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

Hasil: Didapatkan perbedaan bermakna pada proporsi subjek yang mengalami penurunan kadar TNF-α pada kelompok tigesiklin dibanding fosfomisin pada hari ke-7 pascabedah (62% vs 29%, p=0,022). Pengurangan edema pacsa operasi berbeda tidak bermakna pada kedua kelompok (86% vs 80%, p=0,580). Tigesiklin menunjukkan efektivitas klinis mengurangi luaran buruk (GOS ≤ 2 (20% vs 38% ; p=0,096; OR=0,41; NNT=6) dan inhospital mortality ( 17% vs 35%; p=0,083; OR=0,49; NNT=5). LOS ≥ 15 hari ( 40% vs 27%; p=0,243;OR=1,81; NNT=8). Kesimpulan: Tigesiklin memiliki kemampuan antiinflamasi dan neuroproteksi, serta memperbaiki luaran klinis pada PISS yang dilakukan evakuasi hematoma. ABSTRACT Background:The outcome of patients with spontaneous supratentorial intracerebral hemorrhage (SSICH) is unsatisfactory. Inflammatory response secondary to brain injury as well as those resulted from surgical procedure were considered responsible of this outcome. This study was intended to elucidate the anti-inflammatory activity of tigecycline by measuring TNF-α level and its neuroprotective effect as represented by inhospital mortality rate. Methods:Patients with SSICH who were prepared for hematoma evacuation were randomized to receive either tigecycline (n=35) or fosfomycine (n=37) as prophylactic antibiotic. TNF-α level was measured in all subjects before surgery and postoperatively on day-1 and day-7. A repeated brain CT Scan was performed on postoperative day-7. The Glasgow outcome scale (GOS) and length of stay (LOS) were recorded at the time of hospital discharge. Data were analyzed using Mann-Whitney and Chi square test. Relative clinical effectiveness was measured by calculating the number needed to treat (NNT).Results: There was a significant difference regarding the proportion of subject who had reduced TNF-α level on postoperative day-7 between the groups receiving tigecycline and fosfomycine (62% vs 29%, p=0.022). Decrease brain edema on CT control (86% vs 80%, p=0.580). Tigecycline administration showed a tendency of better clinical effectiveness in lowering inhospital mortality (17% vs 35%; p=0.083; OR=0.49; NNT=5) and worse clinical outcome / GOS ≤ 2 (20% vs 38% ; p=0.096; OR=0.41; NNT=6). LOS ≥ 15 hari ( 40% vs 27%; p=0.243; OR=1.81; NNT=8). Conclusion:Tigecycline showed anti-inflammatory and neuroprotective activities. These activities were associated with improved clinical outcome in patients with SSICH after hematoma evacuation.

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ABSTRAKHasil: Didapatkan perbedaan tidak bermakna pada proporsi subjek yang mengalami penurunan kadar MMP-9 pada hari pertama (48% vs 50%; p=0,902;OR=1,(1)(2)(3)(4)(5)(6)(7) p=0,296;OR=1,9); proporsi pengurangan edema serebri (68% vs 80%; p=0,58); LOS (median 12 hari vs 13 hari p=0,256; proporsi subjek dengan LOS ≥15 hari 40% vs 27% p=0,243;OR=1,81; NNT=8).Kesimpulan: Pada pasien PISS yang dilakukan evakuasi hematoma, tigesiklin tidak menurunkan kadar MMP-9 dan derajat edema serebri, serta tidak memperpendek LOS. ABSTRACT Background:The high plasma level of matrix metalloproteinses-9 (MMP-9) is believed to disrupt the bloodbrain barrier (BBB) and cause brain edema, as well as increase patient's length of hospital stay (LOS). Tigecycline showed ability to reduce the MMP-9 level on study in animals. This study aimed to evaluate whether tigecycline can reduce the plasma levels of MMP-9; brain edema; and LOS of patients with supratentorial spontaneous intracerebral hemorrhage (SSICH).