Efficacy and safety of flexible versus rigid endoscopic third ventriculostomy in pediatric and adult populations: a systematic review and meta-analysis View Full Text


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Article Info

DATE

2021-06-25

AUTHORS

Alessandro Boaro, Bhargavi Mahadik, Anthony Petrillo, Francesca Siddi, Sharmila Devi, Shreya Chawla, Abdullah M. Abunimer, Alberto Feletti, Alessandro Fiorindi, Pierluigi Longatti, Francesco Sala, Timothy R. Smith, Rania A. Mekary

ABSTRACT

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. More... »

PAGES

199-216

References to SciGraph publications

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  • 2005-02-17. Outcome of endoscopic third ventriculostomy. Results from an unselected series with noncommunicating hydrocephalus in ACTA NEUROCHIRURGICA
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  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s10143-021-01590-6

    DOI

    http://dx.doi.org/10.1007/s10143-021-01590-6

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1139150559

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/34173114


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