Endoscopic third ventriculostomy and choroid plexus cauterization (ETV+CPC) is a novel procedure for infant hydrocephalus that was developed in sub-Saharan Africa to mitigate the risks associated with permanent implanted shunt hardware. This study summarizes the hydrocephalus literature surrounding the ETV+CPC intraoperative abandonment rate, perioperative mortality rate, cerebrospinal fluid infection rate, and failure rate.

This systematic review and meta-analysis followed a prespecified protocol and abides by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search strategy using MEDLINE, EMBASE, PsychInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science was conducted from database inception to October 2019. Studies included controlled trials, cohort studies, and case-control studies of patients with hydrocephalus younger than 18 years of age treated with ETV+CPC. Pooled estimates were calculated using DerSimonian and Laird random-effects modeling, and the significance of subgroup analyses was tested using meta-regression. The quality of the pooled outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

After screening and reviewing 12,321 citations, the authors found 16 articles that met the inclusion criteria. The pooled estimate for the ETV+CPC failure rate was 0.44 (95% CI 0.37–0.51). Subgroup analysis by geographic income level showed statistical significance (p < 0.01), with lower-middle-income countries having a lower failure rate (0.32, 95% CI 0.28–0.36) than high-income countries (0.53, 95% CI 0.47–0.60). No difference in failure rate was found between hydrocephalus etiology (p = 0.09) or definition of failure (p = 0.24). The pooled estimate for perioperative mortality rate (n = 7 studies) was 0.001 (95% CI 0.00–0.004), the intraoperative abandonment rate (n = 5 studies) was 0.04 (95% CI 0.01–0.08), and the postoperative CSF infection rate (n = 5 studies) was 0.0004 (95% CI 0.00–0.003). All pooled outcomes were found to be low-quality evidence.

This systematic review and meta-analysis provides the most comprehensive pooled estimate for the ETV+CPC failure rate to date and demonstrates, for the first time, a statistically significant difference in failure rate by geographic income level. It also provides the first reported pooled estimates for the risk of ETV+CPC perioperative mortality, intraoperative abandonment, and CSF infection. The low quality of this evidence highlights the need for further research to improve the understanding of these critical clinical outcomes and their relevant explanatory variables and thus to appreciate which patients may benefit most from an ETV+CPC.

Systematic review registration no.: CRD42020160149 (https://www.crd.york.ac.uk/prospero/)

内窥镜第三脑室造口术和脉络丛烧灼术 (ETV+CPC) 是一种针对婴儿脑积水的新型手术，它是在撒哈拉以南非洲地区开发的，旨在降低与永久性植入分流硬件相关的风险。本研究总结了围绕 ETV+CPC 术中放弃率、围手术期死亡率、脑脊液感染率和失败率的脑积水文献。

该系统评价和荟萃分析遵循预先指定的方案，并遵守系统评价和荟萃分析的首选报告项目 (PRISMA) 指南。从数据库成立到 2019 年 10 月，使用 MEDLINE、EMBASE、PsychInfo、Cochrane 对照试验中央注册库、Cochrane 系统评价数据库、Scopus 和 Web of Science 进行了一项综合搜索策略。研究包括对照试验、队列研究和案例研究。对接受 ETV+CPC 治疗的 18 岁以下脑积水患者的对照研究。使用 DerSimonian 和 Laird 随机效应模型计算汇总估计值，并使用元回归检验亚组分析的显着性。汇总结果的质量使用建议分级评估，

在筛选和审查 12,321 篇引文后，作者发现了 16 篇符合纳入标准的文章。ETV+CPC 失败率的汇总估计值为 0.44 (95% CI 0.37–0.51)。按地域收入水平进行的亚组分析显示有统计学意义（p < 0.01），中低收入国家的失败率（0.32, 95% CI 0.28–0.36）低于高收入国家（0.53, 95% CI 0.47– 0.60）。脑积水病因 (p = 0.09) 或失败定义 (p = 0.24) 之间的失败率没有差异。围手术期死亡率（n = 7 项研究）的汇总估计值为 0.001（95% CI 0.00–0.004），术中放弃率（n = 5 项研究）为 0.04（95% CI 0.01–0.08），术后脑脊液感染率（n = 5 项研究）为 0.0004（95% CI 0.00–0.003）。

这项系统回顾和荟萃分析提供了迄今为止对 ETV+CPC 失败率最全面的汇总估计，并首次证明了不同地域收入水平的失败率在统计上的显着差异。它还提供了首次报告的 ETV+CPC 围手术期死亡率、术中放弃和 CSF 感染风险的汇总估计值。该证据的低质量强调需要进一步研究以提高对这些关键临床结果及其相关解释变量的理解，从而了解哪些患者可能从 ETV+CPC 中获益最多。

系统评价注册号：CRD42020160149 (https://www.crd.york.ac.uk/prospero/)