Outcomes of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in the treatment of paediatric hydrocephalus: Systematic review and meta-analysis.

PURPOSE: To evaluate the outcomes of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in the treatment of paediatric hydrocephalus. METHODS: We searched PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials databases for articles published from 2000 to May 2023 (last search date May 6, 2023). Keywords searched included "endoscopic third ventriculostomy", "ventriculoperitoneal shunting", "paediatric population", and "outcomes". Using random-effects models, we compared success rates and complications of ETV and VPS. The primary outcome was ETV vs.VPS success rates, and the secondary outcome was post-treatment complications. Included studies reported on treatment success and complication rates. RESULTS: Out of 126 articles, 8 RCTs and 1 prospective study were included. Six studies reported primary outcome data (806 patients identified: 464 in ETV group, 342 in VPS group). Combined success rates were 81.8% (n = 283/346) for ETV and 86.7% (n = 182/210) for VPS (median follow-up 41 months). There was no difference in success rates between ETV and VPS groups (risk ratio 0.84, 95% confidence interval 0.80-0.90, I2 = 0%, p = 0.93). 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 (risk ratio 0.76, 95% confidence interval 0.42-1.38, I2 = 53%, p = 0.04). CONCLUSIONS: Both ETV and VPS are viable surgical options for the management of paediatric hydrocephalus with similar success rates when used as first-line treatment. However, our study concluded that VPS results in a higher complication rate. REGISTRATION: This systematic review and meta-analysis was formally registered in the PROSPERO International database under the registration number CRD42023452907 on the 29th of August 2023.

Early Preventive Strategies and CNS Meningioma - Is This Feasible? A Comprehensive Review of the Literature.

BACKGROUND: Meningiomas are one of the most common benign primary brain tumors; however, there is a paucity of literature on potential preventability. This comprehensive review aimed to explore the existing evidence for the potential risk factors that may contribute to meningioma development and to discuss early prevention strategies. METHODS: Literature search was conducted via MEDLINE, Embase, Web of Science, and Cochrane Database to retrieve existing literature on various environmental exposures and lifestyle behaviors that are potential risk factors for the development of meningiomas. RESULTS: Significant risk factors included exposure to ionizing radiation and certain environmental chemicals. Notably, this study also identified that cigarette smoking and obesity are associated with the development of meningiomas. To date, wireless phone usage, hormonal exposures, dietary factors, and traumatic brain injury remain inconclusive. Early prevention strategies should primarily be family-driven, community-based, and public health-endorsed strategies. Targeting unhealthy behaviors through healthcare organizations could execute a pivotal role in the maintenance of an optimum lifestyle, reducing the development of risk factors pertinent to meningiomas. CONCLUSIONS: To our knowledge, this is the first study that offers a perspective on prevention of meningiomas. A causal relationship of risk factors in developing meningiomas cannot be directly established with the current evidence. We are aware of the limitations of the hypothesis, but we believe that this study will raise more awareness and our findings could potentially be endorsed by organizations promoting health across the globe. Further prospective and retrospective studies will shed more light on this topic and help establish a definitive relationship.

Global Mentorship in Neurosurgery for Medical Students Study (the GloMNMS Study): a multinational multi-institutional cross-sectional audit.

OBJECTIVES: To assess the perception of global mentorship in neurosurgery among medical students across the world. Secondary aim included investigating the factors affecting the availability and benefits of providing global mentorship scheme in neurosurgery at a medical student level. SETTING: The Global Mentorship in Neurosurgery for Medical Students Study was a multinational cross-sectional audit that included medical students currently in the years 1-6 and intercalating programmes. They were invited to complete an online survey between 11 March and 1 May 2022. PARTICIPANTS: The survey was disseminated to 243 medical university ambassadors worldwide from 60 countries who distributed the survey within their respective medical student cohorts across the duration of the study. RESULTS: Overall, 2962 of 3017 (98.2%) responses from medical students from 60 countries worldwide were included; 1439 of 2962 (49%) and 1523 of 2962 (51%) were from years 1-3 and 4-6 medical students including intercalating degree programmes, respectively. 1712, 1502 and 1359 of responses gathered indicated that possible reasons for the lack of neurosurgical mentorship are lack of time and resources from trainees in neurosurgery, time within medical school's curriculum and awareness of societies in neurosurgery/neurology. 1276 and 1065 of medical students surveyed reported that it could also be due to lack of funding and overall inaccessibility within the area meaning there are few networking opportunities available. CONCLUSIONS: This pilot study indicates that there is a scope for improvement regarding the availability and accessibility of neurosurgical mentorship programmes worldwide at a medical student level. The evaluation suggested that medical students would most benefit from the neurosurgical mentorship in the future by means of increased numbers of mentors within their universities, accessibility to neurosurgical departments and the ability to choose mentorship globally via a unified digital platform.