SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Neurocritical and Neurohospitalist Care
Comparative Efficacy and Safety of Surgical Interventions for Communicating Hydrocephalus: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials
Zhihao Zhao 1
Yang Liu 1
Weiwei Jiang 2
Shuangyu Wang 1
Huijie Yu 1
Xin Qu 3
Shangzhi Xiong 4
Xiaoying Chen 4
Craig S Anderson 4
Tao Liu 3
Rongcai Jiang 3
1. Tianjin Medical University General Hospital, Tianjin, China
2. Zhujiang Hospital of Southern Medical University, Guangzhou, China
3. Xuanwu Hospital Capital Medical University, Beijing, China
4. University of New South Wales, Sydney, Australia
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Abstract
Objectives: Surgical intervention is the standard treatment for communicating hydrocephalus (CH), a condition involving cerebrospinal fluid accumulation in the ventricles without a blockage. The optimal surgical approach for CH remains uncertain, with clinical decisions varying by patient characteristics and institutional practices. This study aims to compare the efficacy and safety of surgical interventions for CH. Methods: In this systematic review and network meta-analysis (NMA), we searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, ClinicalTrials.gov, China National Knowledge Infrastructure, Wanfang, Vip, China Biomedical Literature, and the Chinese Clinical Trial Registry from inception to September 24, 2024, for randomized controlled trials. Primary outcomes were efficacy (favorable outcome) and safety (complications). Secondary outcomes included revision, infection, seizures, operation time (minutes), and duration of hospitalization (days). Bayesian NMAs synthesized the data, and the certainty of evidence was assessed using the confidence in NMA (CINeMA) framework. Surface under the cumulative ranking curve values were generated to rank the treatments. This study is registered with PROSPERO (CRD42024585931). Results: Of 4,159 citations identified by our search, 34 trials (2,528 participants) met the inclusion criteria. For efficacy, lumboperitoneal shunt (LPS) (risk ratio [RR] 1.18, 95% credible interval [CrI] 1.13–1.23; high certainty) and LPS with laparoscope (LPS+LS) (RR 1.27, 95% CrI 1.18– 1.39; high certainty) were more effective than ventriculoperitoneal shunt (VPS). Both LPS and LPS+LS outperformed endoscopic third ventriculostomy (ETV) and ETV with choroid plexus cauterization (ETV+CPC) (RR range 1.16–1.48; high to moderate certainty). For safety, LPS, LPS+LS, and ETV had fewer complications than VPS (RR range 0.20–0.40; high certainty). LPS+LS had fewer complications than LPS (RR 0.49, 95% CrI 0.29–0.79; moderate certainty).
Summary
Keywords
choroid plexus cauterization, communicating hydrocephalus, endoscopic third ventriculostomy, lumboperitoneal shunt, Network meta-analysis, Ventriculoperitoneal Shunt
Received
08 December 2025
Accepted
29 January 2026
Copyright
© 2026 Zhao, Liu, Jiang, Wang, Yu, Qu, Xiong, Chen, Anderson, Liu and Jiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Tao Liu; Rongcai Jiang
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