Long-term outcomes of ventricular entry in high grade glioma resection: A meta-Analysis and meta regression.

Ventricular entry (VE) in high-grade gliomas (HGGs) has been hypothesized to predispose patients to adverse events and poor outcomes; however, the extent remains unclear. This study aimed to systematically evaluate the impact of VE in patients with HGG. A PROSPERO-registered (CRD420251053281) systematic search was conducted in the ScienceDirect, Scopus, PubMed, Google Scholar, and Cochrane databases to identify longitudinal studies up to June 2025. Primary outcomes included leptomeningeal dissemination (LMD), distant parenchymal recurrence (DPR), and hydrocephalus. Additionally, survival analysis with Kaplan-Meier curve and meta-regression were conducted to assess survival patterns and identify study-level moderators contributing to heterogeneity. Seventeen studies involving 4,086 participants (mean age 57.24 ± 11.21 years; 52.26% male) met the inclusion criteria. VE was significantly associated with increased risks of LMD (RR 2.23; 95% CI 1.61-3.11; p < 0.001) and hydrocephalus (RR 3.57; 95% CI 1.88-6.80; p < 0.001), but not DPR in the overall analysis. Survival analysis revealed that VE is associated with increased mortality (HR 1.12; 95% CI 1.03-1.21) up to 84 months. Meta-regression revealed that prior treatment was inversely associated with LMD, whereas increasing age, male sex, glioblastoma histology, and receipt of chemotherapy or radiotherapy were positively associated with DPR. In contrast, non-methylated status and radiotherapy were inversely associated with hydrocephalus. VE in HGGs may be associated with increased risks of LMD, hydrocephalus, and reduced survival. However, these associations should be regarded as provisional.