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

BACKGROUND: Long standing overt ventriculomegaly in adults (LOVA) is a heterogenous term describing forms of adult hydrocephalus. LOVA incidence is increasing, yet the optimal treatment strategy for symptomatic cases remains unclear. We compared the success and complication rates between Endoscopic Third Ventriculostomy (ETV) and Ventriculoperitoneal Shunt (VPS) as a first line treatment for LOVA.

METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines (PROSPEROID CRD42021277542). Three databases were searched, and articles published from 2000 to October 2022 included (last search date 30th September 2022). Success rates and complications of both ETV and VPS were compared using random effects models.

RESULTS: Of 895 articles identified, 22 studies were included in the analysis (556 patients- 346 treated with ETV, 210 VPS). 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 [OR] 0.94, 95% CI 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 (OR 0.22, 95% CI 0.11-0.33, I2 = 0%).

CONCLUSIONS: Symptomatic LOVA can be successfully managed with surgical intervention. ETV and VPS have similar success rates when used as first line treatment. However, VPS has a higher complication rate.