Efficacy and safety of endoscopic third ventriculostomy with choroid plexus cauterization compared to ventriculoperitoneal shunting in pediatric hydrocephalus: a systematic review and meta-analysis with subgroup analysis.

PURPOSE: To compare the efficacy and safety outcomes of endoscopic third ventriculostomy with choroid plexus cauterization (ETV + CPC) and ventriculoperitoneal shunting (VPS) in pediatric hydrocephalus.

METHODS

This systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. Comprehensive searches were performed in PubMed, Embase, Cochrane Library, and Web of Science until May 2025. Risk of bias was assessed using ROBINS-I for non-randomized studies and RoB 2 for randomized trials. Statistical analyses were conducted using RStudio (version 4.4.1).

RESULTS

Eighteen studies were included, comprising 7256 pediatric patients. ETV + CPC showed a significantly higher mortality rate after the procedure than VPS (RR = 1.14; 95% CI 1.06-1.22; p < 0.001; I2 = 0%). However, no significant differences were observed in seizure (p = 0.664; I2 = 0%), infection (p = 0.188; I2 = 0%), or procedural failure rates (p = 0.566; I2 = 72.1%). Heterogeneity was low across all outcomes. Sensitivity and Baujat analyses confirmed the robustness of the primary findings, with no single study disproportionately influencing the overall result. Subgroup analysis focusing on randomized controlled trials (RCT) was performed for all four outcomes.

CONCLUSION

EVT + CPC is associated with a higher mortality rate compared to VPS, and shows similar rates of seizure, infection and procedural failure. These findings indicate that physicians should adopt a more cautious approach when opting for ETV + CPC; however additional RCTs are needed to address this question.