Meta-analysis Of Endoscopic Third Ventriculostomy Versus Ventriculoperitoneal Shunt For Treating Normal Pressure Hydrocephalus

Objective:We conducted a meta-analysis to compare the safety and efficacy of endoscopic third ventriculostomy(ETV)and ventriculo-peritonea shunt(VPS)for treating normal pressure hydrocephalus(NPH),which aim to provide a scientific basis for the choice of surgical treatment strategy of NPH and guide clinical practice.Methods:Through electronic searches in Chinese biomedical literature database,CNKI,Wanfang medical network,Pubmed,EMBASE,Cochrane Library,and manual search of Gray literature(such as internal reports,conference papers),we collected studies about comparison of efficacy between ETV and VPS for patients with NPH,published up to December 2019.Languages are limited to Chinese and English.After screening literatures according to the inclusion criteria and exclusion criteria,we evaluated the quality of original studies by using the Cochrane Collaboration's tool for assessing risk of bias or the "Newcastle Ottawa scale(NOS)",depending on the type of the study.Rev Man5.3 software was used for data analysis.Results:In this meta-analysis,6 articles were included,and a total of 13960 NPH patients participated,including 848 in ETV group and 13112 in VPS group.Meta-analysis showed that there was no significant difference in clinical efficiency between the two groups(RR combination = 1.01,95% CI: 0.94 ~ 1.08,P = 0.84 > 0.05);in postoperative complications,ETV group had a lower incidence of complications than VPS,and the difference was statistically significant(RR combination = 0.53,95%CI: 0.39~0.72,P <0.0001).Subgroup analysis showed that there was no significant difference in the incidence of complications between ETV and VPS in the short term(RR combination = 0.55,95%CI: 0.22~1.37,P =0.20);but in the long term,ETV had a lower incidence of complications,the difference was statistically significant(RR combination = 0.53,95%CI: 0.39~0.73,P<0.0001).Conclusion:According to the existing research evidence,there is no statistical difference between ETV and VPS in clinical efficiency for treating NPH;in the short term,there is no statistical significance between ETV and VPS in the incidence of complications;but in the long term,ETV has a lower incidence of complications,and the difference is statistically significant.Different types of research may affect the final conclusion,which needs to be further verified by more high-quality randomized controlled studies.