Treatment options for hydrocephalus include endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS). Some ambiguity remains regarding indications, safety, and efficacy for these procedures in different clinical scenarios. The objective of the present study was to pool the available evidence to compare outcomes among patients with hydrocephalus undergoing ETV versus VPS. A systematic search of the literature was conducted via PubMed, EMBASE, and Cochrane Library through 11/29/2018 to identify studies evaluating failure and complication rates, following ETV or VPS. Pooled effect estimates were calculated using random effects. Heterogeneity was assessed by the Cochrane Q test and the I2 value. Heterogeneity sources were explored through subgroup analyses and meta-regression. Twenty-three studies (five randomized control trials (RCTs) and 18 observational studies) were meta-analyzed. Comparing ETV to VPS, failure rate was not statistically significantly different with a pooled relative risk (RR) of 1.48, 95%CI (0.85, 2.59) for RCTs and 1.17 (0.89, 1.53) for cohort studies; P-interaction: 0.44. Complication rates were not statistically significantly different between ETV and VPS in RCTs (RR: 1.34, 95%CI: 0.50, 3.59) but were statistically significant for prospective cohort studies (RR: 0.47, 95%CI: 0.30, 0.78); P-interaction: 0.07. Length of hospital stay was no different, when comparing ETV and VPS. These results remained unchanged when stratifying by intervention type and when regressing on age when possible. No significant differences in failure rate were observed between ETV and VPS. ETV was found to have lower complication rates than VPS in prospective cohort studies but not in RCTs. Further research is needed to identify the specific patient populations who may be better suited for one intervention versus another.

中文翻译：

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内窥镜第三脑室造口术与儿童和成人脑室腹腔分流术：系统评价和荟萃分析。

脑积水的治疗选择包括内窥镜第三脑室造口术 (ETV) 和脑室腹腔分流术 (VPS)。在不同临床情况下，这些程序的适应症、安全性和有效性仍然存在一些模糊性。本研究的目的是汇集现有证据，以比较接受 ETV 与 VPS 的脑积水患者的结果。在 2018 年 11 月 29 日之前，通过 PubMed、EMBASE 和 Cochrane 图书馆对文献进行了系统搜索，以确定评估 ETV 或 VPS 后失败和并发症发生率的研究。使用随机效应计算合并效应估计值。通过 Cochrane Q 检验和 I2 值评估异质性。通过亚组分析和元回归探索异质性来源。对 23 项研究（5 项随机对照试验 (RCT) 和 18 项观察性研究）进行了荟萃分析。将 ETV 与 VPS 进行比较，RCT 的合并相对风险 (RR) 为 1.48，95%CI (0.85, 2.59) 和队列研究的合并相对风险 (RR) 为 1.17 (0.89, 1.53)；P-相互作用：0.44。在 RCT 中，ETV 和 VPS 的并发症发生率无统计学差异（RR：1.34，95%CI：0.50，3.59），但在前瞻性队列研究中具有统计学意义（RR：0.47，95%CI：0.30，0.78）；P-相互作用：0.07。比较 ETV 和 VPS 时，住院时间没有什么不同。在按干预类型分层时以及在可能的情况下对年龄进行回归时，这些结果保持不变。在 ETV 和 VPS 之间没有观察到故障率的显着差异。在前瞻性队列研究中发现 ETV 的并发症发生率低于 VPS，但在 RCT 中则不然。需要进一步的研究来确定可能更适合一种干预而不是另一种干预的特定患者群体。