• Lau Jonathan C JC Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Imaging Research Laboratories, Robarts Research Institute, We, Suzanne E Kosteniuk, Thomas Walker, Alla Iansavichene, David R Macdonald, and Joseph F Megyesi.
• Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada. Electronic address: jonathan.lau@londonhospitals.ca.
• World Neurosurg. 2019 Feb 1; 122: 404-414.

BackgroundThe 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 1960s, far preceding the modern neuronavigation era. We conducted a systematic review and meta-analysis investigating the impact of IG on surgical outcome from ORI.MethodsA systematic database search of MEDLINE and EMBASE was performed to identify studies on operative outcomes from ORI. Only studies reporting patient demographics and perioperative outcomes (hemorrhage, infection, malposition, malfunction, and mortality) were included. Study quality was assessed via MINORS criteria.ResultsOf the 3560 records screened, 43 studies met study inclusion criteria, for a total of 1995 ORI procedures. Pooled rates of outcome for IG compared with non-IG were 6.4% versus 14.1% for overall complications; 2.0% compared with 2.8% for catheter malfunction; 2.3% compared with 3.3% for catheter malposition; 0.7% compared with 4.5% for early infection; and 0.6% compared with 1.4% for mortality. Postoperative hemorrhage was increased at 3.4% compared with 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.ConclusionsThis 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.Copyright © 2018 Elsevier Inc. All rights reserved.

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