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 and Purpose Vestibular schwannoma (VS) is the most common type of tumor found in the cerebellopontine angle that accounts for 8% of all intracranial tumors. VS management is currently a challenge due to the unpredictable nature of the tumor. Few studies have compared the results and complications of various therapeutic approaches to VS. Therefore, as a treatment option for VSs smaller than 25 mm, we conducted a systematic review to compare Gamma Knife radiosurgery (GKRS) with conventional surgery. Methods Literature searches were conducted of four online databases (PubMed, Google Scholar, Cochrane, and ScienceDirect) using the following keyword search: (“vestibular schwannoma” OR “acoustic neuroma”) AND (“gamma knife” OR “gamma knife radiosurgery”) AND (“resection” OR “open surgery”) AND (“hearing preservation” OR “facial nerve” OR “tumor growth”). Results We identified six retrospective cohort studies, five of which were of fair-to-good quality. All studies showed that GKRS was superior to surgery in hearing preservation. Two studies indicated that surgery was superior to GKRS in maintaining tumor control, one indicated that GKRS was superior, and the remainder indicated that there was no significant difference in maintaining tumor control between GKRS and microsurgery. Conclusions Based on the three outcomes chosen for this review, GKRS was superior to microsurgery in small VS.

Meningiomas are primary central nervous system tumor with the highest prevalence. Meningiomas have a high recurrence rate in the same location. One of the factors thought to be associated with the frequency of meningiomas is hormonal status. However, research on this subject is still controversial. This review aims to discuss the effect of sex hormones on meningiomas. Sex hormones, especially progesterone, have been shown to play a role in tumorigenesis and meningioma recurrence. Progesterone receptors also play a role in meningioma recurrence where a low number of receptors indicates a poor prognosis. However, the molecular relationship between meningiomas at low progesterone receptor expression is still unknown. Further research is still needed to determine the role of sex hormones, especially progesterone, and their receptors, in both tumorigenesis and meningioma progression. This research ensures that new science in the field of endocrinology can be utilized for both primary preventive, secondary preventive, and therapeutic strategies for meningiomas.

AIM: The goal of this systematic review is to know how outcome of GKRS for tremor movement disorder. METHODS: Literature searching was conducted in database online that is PubMed, Science Direct, Cochrane Library, Google Scholar and hand searching with keyword “gamma knife,” “parkinson,” “tremor,” “success rate,” “good outcome,” and “free tremor.” Articles included were full-text and observational study and written in Bahasa or English. RESULTS: This systematic review used only six articles, which five of them examined ET and the other PD. Majority of studies used Fahn-Tolosa-Marin clinical tremor rating scale (TRS) for evaluation pre- and post-GKRS. However, the duration of follow-up is varies from <1 year until 76 months. The doses are also varies from 110 until 150 Gy (Median 120–130 Gy). A study report that 1 year after GKRS, ET patients could have 58% improvement in writing and 51% in drawing. Other study, which of median follow-up was 36 months, had 69% of samples showed improvement in both action tremor and writing scores. Ohye et al. in 2008 reported that since 1992, they have 80% successful in GK thalamotomy for tremor, either ET or PD. Similar author has been done multivariate study in six Japanese institution which of result was GKRS thalamotomy could be alternative treatment for intractable tremor, either ET or PD until 24 months. All of the study about ET have improvement results with GKRS in ventralis intermedius (VIM) of the thalamus. However, one study about PD evaluated GKRS in subthalamic nucleus (STN) of thalamus and got neurological complication with higher-risk of GKRS hyper response. CONCLUSION: GKRS, especially VIM thalamotomy, offers effective and safe alternative for ET and PD. We need more studies with approved method to answer this clinical question accurately. However, the study comparing GKRS and open surgical is still needed.