Meta-analysis Of The Efficacy Of Neuroendoscopic Third Ventricular Floor Fistula And Ventricular-abdominal Shunt In The Treatment Of Obstructive Hydrocephalus

Objective: A systematic review of the clinical efficacy of neuroendoscopic third ventricle floor fistula and ventricular-abdominal shunt in the treatment of obstructive hydrocephalus。Materials and Methods:In January 2021,a comprehensive search strategy of 8 electronic databases was initiated.A systematic search from database inception to January 30,2021 was conducted.Pub Med,EMBASE,web of science and Cochrane Library of our foreign databases;CBM,CNKI,Wanfang and VIP Etc of four domestic databases.Objective to compare ETV and V-P shunt in the treatment of obstructive hydrocephalus in an independent randomized controlled trial,and to observe the effective rate,recurrence rate,complication rate,infection rate,bleeding rate and other complications of the two methods.Infection rate,bleeding rate and other subgroup complications.Results:Of the 1665 studies identified,16 RCTs involving 1075 patients met our inclusion criteria.The analysis of the results showed that after the heterogeneity test,14 articles were finally included for the postoperative effective statistics of ETV and VP shunting,and the results were not statistically significant [RR=1.03,95%CI(0.98-1.08),P =0.28].The incidence of postoperative recurrence,total complications,infection,bleeding,and tube blockage,the differences were significant [RR=0.38,95%CI(0.27,0.54),P<0.00001;RR=0.35,95%CI(0.26),0.46),P<0.00001;RR=0.31,95%CI(0.15,0.63),P=0.001;RR=0.43,95%CI(0.22,0.87),P=0.02;RR=0.33,95%CI(0.17,0.65),P=0.001]。There was no significant effect on incidence rate of postoperative cerebrospinal fluid leakage [RR=0.91,95%CI(0.25,3.36),Z=0.14,P=0.089] and mortality rates [RR =0.19,95%CI(0.03,1.09),Z=1.86,P=0.06],but there have been no deaths in patients treated with ETV.The results showed that neuroendoscopic third ventricular floor fistula had obvious advantages in the treatment of postoperative complications of obstructive hydrocephalus.Conclusion:This study showed that there was no significant difference in postoperative efficiency between ETV and VPS,but the incidence of complications after ETV was significantly lower than that of V-P shunt.The comparison of the postoperative efficacy of the two surgical methods needs to be supported by evidence from a multicenter randomized double-blind controlled trial.