Objective To evaluate the clinical effectiveness of endoscopic third ventriculostomy (ETV) and ventriculal peritoneum shunt (VPS) for hydrocephalus. Methods A fully recursive literature search was conducted in PubMed (1996 to June, 2011), EMBASE (1996 to June, 2011), Cochrane Central Register of Controlled Trials (Issue 3, 2011), CBM (1996 to June, 2011), CNKI and Wanfang Database (1996 to June, 2011) in any language. The randomized or non-randomized controlled trials of hydrocephalus treated by endoscopic third ventriculostomy and ventriculal peritoneum shunt were considered for inclusion. The analyzed outcome variables were overall complications and the survival rate of all time points. Data related to clinical outcomes were extracted by two reviewers independently. Statistical analyses were carried out by using RevMan 5.0 software. Results Nine published reports of eligible studies involving 1 187 participants met the inclusion criteria. Compared with VPS, ETV had no significant differences in short-term (1 or 2 years) survival rate (RR=1.02, 95%CI 0.90 to 1.16, P=0.74; RR=1.14, 95%CI 1.00 to 1.30, P=0.06), but there were significant differences between the two groups in overall complication rate (RR=0.70, 95%CI 0.57 to 0.89, P=0.001), postoperative 3-year survival rate (RR=1.23, 95%CI 1.07 to 1.41, P=0.004), and postoperative 5-year survival rate (RR=1.14, 95%CI 1.29 to 1.66, P=0.05). So the outcomes indicated ETV was superior in controlling the overall complication rate and prolonging the long-term survival rate. Conclusion Current evidence suggests that endoscopic third ventriculostomy is superior to ventriculal peritoneum shunt in reducing the overall complications and prolonging the long-term survival rate, but there is no significant difference in short-term survival rate between the two methods. The effectiveness of the two operational methods for hydrocephalus caused by all specific reasons still has to be further proved by more high-quality, multi-centered and double-blind RCTs.
Objective To systematically review the clinical effectiveness and safety of programmable valves (PV) vs. standard valves (SV) for hydrocephalus. Methods Literature search was conducted in PubMed, The Cochrane Library, EMbase, CNKI, CBM, VIP and WanFang Data to collect both randomized controlled trials (RCTs) and non-randomized concurrent controlled trials on hydrocephalus treated by PV and SV published from January 1992 to January 2012. According to the inclusion criteria, two reviewers independently screened articles, extracted data, and evaluated and cross-checked the quality of the included studies. Then meta-analysis was performed using RevMan 5.0 software. Results A total of 11 non-randomized concurrent controlled trials involving 1,485 participants were included. The results of meta-analysis showed that, compared with SV, PV was superior in overall effective rate (RR=1.14, 95%CI 1.03 to 1.27, P=0.01), 2-year survival rate (RR=1.25, 95%CI 1.04 to 1.51, P=0.02), secondary surgery rate (RR=0.53, 95%CI 0.39 to 0.73, Plt;0.001), overall complications rate (RR=0.62, 95%CI 0.51 to 0.76, Plt;0.001), and over-drainage/ under-drainage rates (RR=0.42, 95%CI 0.21 to 0.83, P=0.01). But there were no significant differences in 1-year survival rate (RR=1.04, 95%CI 0.91 to 1.19, P=0.55), postoperative infection rate (RR=1.08, 95%CI 0.73 to 1.60, P=0.71) and valve related complication rate (RR=0.80, 95%CI 0.56 to 1.21, P=0.20) between the two groups. Conclusion Current evidence suggests that PV is superior to SV in increasing the effective rate, decreasing complications, and prolonging the long-term survival rate. Because of the limitation of quantity and quality of the included studies, more high quality, multicenter and double-blind RCTs are needed to prove whether PV can be clinically recommended as a preferred drainage surgery or not.