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  • 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

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New devices and techniques
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
  1. Juan Vivanco-Suarez1,
  2. Georgios S Sioutas1,
  3. Irina-Mihaela Matache1,2,
  4. Najib Muhammad1,
  5. Mohamed M Salem1,
  6. Sandeep Kandregula3,
  7. Brian T Jankowitz1,
  8. Jan-Karl Burkhardt1,
  9. Visish M Srinivasan1
  1. 1 Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2 Department of Physiology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  3. 3 Department of Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA
  1. Correspondence to Dr Visish M Srinivasan, Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; visishs{at}gmail.com

Abstract

Background There 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.

Objective To carry out a systematic review and meta-analysis of the literature to evaluate the safety and efficacy of IOA during neurosurgical procedures.

Methods We 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.

Results A 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.

Conclusion We 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.

  • Angiography
  • Vascular Malformation
  • Aneurysm
  • Spinal cord
  • Posterior fossa

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2022-020035

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @jsvivanco1, @GSSioutas, @IrinaMatache_3, @MMSalemMD, @DrKandregula, @JanKarlBurchar1, @visishs

    • Contributors JV-S made substantial contributions to the conception and design of the work, acquisition, analysis, and interpretation of data and drafted the work, gave final approval of the published version, and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GSS, I-MM, NM, MMS, SK, BTJ, and J-KB made substantial contributions to the acquisition, analysis, and interpretation of data, revised it critically for important intellectual content, gave final approval of the published version, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. VMS is responsible for the overall content and is the guarantor of the entire work. He accepts full responsibility for the work and conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.