Abstract Details

Title Role of Intraoperative Computed Tomography in Optimizing Neurovascular Surgical Outcomes: A Systematic Review and Meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 5-019

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.

Authors/Disclosures
Dhyey Sidhpura, MD PRESENTER	Dr. Sidhpura has nothing to disclose.
Huzaifa S. Nawaz, MBBS	Dr. Nawaz has nothing to disclose.
Sophia Ahmed, MBBS	Miss Ahmed has nothing to disclose.
Muhammad A. Nadir, MBBS (University of Health Sciences, Lahore)	Mr. Nadir has nothing to disclose.
Zainab Awan, MBBS	Miss Awan has nothing to disclose.
Meher Ayyazuddin, MD	Dr. Ayyazuddin has nothing to disclose.
Maha Malik, MBBS	Dr. Malik has nothing to disclose.
Eeman Ahmad	Eeman Ahmad has nothing to disclose.
Amna Iqbal, MBBS	Dr. Iqbal has nothing to disclose.
salwa Shoaib, Medical Student	Miss Shoaib has nothing to disclose.
Arfa A. Assad	Dr. Assad has nothing to disclose.
Syeda T. Fatima	Syeda T. Fatima has nothing to disclose.
AYRA MAQBOOL	Dr. MAQBOOL has nothing to disclose.

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