<![CDATA[Background. Pediatric hydrocephalus is a serious neurological condition requiring effective surgical intervention to prevent long-term morbidity and mortality. Two primary approaches are commonly employed: ventriculoperitoneal (VP) shunt and endoscopic third ventriculostomy with choroid plexus cauterization (ETV+CPC), each presenting distinct advantages and limitations, particularly in resource-limited healthcare settings. This study aimed to compare the effectiveness and safety of both procedures in children with hydrocephalus. Methods. A systematic review and meta-analysis of 10 observational studies retrieved from PubMed and ScienceDirect was performed. Study selection followed the PRISMA 2020 guideline, and statistical analyses were conducted using both fixed- and random-effects models. Categorical outcomes were pooled as risk ratios (RR) and the continuous outcome (time to failure) as mean difference (MD), each with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic, and sensitivity and publication-bias analyses were undertaken. Results. There was no significant difference in procedural success (RR 0.96; 95% CI 0.84–1.09; p = 0.52) or mortality (RR 1.01; 95% CI 0.55–1.83; p = 0.98) between the two procedures. However, ETV+CPC was associated with significantly fewer complications (RR 0.42; 95% CI 0.21–0.83; p = 0.02) and a longer time to failure (MD 3.62 months; 95% CI 0.12–6.45; p = 0.04). Revision rates showed no significant difference (RR 1.30; 95% CI 0.72–2.33; p = 0.38). Conclusion. ETV+CPC offers comparable effectiveness to VP shunt with superior safety and durability profiles, making it a viable alternative, particularly in settings with limited resources.]]>
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