Endoscopic third ventriculostomy (ETV) is a well-established surgical procedure for hydrocephalus treatment, but there is sparse evidence on the optimal choice between flexible and rigid approaches. A meta-analysis was conducted to compare efficacy and safety profiles of both techniques in pediatrics and adults. A comprehensive search was conducted on PubMED, EMBASE, and Cochrane until 11/10/2019. Efficacy was evaluated comparing incidence of ETV failure, while safety was defined by the incidence of perioperative complications, intraoperative bleedings, and deaths. Random-effects models were used to pool the incidence. Out of 1365 studies, 46 case series were meta-analyzed, yielding 821 patients who underwent flexible ETV and 2918 who underwent rigid ETV, with an age range of [5 days–87 years]. Although flexible ETV had a higher incidence of failure in adults (flexible: 54%, 95%CI: 22–82% vs rigid: 20%, 95%CI: 22–82%) possibly due to confounding due to etiology in adults treated with flexible, a smaller difference was seen in pediatrics (flexible: 36%, pediatric: 32%). Safety profiles were acceptable for both techniques, with a certain degree of variability for complications (flexible 2%, rigid 18%) and death (flexible 1%, rigid 3%) in pediatrics as well as complications (rigid 9%, flexible 13%), death (flexible 4%, rigid 6%) and intra-operative bleeding events (rigid 6%, flexible 8%) in adults. No clear superiority in efficacy could be depicted between flexible and rigid ETV for hydrocephalus treatment. Safety profiles varied by age but were acceptable for both techniques. Well-designed comparative studies are needed to assess the optimal endoscopic treatment option for hydrocephalus.

内镜下第三脑室造口术 (ETV) 是一种成熟的脑积水治疗外科手术，但关于灵活和刚性方法之间的最佳选择的证据很少。进行了一项荟萃分析，以比较这两种技术在儿科和成人中的疗效和安全性。对 PubMED、EMBASE 和 Cochrane 进行了全面搜索，直至 2019 年 11 月 10 日。疗效评估比较 ETV 失败的发生率，而安全性由围手术期并发症、术中出血和死亡的发生率定义。随机效应模型用于汇总发病率。在 1365 项研究中，对 46 个病例系列进行了荟萃分析，得出 821 名接受柔性 ETV 的患者和 2918 名接受刚性 ETV 的患者，年龄范围为 [5 天至 87 岁]。尽管柔性 ETV 在成人中的失败率较高（柔性：54%，95%CI：22-82% 与刚性：20%，95%CI：22-82%）可能是由于治疗成人的病因引起的混杂灵活，小儿科的差异较小（灵活：36％，儿科：32％）。两种技术的安全性都是可以接受的，儿科并发症（柔性 2%，刚性 18%）和死亡（柔性 1%，刚性 3%）以及并发症（刚性 9%，柔性 13%）具有一定程度的可变性)、死亡（柔性 4%，刚性 6%）和成人术中出血事件（刚性 6%，柔性 8%）。在治疗脑积水的柔性和刚性 ETV 之间没有明显的疗效优势。安全概况因年龄而异，但两种技术都可以接受。