PURPOSE Hydrocephalus is a major cause of morbidity in the pediatric population, with potentially severe consequences if left untreated. Two viable strategies for management of non-communicating hydrocephalus are endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunting. However, there is uncertainty over the safety and efficacy of ETV in younger infants aged 1 year or below. In this systematic review, we aim to elucidate the success rate and procedural risks of ETV in this age group. METHODS A multi-database (PubMed, Embase, Web of Science) literature search between January 1990 and April 2018 was performed in accordance with PRISMA guidelines. Eligible studies were included if they (i) examined non-communicating hydrocephalus; (ii) quantified the success/failure rates of ETV; and (iii) assessed outcomes in children 1 year of age or younger. RESULTS A total of 19 articles with 399 patients were eligible for inclusion. Mean age at procedure was 4.2 months (range 34 weeks gestation to 12 months), with 116 females and 143 males. Commonest underlying aetiology was congenital aqueductal stenosis (AS) (60.4%). Remaining causes included post-haemorrhagic, post-infection, Chiari malformations, malignancies and others. Overall and AS mean success rates were 51.6% and 56.5% respectively. Overall complication rate was 10.0%, consisting mainly of CSF leak, infection, and haemorrhage. Younger age was significantly associated with poorer ETV success rate when divided into <6 months and 6-12 months of age (44.4 vs 66.7%; p = 0.0007). Underlying pathology had no significant association with ETV outcome when divided into AS and other pathologies (p = 0.53). CONCLUSIONS Age is significantly associated with ETV success rates. Pathology-dependent effects were not found in this age group. Despite a lower ETV success rate at younger ages (44.4 vs 66.7%), it offers a comparable safety profile that is independent of age. ETV remains a viable treatment option for non-communicating hydrocephalus for infants aged 1 year or younger.

中文翻译：

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内镜下第三脑室造口术对 1 岁及以下儿童的疗效：系统评价和荟萃分析

目的 脑积水是儿科人群发病的主要原因，如果不及时治疗，可能会造成严重后果。治疗非交通性脑积水的两种可行策略是内窥镜第三脑室造口术 (ETV) 和脑室腹腔分流术。然而，对于 1 岁或以下的小婴儿，ETV 的安全性和有效性存在不确定性。在本系统综述中，我们旨在阐明 ETV 在该年龄段的成功率和手术风险。方法 根据 PRISMA 指南，对 1990 年 1 月至 2018 年 4 月期间的多数据库（PubMed、Embase、Web of Science）文献进行检索。如果符合条件的研究 (i) 检查了非交通性脑积水；(ii) 量化 ETV 的成功/失败率；(iii) 1 岁或以下儿童的评估结果。结果 共有 19 篇文章和 399 名患者符合纳入条件。手术时的平均年龄为 4.2 个月（范围为 34 周妊娠至 12 个月），其中 116 名女性和 143 名男性。最常见的潜在病因是先天性导水管狭窄 (AS) (60.4%)。其余原因包括出血后、感染后、Chiari 畸形、恶性肿瘤等。总体和 AS 平均成功率分别为 51.6% 和 56.5%。总体并发症发生率为 10.0%，主要包括脑脊液漏、感染和出血。当分为 <6 个月和 6-12 个月大时，年龄较小与较差的 ETV 成功率显着相关（44.4 vs 66.7%；p = 0.0007）。当分为 AS 和其他病理时，潜在病理与 ETV 结果没有显着关联（p = 0.53）。结论 年龄与 ETV 成功率显着相关。在该年龄组中未发现病理依赖性影响。尽管年轻时 ETV 的成功率较低（44.4% vs 66.7%），但它提供了与年龄无关的可比安全性。对于 1 岁或以下婴儿的非交通性脑积水，ETV 仍然是一种可行的治疗选择。