Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Physiology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
J Neurointerv Surg. 2023 Aug;15(8):793-800. doi: 10.1136/jnis-2022-020035. Epub 2023 Apr 17.
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.
To carry out a systematic review and meta-analysis of the literature to evaluate the safety and efficacy of IOA during neurosurgical procedures.
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.
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%; I=0%). The rate of surgical adjustment/revision was 18% (95% CI 12% to 28%; I=0%). The rate of complications related to the angiography was 1% (95% CI 0% to 5%; I=0%). There were no deaths associated with IOA.
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.
术中血管造影（IOA）在患者处于俯卧位、四分之三俯卧位和公园长椅位进行神经外科手术中的作用和效果的证据有限。
对文献进行系统回顾和荟萃分析，以评估 IOA 在神经外科手术中的安全性和有效性。
我们回顾了（1960 年 1 月至 2022 年 7 月期间）所有在患者处于俯卧位、四分之三俯卧位或公园长椅位进行神经外科手术时进行 IOA 的研究。此外，还纳入了我们机构经验中的一组患者。疗效结果是血管造影成功的比率和 IOA 后手术调整/修订的比率。安全性结果是与血管造影相关的并发症和死亡率。使用随机效应荟萃分析的比例数据进行分析，并评估了统计异质性。
共有 26 项研究，包括 142 名患者和来自我们机构的 32 名患者，纳入了分析。术中血管造影成功率为 98%（95%CI 94%至 99%；I=0%）。手术调整/修订率为 18%（95%CI 12%至 28%；I=0%）。与血管造影相关的并发症发生率为 1%（95%CI 0%至 5%；I=0%）。没有与 IOA 相关的死亡。
我们发现，在患者处于俯卧位、四分之三俯卧位和公园长椅位进行 IOA 是可行且安全的，术中血管造影后手术调整/修订的比率相当高。我们的研究结果表明，IOA 作为补充血管神经外科手术的一种手段，可能在改善患者预后方面发挥有价值的作用。
