Success and complication rates of endoscopic third ventriculostomy for tuberculous meningitis: a systematic review and m
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ORIGINAL ARTICLE
Success and complication rates of endoscopic third ventriculostomy for tuberculous meningitis: a systematic review and meta-analysis Gerardo D. Legaspi 1 & Adrian I. Espiritu 2,3 & Abdelsimar T. Omar II 1 Received: 8 May 2020 / Revised: 3 September 2020 / Accepted: 17 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Because ventriculoperitoneal shunt (VPS) insertion for patients with hydrocephalus from tuberculous meningitis (TBM) can be complicated by shunt infection and malfunction, endoscopic third ventriculostomy (ETV) has been proposed as an alternative. The aim of this review was to determine the success, technical failure, and complication rates of ETV in TBM in a meta-analysis and determine which factors are predictive of outcome. The PubMed, Scopus, and CENTRAL databases were searched from inception to April 2020 for case series, cohort studies, or randomized controlled trials reporting success, technical failure, or complication rates. For studies with individual patient data available, logistic regression analysis was done to determine whether age, sex, clinical grade, and type of hydrocephalus on imaging was predictive of outcome. Eight studies with a total of 174 patients were included in the review. Using random-effects modeling, the pooled estimate of success rate was 59% (95% CI 50– 68%), with low heterogeneity (I2 = 30%). The technical failure and complication rates were 5% and 15%, respectively, but these variables had moderate heterogeneity. In 36 patients with individual patient data, a non-communicating type of hydrocephalus on imaging was associated with an odds ratio of 5.90 (95% CI 1.1–32.9, p = 0.043) for success. In summary, ETV for TBM had a pooled success rate of 59%, technical failure rate of 5%, and complication rate of 15%. An imaging finding of noncommunicating hydrocephalus was associated with increased success. High-quality randomized, prospective studies using VPS insertion as control are needed to further define the role of ETV in TBM. Keywords Endoscopic third ventriculostomy . Tuberculous meningitis . Hydrocephalus
Introduction Tuberculous meningitis (TBM) is a severe extrapulmonary form of tuberculosis which affects an estimated 100,000 individuals annually [21]. Among its most common Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10143-020-01396-y) contains supplementary material, which is available to authorized users. * Abdelsimar T. Omar, II [email protected] 1
Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Taft Avenue, Ermita, 1000 Manila, Philippines
2
Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Taft Avenue, Ermita, 1000 Manila, Philippines
3
Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Taft Avenue, Ermita, 1000 Ma
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