SURP-02. Re-ETV versus Ventriculoperitoneal Shunting in Failed ETV in Pediatric Patients with Hydrocephalus: A Systematic Review

INTRODUCTION Hydrocephalus in pediatric patients is commonly treated with endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunting (VPS). When primary ETV fails, clinicians must decide between repeat ETV (Re-ETV) and VPS placement. However, the optimal secondary intervention remains debated. Objective: To compare the efficacy and outcomes of Re-ETV versus VPS placement following failed primary ETV in pediatric hydrocephalus. METHODS We conducted a systematic review following PRISMA guidelines. Searches of PubMed, Embase, and the Cochrane Library identified English-language studies (2001–2023) reporting on Re-ETV or VPS after failed primary ETV in patients aged 0–18 years. Comparative studies, including randomized controlled trials, cohort studies, and prospective designs were eligible. Two independent reviewers screened titles, abstracts, and full texts; extracted data on sample size, intervention rates, failure rates, and complications; and assessed study quality using RoB 2.0 and CASP tools. Pooled descriptive statistics and odds ratios (OR) were calculated for secondary intervention failure. RESULTS Nine studies (n = 663) met inclusion criteria. Re-ETV was performed in 220 patients (33.2%) and VPS in 443 (66.8%). Primary ETV failure rates ranged from 16.6% to 60.9% (mean 40.6%). Re-ETV exhibited a pooled failure rate of 74.98%, whereas VPS failure was 22.26% (OR 4.86; 95% CI 3.21–7.38; p < 0.05). Hemorrhagic etiology during primary ETV significantly favored VPS over Re-ETV (p < 0.05). Time to secondary failure averaged 15.8 ± 21.7 months, with broad inter-study variability. CONCLUSION VPS placement demonstrates a substantially lower failure rate than Re-ETV as a secondary intervention after primary ETV failure in pediatric hydrocephalus. Nevertheless, variability in patient age, etiology, and follow-up underscores the necessity of individualized decision-making. Prospective trials with standardized outcome measures are warranted to refine secondary treatment guidelines.