Choudry, Usama Khalid

Abstract Background Hydrocephalus, the abnormal buildup of cerebrospinal fluid (CSF) in the brain’s ventricles, makes pediatric neurosurgery difficult. Endoscopic Third Ventriculostomy (ETV) and Ventriculoperitoneal Shunting (VPS) are the basic treatments, however unsuccessful ETV management is disputed. This study aims to compare RE-ETV with VPS in pediatric hydrocephalus patients after unsuccessful ETV. Methods A comprehensive literature review was performed using PubMed, Embase, and Cochrane Library. The review covered pediatric RE-ETV or VPS trials following ETV failure. Success rates, complications, failure timings, and reoperation rates were extracted. The Cochrane Collaboration’s risk of bias instrument (RoB 2.0) and Critical Appraisal Skills Programme (CASP) were utilized to assess quality of studies. Results 40 articles were chosen for comprehensive full-text evaluation. Nine publications specifically addressing the topic of Re-ETV and/or VPS placement after the failure of original ETV were identified as acceptable for the review. A data set of 663 patients was assessed. Re-ETV was carried out in 220 patients (33.18%) and VPS Placement was done in 443 patients (66.81%). The primary ETV failure rates ranged from 16.6% to 60.89%. There was a larger failure rate of Re-ETV (74.98%) compared to VPS (22.26%) showing that VPS is often more effective as a secondary intervention. The presence of bleeding during primary ETV suggested more benefit from VPS placement rather than Re-ETV (p < 0.05). Conclusions VPS is more commonly employed than RE-ETV in pediatric patients after unsuccessful ETV. Although RE-ETV provides a less invasive technique, it has a greater failure rate. However, owing to inadequate evidence on VPS failure post-ETV, additional research is recommended. Future research should concentrate on enhancing the evidence foundation to aid clinical decision-making in treating hydrocephalus post-ETV failure.

Abstract INTRODUCTION Hydrocephalus in pediatric patients is commonly treated with endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunting (VPS). When primary ETV fails, clinicians must decide between repeat ETV (Re-ETV) and VPS placement. However, the optimal secondary intervention remains debated. Objective: To compare the efficacy and outcomes of Re-ETV versus VPS placement following failed primary ETV in pediatric hydrocephalus. METHODS We conducted a systematic review following PRISMA guidelines. Searches of PubMed, Embase, and the Cochrane Library identified English-language studies (2001–2023) reporting on Re-ETV or VPS after failed primary ETV in patients aged 0–18 years. Comparative studies, including randomized controlled trials, cohort studies, and prospective designs were eligible. Two independent reviewers screened titles, abstracts, and full texts; extracted data on sample size, intervention rates, failure rates, and complications; and assessed study quality using RoB 2.0 and CASP tools. Pooled descriptive statistics and odds ratios (OR) were calculated for secondary intervention failure. RESULTS Nine studies (n = 663) met inclusion criteria. Re-ETV was performed in 220 patients (33.2%) and VPS in 443 (66.8%). Primary ETV failure rates ranged from 16.6% to 60.9% (mean 40.6%). Re-ETV exhibited a pooled failure rate of 74.98%, whereas VPS failure was 22.26% (OR 4.86; 95% CI 3.21–7.38; p < 0.05). Hemorrhagic etiology during primary ETV significantly favored VPS over Re-ETV (p < 0.05). Time to secondary failure averaged 15.8 ± 21.7 months, with broad inter-study variability. CONCLUSION VPS placement demonstrates a substantially lower failure rate than Re-ETV as a secondary intervention after primary ETV failure in pediatric hydrocephalus. Nevertheless, variability in patient age, etiology, and follow-up underscores the necessity of individualized decision-making. Prospective trials with standardized outcome measures are warranted to refine secondary treatment guidelines.

Background: The objective of this research article is to compare endoscopic treatment versus shunting procedures for failed endoscopic third ventriculostomies (ETVs) in pediatric patients with hydrocephalus. Methods: We did a systematic review based on preferred reporting items for systematic reviews and meta-analyses guidelines on Studies involving pediatric patients (aged 0–18 years) diagnosed with hydrocephalus, reporting on the use of repeat ETV (Re-ETV) or Ventriculoperitoneal shunting (VPS) as a treatment option following failed ETV. Comparative studies, including randomized controlled trials, cohort studies, and any prospective studies, are included. Studies published in the English language conducted between 2001 and 2023 are included. Results: Forty articles were selected for full-text review. Out of which nine articles that clearly addressed the topic of Re-ETV and/or VPS placement after failure of primary ETV were deemed suitable for analysis. A data set of 663 patients was analyzed. Re-ETV was done in 220 patients (33.18%) and VPS Placement was done in 443 patients (66.81%). The primary ETV failure rates ranged from 16.6 to 60.89%. There was a higher failure rate of Re-ETV (74.98%) compared to VPS (22.26%) indicating that VPS is generally more successful as a secondary intervention. The presence of hemorrhage during primary ETV suggested more benefit from VPS placement rather than Re-ETV (P < 0.05). Conclusion: Our systematic review suggests that VPS placement is the more prevalent choice after primary ETV failure, likely due to its higher overall success rate and the nature of complications. The wide variability in failure rates and follow-up durations suggests that treatment outcomes can differ greatly between patients and studies. Decisions regarding secondary interventions should be individualized, considering patient-specific factors such as age, complications, and timing of intervention.