Intraoperative MRI versus 5-ALA in high-grade glioma resection: a network meta-analysis

Area of Science:

• Neurosurgery
• Oncology
• Medical Imaging

Background:

• High-grade gliomas (HGGs) have poor prognoses, with extent of resection (EOR) being a critical factor.
• Conventional image-guided surgery is limited by intraoperative brain shift, impacting EOR.
• Advanced techniques like intraoperative imaging and fluorescent dyes aim to maximize EOR.

Purpose of the Study:

• To systematically compare the efficacy of 5-aminolevulinic acid (5-ALA) and intraoperative MRI (IMRI) in optimizing EOR for HGG.
• To secondarily analyze the impact of these techniques on progression-free and overall survival.
• To conduct subgroup analyses based on the level of evidence.

Main Methods:

• Systematic review and quantitative network meta-analyses of studies from PubMed, Embase, Cochrane Central, and Web of Science.
• Primary endpoint: proportion of patients achieving gross-total resection (GTR).
• Secondary endpoints: overall and progression-free survival; Bayesian network meta-analysis for comparative efficacy of IMRI vs. 5-ALA.

Main Results:

• Both IMRI and 5-ALA significantly outperformed conventional navigation in achieving GTR.
• No significant difference in GTR was found when comparing IMRI directly to 5-ALA (OR 1.9, 95% CI 0.905-3.989, p = 0.090).
• Preliminary data suggest both IMRI and 5-ALA may improve progression-free and overall survival.

Conclusions:

• IMRI and 5-ALA are superior to conventional neuronavigation for achieving GTR in HGG.
• Neither IMRI nor 5-ALA demonstrates a clear advantage over the other in terms of GTR.
• Future research should compare the cost and surgical time of IMRI and 5-ALA to inform cost-benefit analyses.