ArticleChild's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery2026
Treatment failure after endoscopic third ventriculostomy with choroid plexus cauterization, endoscopic third ventriculostomy alone, and ventriculoperitoneal shunt in congenital hydrocephalus: a network and time-to-event meta-analysis.
Article in Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeCongenital hydrocephalus is commonly treated with endoscopic third ventriculostomy (ETV), ETV with choroid plexus cauterization (ETV + CPC), or ventriculoperitoneal shunting (VPS), yet outcomes vary, and treatment failure is frequent. This study examines treatment failure between procedures in patients with congenital hydrocephalus.
methodsWe conducted a database search from inception to February 2025 for head-to-head studies comparing the primary treatments. A network meta-analysis (NMA) was employed to assess failure rates, and pseudo-individual patient data from published Kaplan-Meier (KM) curves were used to evaluate time to failure. This study was registered with PROSPERO (CRD420251142532).
resultsThe initial search identified 851 articles, of which eight studies (402 patients; 155 VPS, 175 126 only and 121 ETV + CPC) were included. Aqueductal stenosis was the most frequent etiology in ETV only (68.3%) and ETV + CPC groups (51.0%). Myelomeningocele-related hydrocephalus was most reported in the ETV + CPC group (28.9%). Treatment failure was reported at 35.5% in the VPS group, 31.4% for ETV + CPC and 23.8% for ETV only. ETV + CPC demonstrated a significantly lower risk of failure compared with VPS (RR = 0.43, 95% CI: 0.19-0.99). Surface under the cumulative ranking curve analysis ranked ETV + CPC as the most effective strategy in minimizing treatment failure (Rank 1: 88.9%). In KM analysis, the median failure-free survival was not reached in the ETV + CPC group, but was 57.3 months for ETV only and 19.8 months for VPS.
conclusionETV + CPC ranked best in reducing treatment failure with significant benefits over VPS. Larger studies are required to clarify the comparative efficacy of treatment modalities and to identify surgical and etiological factors predictive of treatment failure.
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