Surgical management of longstanding overt ventriculomegaly in adults: evaluating the role of endoscopic third ventriculostomy.

Abstract

<h4>Background</h4>Longstanding Overt Ventriculomegaly in Adults (LOVA) and Obstructive Hydrocephalus (o-HCP) is the abnormal accumulation of cerebrospinal fluid (CSF), leading to increased intracranial pressure, and associated neurological symptoms. Endoscopic Third Ventriculostomy (ETV) is a minimally invasive surgical treatment for these conditions. ETV has demonstrated effectiveness in pediatric populations, its efficacy in adult patients remains ambigous. This systematic review and meta-analysis aims to evaluate the outcomes of ETV in adult patients with LOVA and o-HCP.<h4>Methods</h4>A systematic review along with meta-analysis were carried out following the PRISMA guidelines. Studies were identified through PubMed, Cochrane, Scopus, and CINAHL databases using relevant MeSH terms and BOOLEAN operators. The inclusion criteria followed the PICO model, focusing on adult patients (> 18 years) undergoing ETV. Data on postoperative complications, symptom improvement, and successful treatment outcomes were extracted. Statistical analysis, including sensitivity analyses, was performed using R Studio, with odds ratios (OR) and heterogeneity (I²) calculated. The Newcastle-Ottawa Scale was employed to assess for risk of bias.<h4>Results</h4>A total of 8 studies comprising 200 patients were included. The overall odds ratio for successful treatment following ETV was 4.59 (95% CI: 2.74-7.67) with moderate heterogeneity (I² = 53%). Sensitivity analysis reduced the heterogeneity to 0%, increasing the OR to 5.56 (95% CI: 3.80-8.13). Significant improvements were noted in specific symptoms, including headache (OR 9.47, 95% CI: 4.31-20.81, I² = 0%), balance (OR 10.78, 95% CI: 4.00-29.03, I² = 35%), and memory (OR 6.64, 95% CI: 1.38-31.86, I² = 61%). A low risk of bias was observed across all studies included.<h4>Conclusions</h4>ETV is an effective treatment for patients with LOVA and o-HCP, demonstrating significant symptom improvement and a high success rate. Low heterogenicity of outcomes with robust findings confirmed sensitivity analyses. However, patient-specific factors, such as age and duration of symptoms, should be considered for ETV.