• World Neurosurg · Jun 2023

    Review Meta Analysis

    Long standing overt ventriculomegaly in adults (LOVA): a systematic review and meta-analysis of endoscopic third ventriculostomy vs ventriculoperitoneal shunt as first line treatment.

    • Conor S Gillespie, FangWen Yung StephanieWYSDepartment of Clinical Neurosciences, St George's, University of London, London, United Kingdom., Keng Siang Lee, Abigail L Clynch, Ali M Alam, and Catherine J McMahon.
    • Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom. Electronic address: conorgillespie1@gmail.com.
    • World Neurosurg. 2023 Jun 1; 174: 213220.e2213-220.e2.

    BackgroundLong-standing overt ventriculomegaly in adults (LOVA) is a heterogeneous term describing forms of adult hydrocephalus. LOVA incidence is increasing, yet the optimal treatment strategy for symptomatic cases remains unclear. We compared success rates and complication rates between endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) as first-line treatment for LOVA.MethodsA systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Three databases were searched, and articles published from 2000 to October 2022 were included (last search date October 24, 2022). Success rates and complications of both ETV and VPS were compared using random-effects models.ResultsOf 895 articles identified, 22 studies were included in the analysis (556 patients: 346 in ETV group, 210 in VPS group). Mean age was 44.8 years. The most common presenting symptoms were gait disturbance (n = 178), headache (n = 156), and cognitive decline (n = 134). Combined success rates were 81.8% (n = 283/346) in the ETV group and 86.7% (n = 182/210) in the VPS group (median follow-up 41 months). There was no difference in success rates between ETV and VPS groups (odds ratio 0.94, 95% confidence interval 0.86-1.03, I2 = 0%). Combined complication rates were 4.6% (n = 16/346) in the ETV group and 27.1% (n = 57/210) in the VPS group. ETV had a lower rate of postoperative complications (odds ratio 0.22, 95% confidence interval 0.11-0.33, I2 = 0%).ConclusionsSymptomatic LOVA can be successfully managed with surgical intervention. ETV and VPS have similar success rates when used as first-line treatment. VPS has a higher complication rate.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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