Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in the treatment of hydrocephalus due to posterior fossa tumors in children: an updated meta-analysis.

[OBJECTIVE] This study aimed to compare endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in managing obstructive hydrocephalus secondary to posterior fossa tumors in pediatric patients.

[METHODS] A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Searches of PubMed, Cochrane, and Embase databases were performed on April 1, 2025. Primary outcomes included mortality and control of intracranial hypertension, while secondary outcomes encompassed infection and bleeding rates.

[RESULTS] The search identified 417 studies, of which 12 met the inclusion criteria, encompassing 917 pediatric patients (360 ETV and 557 VPS). Ages ranged from 0 to 19 years, with 61% being male. No significant differences were observed between ETV and VPS in terms of mortality (OR 0.49; 95% CI 0.14-1.73; p = 0.27; I = 0%), control of intracranial hypertension (OR 0.79; 95% CI 0.49-1.25; p = 0.31; I = 66%), or need for reoperation (OR 0.65; 95% CI 0.43-1.00; p = 0.05; I = 58%). However, ETV was associated with a significantly lower infection rate (OR 0.15; 95% CI 0.03-0.73; p = 0.02; I = 0%) and a lower incidence of bleeding complications (OR 0.40; 95% CI 0.17-0.97; p = 0.04; I = 0%).

[CONCLUSION] ETV and VPS demonstrated comparable outcomes regarding mortality, ICP control, and need for reoperation. ETV was associated with lower rates of infection and overall intracranial hemorrhage, although no difference was observed for intracerebral hemorrhage alone. Larger prospective studies are needed to confirm these findings.