Assessment Of The Outcomes Of Endoscopic Third Ventriculostomy With Or Without Choroid Plexus Cauterization Among African Children Treated For Hydrocephalus: A Systematic Review And Meta-Analysis.

Abstract

Background

Endoscopic third ventriculostomy (ETV) with or without choroid plexus cauterization (CPC) is widely used in the treatment of pediatric hydrocephalus. A number of studies have been done to determine the outcomes of this procedure. However, pooled outcomes of these studies have not been investigated. This systematic review and meta-analysis reports pooled outcomes of ETV with or without CPC in treatment of hydrocephalus among African children.

Methods

The study was conducted according to PRISMA guidelines. Eligible studies were identified through a search of PubMed, Embase, Google Scholar and African Journal Online until April 15th, 2022.

Results

A total of 22 studies involving 2,422 participants were included in the final analysis. The overall pooled success rate among children treated with ETV with or without CPC was 65%. The pooled success rate was higher in patients treated with ETV/CPC, 70% compared to those treated with ETV alone, 53%. The median age was 6.2 months. Overall, there were more boys (n=607, 56.3%) than girls (n=472, 43.7%).
Post-infectious hydrocephalus was the most common (39.4%, n=561) form of hydrocephalus.
Cerebrospinal fluid leak (25%, n=28), infections (21%, n=24) and hemorrhage (16%, n=18) were the most frequent complications. Overall all-course mortality was 2% (n=49).

Conclusions

This systematic review reports a higher success rate when ETV is combined with CPC compared to ETV alone in the management of pediatric hydrocephalus in Africa. Therefore, ETV/CPC should be considered a superior alternative to commonly used procedures such as ETV alone or VPS. Post-procedural complications were common, particularly CSF leak and infections, however, overall all-cause mortality was extremely low.