteen studies with a total of 325 patients who underwent either ETV or ETV+CPC were included in the review. Using random-effects modeling, the pooled estimate of the success rate was 56% (95% CI 44%-68%, I2 = 78%), while the technical failure rate was 2% (95% CI 0%-6%, I2 = 32%). The estimate for the success rate had high heterogeneity, due to the type of surgical intervention (ETV vs ETV+CPC, p < 0.001). Random-effects analysis of 9 studies with 117 patients who underwent ETV alone yielded an estimated success rate of 48% (95% CI 0.39-0.57, I2 = 0%), while analysis of 4 studies with 166 patients who underwent ETV+CPC revealed a success rate of 75% (95% CI 67%-82%, I2 = 21%). The estimates for the mild/moderate, severe, and fatal complication rates were 0 (95% CI 0%-4%, I2 = 0%), 2% (95% CI 0%-10%, I2 = 52%), and 0 (95% CI 0%-1%, I2 = 0%), respectively.
Conclusions:
ETV+CPC was associated with a higher success rate than ETV alone for MAH in a meta-analysis of published studies. ETV, with or without CPC, was technically feasible and safe for this patient population.
Insights
Endoscopic third ventriculostomy with choroid plexus coagulation (ETV+CPC) offers a higher success rate for treating myelomeningocele-associated hydrocephalus (MAH) compared to ETV alone. Both ETV and ETV+CPC are safe and feasible surgical options for MAH.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Hydrocephalus Management
Background:
- Myelomeningocele-associated hydrocephalus (MAH) is commonly treated with ventriculoperitoneal shunt (VPS) insertion.
- VPS insertion is associated with risks of infection and malfunction.
- Endoscopic third ventriculostomy (ETV), with or without choroid plexus coagulation (CPC), presents an alternative surgical approach.
Purpose of the Study:
- To evaluate the efficacy and safety of ETV, with or without CPC, as a treatment for MAH.
- To determine the success, technical failure, and complication rates of ETV versus ETV+CPC in patients with MAH.
Main Methods:
- A systematic review and meta-analysis of published studies.
- Searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials databases up to June 2020.
- Included case series, cohort studies, and randomized controlled trials; assessed quality using the Newcastle-Ottawa Scale.
Main Results:
- Thirteen studies including 325 patients were analyzed.
- The pooled success rate for ETV with or without CPC was 56% (95% CI 44%-68%).
- ETV+CPC demonstrated a higher success rate (75%) compared to ETV alone (48%).
- Technical failure rate was low at 2% (95% CI 0%-6%).
- Complication rates were low, with severe complications at 2% and no fatal complications reported.
Conclusions:
- ETV+CPC is associated with a significantly higher success rate than ETV alone for managing MAH.
- ETV, with or without CPC, is a technically feasible and safe neurosurgical procedure for MAH.
- These findings support ETV+CPC as a potentially superior alternative to standard VPS for MAH.
