Background:Using Endoscopic Third Ventriculostomy (ETV) or Ventriculoperitoneal Shunt (VPS) as standard technique of cerebrospinal fluid (CSF) diversion has been a debatable issue. To date, a meta-analysis on the best treatment for pediatric hydrocephalus is yet to be done. ETV has been reported to have successful outcomes in many studies. The objective of this meta-analysis is to know the effectiveness of ETV compared to VPS in pediatric hydrocephalus.Methods:This study used electronic articles published in PubMed, EBSCO, and Google Scholar from January 1990 until January 2017. Articles included were full-text observational study or randomized control trial in Bahasa or English. Surgical failure was compared for this meta-analysis. Statistical analysis was done by using Review Manager 5.Results:Five articles met our inclusion and exclusion criteria. The pooled risk ratio (ETV vs. VPS) of surgical failure was 0.95 [0.76, 1.19] for fixed effect model. This analysis had no or little heterogeneity (I2 = 18%; X2=0.25).Conclusion:In one year follow up, there is no superiority between both procedures in surgical failure. Limited studies have been conducted to compare the effectiveness of ETV compared with VPS for pediatric hydrocephalus management. Further studies comparing both treatments are required to know the best management for pediatric hydrocephalus.Keywords: ETV, VPS, pediatric hydrocephalus, meta-analysis

Background: Carotid artery stenosis (CAS) may manifest with stroke, transient ischemic attack (TIA), or more covert non-hemispheric symptoms. While symptoms can be subtle, brain MRI abnormalities may already reflect substantial changes. This study aimed to determine the association between brain MRI abnormalities and symptomatic CAS. Methods: A retrospective cross-sectional study was conducted to subjects with symptomatic ICA stenosis admitted to a private secondary hospital in Jakarta, Indonesia, from January to December 2022. Symptoms were categorized to stroke/TIA and non-hemispheric symptoms (vertigo, headache, presyncope, etc.). Properties of CAS were recorded using digital subtraction angiography report. Brain abnormalities were recorded using MRI report. Results: Brain MRI abnormalities were detected in 96.2% CAS cases and similar between stroke (96.2%) and non-hemispheric symptoms (96.0%). The abnormalities tended to be in bilateral hemisphere (61.0%), predominantly periventricle (41.9%), basal ganglia (26.1%), and internal capsule for mild CAS (16.8%). Ipsilateral brain lesions were significantly associated with severe CAS (20.9% versus 10.8% for non-ipsilateral brain lesion, p=0.042) and stroke (45.9% versus 24.0% in non-hemispheric symptoms, p=0.035). Non-ipsilateral brain lesions were significantly associated with mild CAS (49.6% versus 40.7% for ipsilateral brain lesion, p=0.042) and non-hemispheric symptoms (72.0% versus 50.3% in stroke, p=0.035). Conclusions: Brain MRI abnormalities were very prevalent in CAS. There were no specific markers of brain MRI abnormalities associated with CAS. Brain abnormalities had been found since mild CAS, which presented in bilateral hemisphere as non-hemispheric symptoms. This study underlines the importance for the assessment of CAS in subjects since non-hemispheric symptoms with brain ischemic-related pathologies.