Background 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.

Objective To carry out a systematic review and meta-analysis of the literature to evaluate the safety and efficacy of IOA during neurosurgical procedures.

Methods 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.

Results 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%; I²=0%). The rate of surgical adjustment/revision was 18% (95% CI 12% to 28%; I²=0%). The rate of complications related to the angiography was 1% (95% CI 0% to 5%; I²=0%). There were no deaths associated with IOA.

Conclusion 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.