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Operative complications with and without image-guidance: A systematic review and meta-analysis of the Ommaya reservoir literature.

World Neurosurgery 2018 November 15
BACKGROUND: The use of image guidance (IG) in neurosurgery is ubiquitous, even though evidence from patient outcome data has remained limited to smaller, mostly observational, studies. Ommaya reservoir insertion (ORI) has been available as a treatment option for targeted intraventricular pharmacotherapy since the 1960's, far preceding the modern neuronavigation era. We conducted a systematic review and meta-analysis investigating the impact of IG on surgical outcome from ORI.

METHODS: A systematic database search of MEDLINE and EMBASE was performed to identify studies on operative outcomes from ORI. Only studies reporting patient demographics and peri-operative outcomes (hemorrhage, infection, malposition, malfunction, and mortality) were included. Study quality was assessed via MINORS criteria.

RESULTS: Of the 3560 records screened, 43 studies met study inclusion criteria, for a total of 1995 ORI procedures. Pooled rates of outcome for IG compared to non IG were 6.4% versus 14.1% for overall complications; 2.0% compared to 2.8% for catheter malfunction; 2.3% compared to 3.3% for catheter malposition; 0.7% compared to 4.5% for early infection; 0.6% compared to 1.4% for mortality. Post operative hemorrhage was increased at 3.4% compared to 2.4%. Subgroup analysis revealed a difference in early infection rate between frameless and frame-based IG at 0.0% versus 1.9%. Meta-regression revealed a relationship between publication date and all operative outcomes except for catheter malposition and hemorrhage.

CONCLUSIONS: This study offers a historical context on the evolution of the practice of ORI and comprises the largest observational analysis of operative outcomes providing objective support for the use of IG in neurosurgery.

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