Third ventricular floor bowing indicates surgical success in patients undergoing endoscopic third ventriculostomy - Systematic review and meta-analysis.

PURPOSE This meta-analysis aimed to evaluate the prognostic performance of third ventricular floor bowing (TVFB) as a marker for surgical success in patients undergoing endoscopic third ventriculostomy (ETV). METHODS We performed a comprehensive literature search for studies comparing ETV success in patients with TVFB compared to those without using PubMed, SCOPUS, Embase, and EuropePMC. TVFB was defined as inferior bowing or bulging deformation or convex third ventricular floor. Surgical success was defined as resolution of symptoms post-surgery and requires no further intervention for hydrocephalus. The outcome was surgical success in patients with TVFB compared to those without TVFB, the effect estimate was reported as odds ratio (OR). RESULTS Five studies comprising of 439 patients were included in this meta-analysis. The prevalence of overall surgical success was 42%. The prevalence of surgical success was 85% in patients with TVFB. TVFB was associated with increased success rate (OR 5.94 [95%CI 3.07, 11.5], p<0.001; I2: 26.04%, p=0.248). TVFB was associated with sensitivity 0.83, specificity 0.54, positive likelihood ratio 1.8, negative likelihood ratio 0.32, diagnostic odds ratio 6, and area under curve 0.81 [0.77 - 0.84] for surgical success. Presence of TVFB confers to 56% rate of surgical success and no TVFB confers to rate of 19% surgical success. The association between TVFB and surgical success was not affected by age (coefficient: -0.03, p=0.474) and aqueductal stenosis (p=-0.05, p=0.237). CONCLUSION This meta-analysis showed that the presence of TVFB was associated with increased ETV success.