Outcome Comparison of Endoscopic Third Ventriculostomy Versus Ventriculoperitoneal Shunt in Obstructive Hydrocephalus

Abstract

Objective: The aim of this study is to compare the outcomes of endoscopic third ventriculostomy versus ventriculoperitoneal shunt in Obstructive Hydrocephalus. Study Design: Randomized/Control study Place and Duration: Neurosurgery Department, Mardan Medical Complex, Mardan for the duration 04 years from April 2017 to April 2021. Methods: Sixty individuals of both sexes were brought in for consultation. Involved individuals had hydrocephalus that blocked their airways. The written consent of every patient allowed the collection of comprehensive demographic data, including age, gender, and body mass index (BMI). CT and MRI scans were performed on patients. Two groups of patients were formed, and the patients were split evenly between the two. An endoscopic third ventriculostomy was performed on group I, whereas ventriculoperitoneal shunt was implanted in group II patients. Efficacy and complications of therapy were evaluated at six-month intervals. All collected data were analyzed by using the SPSS 24.0 edition. Results: There was no any significant difference of age among both groups. Majority of the patients among both groups were males. Mean hospital stay in group I was lower 3.4± 6.45 days as compared to group II 8.1±1.35 days. Success rate in group I was higher 25 (83.3%) as compared to group II 20 (66.7%). Complications in group II was higher among 10 (33.3%) cases as compared to group I 5 (16.7%) in which CSF leak was the most common. Recurrence rate in group I was 4 (13.3%) and in group II was 6 (20%). Conclusion: In this research, we found that the endoscopic third ventriculostomy is an effective and safe procedure for treating patients with obstructive hydrocephalus as compared to ventriculoperitoneal shunt because of its low complication rate and decreased recurrence rate. Keywords: Ventriculoperitoneal Shunt, Obstructive Hydrocephalus, Endoscopic Third Ventriculostomy, Complications, Recurrence

Outcomes of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in the treatment of paediatric hydrocephalus: Systematic review and meta-analysis

“…Four studies reported incomplete reporting of outcomes, hence introducing “some concerns” and “high risk of bias” limitation of the overall quality and reliability of the evidence synthesised in this review and meta-analysis [ 1 , 6 , 9 , 11 ]. Further, four studies were found to have “some concerns” in terms of the randomisation process which again may introduce reduced generalisability of our findings [ 1 , 9 , 12 , 13 ].…”

Endoscopic Third Ventriculostomy versus Ventriculoperitoneal Shunt in Patients with Obstructive Hydrocephalus: An Updated Systematic Review and Meta-Analysis

“…14 Ul Haq et al reported the occurrence of one bleeding in each group of patients. 15 Even though we found no significant difference in intraoperative or postoperative bleeding events, patients who underwent VPS had clinically more severe bleedings, due to a higher occurrence of subdural and epidural hematomas, the need for new interventions, and even one death reported by Rahman et al 14 In the previous meta-analysis, there was a significant difference regarding postoperative bleeding. 6 However, some bleedings that were considered postoperative for the previous statistical analysis are inconsistent: the bleeding reported in the VPS group in Navaei et al was intraoperative; the bleeding reported in the ETV group in El-Ghandour was intraoperative and the bleeding reported in the VPS group in Kamikawa et al was not specified.…”

“…2C), in accordance with all included studies. 4,5,[13][14][15] Blockage Rate There was a significant increase in blockage ratio in the VPStreated group (RR: 0.15; 95% CI: 0.03-0.75; p ¼ 0.02; I 2 ¼ 53%; ►Fig. 3A).…”

“…Considering 30 postoperative infections reported in all five RCTs, 93.3% occurred in patients with VPS. 4,5,[13][14][15] There was a significant reduction in the total number of postoperative infections favoring ETV (RR: 0.11; 95% CI: 0.04-0.33; p < 0.0001; I 2 ¼ 0%; ►Fig. 2B).…”

“…We performed a leave-one-out sensitivity analysis. There was no significant difference in blockage rate when omitting El-Ghandour, 4 Kamikawa et al, 13 or Ul Haq et al 15 Sensitivity analysis is reported in ►Supplementary Fig. S1 (online only).…”