Clinical utility and cost-effectiveness of interactive image-guided craniotomy: Clinical comparison between conventional and image-guided meningioma surgery

OBJECTIVE: Although interactive image guidance has been determined to be an increasingly important and reliable tool in contemporary neurosurgery, the clinical results and cost-effectiveness of the use of these systems, compa red with conventional techniques, remain understudied. The aim of this stud y was to investigate the possible benefits of image-guided craniotomies to treat meningiomas, in terms of hospital stays, surgical complications, and, consequently, cost-effectiveness, compared with the results of standard su rgery (SS). METHODS: During; a 3.5-year period, 100 patients were surgically treated fo r meningiomas using image-guided surgery (ICS) with neuronavigation assista nce and 170 were surgically treated using SS. From the consecutive series o f the 100 IGS cases, it was possible to statistically match 50 (in terms of the demographic data, the location and size of the tumor, and the experien ce of the surgeon) with 50 SS cases. The clinical data were collected prosp ectively for the ICS group and retrospectively for the SS group. RESULTS: The anesthetic (operation) times were similar for the two groups, although surgical times were shorter for the ICS group (P = 0.02). Blood lo ss during surgery was less for the ICS group (although not statistically si gnificantly, P > 0.05), but more SS cases required transfusions (P = 0.03). The mean intensive therapy unit stay was 1.7 days for the SS group and 1 d ay for the ICS group (P = 0.12); the mean hospital stays were 13.5 and 8.5 days, respectively (P = 0.017). Severe complications (permanent or requirin g additional surgical procedures) were encountered in 14% of the cases in t he SS group and 6% of the cases in the IGS group (P = 0.019), whereas the r ates of minor complications (resolved within 30 d without further surgery) were similar (8 and 10%, respectively). The most common problems for the co ntrol group were postoperative hematomas (n = 3), which required urgent sur gery in two cases; intractable postoperative swelling was treated by lobect omy in another case. In the IGS group, the two severe complications include d one case of an infected bone flap and one case of a new permanent neurolo gical deficit. The mean cost per patient was approximately 20% higher for S S than for ICS. CONCLUSION: Although this was not a randomized study, the analysis of these results strongly suggests a positive effect of neuronavigation on the comp lication rate and thus on intensive care unit and hospital stays, with atte ndant financial implications.