Role of Intraoperative Computed Tomography in Optimizing Neurovascular Surgical Outcomes: A Systematic Review and Meta-analysis
Huzaifa Nawaz1, Sophia Ahmed2, Muhammad Nadir2, Abdul Rafeh Awan3, Meher Ayyazuddin4, Maha Malik5, Eeman Ahmad6, Mahrukh Iqbal2, Muhammad Hamza Shoaib5, Arfa Ahmed Assad2, Syeda Takreem Fatima1, Ayra Maqbool2
1Services Insitute of Medical Sciences, Lahore, 2Allama Iqbal Medical College, Lahore, 3Nishtar Medical University, Multan, 4CMH Lahore Medical College, 5Allama Iqbal Medical College, Lahore, Pakistan, 6Fatima Memorial Hospital College of Medicine and Dentistry, Lahore
Objective:
We systematically evaluated the efficacy of intraoperative computed tomography (iCT) in neurovascular surgery, with a special focus on aneurysmal correction and intracranial hematoma evacuation.
Background:
Traditional neuronavigation relies on preoperative imaging, which limits real-time assessment and may potentially miss ischemia or residual hematomas. iCT, an emerging intraoperative imaging modality, not only provides high-resolution three-dimensional visualization but also an immediate assessment of vessel patency and cerebral perfusion. It has demonstrated utility in aneurysmal clipping, arteriovenous malformation (AVM) resection, and hematoma evacuation.
Design/Methods:
Following PRISMA and Cochrane guidelines, we conducted a systematic review and meta-analysis. PubMed, Embase, Cochrane Library, Scopus, and Google Scholar were searched through November 2024. Studies assessing the use of iCT in aneurysm, AVM, or intracerebral hemorrhage (ICH) surgery were included. Surgical outcome and complication data were extracted. Random-effects meta-analyses were performed in R. Pooled proportions and mean differences with 95% confidence intervals (CIs) were calculated. Surgical success was defined as complete aneurysm/AVM occlusion or satisfactory hematoma volume reduction.
Results:
Ten studies (348 patients) met inclusion criteria. These included four ICH, five aneurysm, and two AVM studies. Overall, the pooled surgical goal achievement ratio was 0.91, with subgroup ratios of 0.90 for ICH, 0.91 for aneurysms, and 0.89 for AVMs. The pooled complication rate across seven studies, which included 316 patients, was 9%. iCT identified additional pathology requiring intervention in 10% of aneurysm/AVM cases. With regard to ICH, pooled hematoma volume reduction was 33.21 mL, and residual hematomas were detected in 25% of patients. Evacuation rates ranged from 80% to 95%. Operative times varied between 75 and 190 minutes. Imaging artifacts did not hinder interpretation.
Conclusions:
iCT enhances precision and safety in neurovascular surgery by enabling real-time assessment of neuroanatomy and cerebral perfusion. It facilitates rapid detection of residual hematomas, incomplete aneurysm occlusion, and ischemic changes and thus allows for timely intraoperative correction.
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