Intraoperative angiography during neurosurgical procedures on patients in prone, three-quarters prone, and park-bench positions: tertiary single-center experience with systematic review and meta-analysis

• Published in: Journal of neurointerventional surgery Vol. 15; no. 8; pp. 793 - 800
• Main Authors: Vivanco-Suarez, Juan, Sioutas, Georgios S, Matache, Irina-Mihaela, Muhammad, Najib, Salem, Mohamed M, Kandregula, Sandeep, Jankowitz, Brian T, Burkhardt, Jan-Karl, Srinivasan, Visish M
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.08.2023; BMJ Publishing Group LTD
• Subjects: Aneurysm; Aneurysms; Angiography; Case reports; Data collection; Humans; Medical imaging; Meta-analysis; Monitoring, Intraoperative - methods; Mortality; Neurosurgery; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - methods; New devices and techniques; Patients; Posterior fossa; Software; Spinal cord; Surgery; Surgical outcomes; Systematic review; Vascular Malformation; Spinal cord; Posterior fossa; Angiography; Aneurysm; Vascular Malformation
• ISSN: 1759-8478; 1759-8486; 1759-8486
• DOI: 10.1136/jnis-2022-020035

BackgroundThere is limited evidence about the role and effectiveness of intraoperative angiography (IOA) during neurosurgical procedures with patients in prone, three-quarters prone, and park-bench positions.ObjectiveTo carry out a systematic review and meta-analysis of the literature to evaluate the safety and efficacy of IOA during neurosurgical procedures.MethodsWe reviewed (between January 1960 and July 2022) all studies in which IOAs were performed during neurosurgical procedures with patients in either prone, three-quarters prone, or park-bench positions. Additionally, a cohort of patients from our institutional experience was included. Efficacy outcomes were the rate of successful angiography and the rate of surgical adjustment/revision after IOA. Safety outcomes were the rate of angiography-related complications and mortality. Data were analyzed using a random-effects meta-analysis of proportions, and statistical heterogeneity was assessed.ResultsA total of 26 studies with 142 patients plus 32 subjects from our institution were included in the analysis. The rate of successful intraoperative angiography was 98% (95% CI 94% to 99%; I2=0%). The rate of surgical adjustment/revision was 18% (95% CI 12% to 28%; I2=0%). The rate of complications related to the angiography was 1% (95% CI 0% to 5%; I2=0%). There were no deaths associated with IOA.ConclusionWe found that IOA performed with patients in prone, three-quarters prone, and park-bench positions is feasible and safe with a non-negligible rate of intraoperative post-angiographical surgical adjustment/revision. Our findings suggest that the performance of IOA to complement vascular neurosurgical procedures might have a valuable role in favoring patient outcomes.