Long-tunneled external ventricular drainage (LTEVD) for the prevention and treatment of infections in pediatric and adult hydrocephalus

Background Long-tunneled external ventricular drainage (LTEVD) has been proposed as an alternative to conventional short-tunneled external ventricular drainage (STEVD), particularly to reduce complications such as catheter dislocation and secondary infections. Despite potential advantages, awareness of LTEVD and high-quality literature remain limited. This systematic review and meta-analysis intends to evaluate the safety and efficacy of LTEVD in pediatric and adult populations. Methods A systematic review was conducted to identify studies including both adult and pediatric patients undergoing LTEVD and reporting intra-, peri-, and postoperative clinical outcomes, indications, and complication rates. Major scientific databases were searched for articles published up to 2024. Two authors independently extracted data. Results Fifteen studies (n = 1,024; 612 adults, 412 children) met inclusion criteria, with most applying LTEVD to manage infections. The mean tunneling length was 41.3 cm, and the median duration of drainage was 7 days. LTEVD removal was performed in the operating room in 87% of cases, compared to 92% bedside removals for STEVD. Six studies (n = 123) reported conversion to ventriculoperitoneal shunt. Meta-analysis of infection rates (10 studies, n = 824) showed no statistically significant difference between LTEVD and STEVD (OR 1.83, 95%CI 0.84–3.99; p = 0.13). Blockage and dislocation rates were comparable (LTEVD 2.7% vs. STEVD 7.0%, p = 0.075; LTEVD 5.4% vs. STEVD 2.3%, p = 0.151). Conclusion Outcomes for LTEVD are generally comparable to STEVD in both children and adults. While LTEVD may offer potential long-term advantages for infection management, current evidence does not confirm its superiority. LTEVD may be appropriate for prolonged drainage needs, but further research is required due to limited evidence and study heterogeneity.