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Updated: Oct 3, 2026
Image-Guided Resection of Glioblastoma and Intracranial Implantation of Therapeutic Stem Cell-seeded Scaffolds
Published on: July 16, 2018
Neuronavigation-guided precise resection versus conventional glioma surgery: a meta-analysis of clinical outcomes
Shuanglei Guo1, Kang He1, Bingjian Yuan1
1Department of Neurosurgery, Huaihe Hospital of Henan University, Kaifeng, China.
Background:
Neuronavigational surgery has become a cutting-edge technique that improves surgical accuracy, increases tumor excision rates, and preserves neurological function in glioma patients.
Aim:
This meta-analysis was conducted to assess the efficacy of neuronavigational and advanced imaging-assisted surgery compared to traditional glioma surgery.
Methods:
In total, 30 articles published between 2006 and 2026, including randomized controlled trials, prospective cohort studies, retrospective cohort studies, and case series, were evaluated. The intervention involved intraoperative MRI (iMRI), ultrasound-guided navigation, functional neuronavigation, and other advanced navigational technologies. Meta-analysis was carried out using random effects models with inverse variance to calculate pooled odds ratios (ORs), 95% confidence intervals (CIs), I 2 and τ 2 measures of heterogeneity, and publication bias using funnel plots and Egger's regression test. The risk of bias was assessed through the Cochrane RoB 2 for 7 randomized controlled trials and ROBINS-I for 23 observational studies.
Results:
Overall analysis demonstrated significant improvement with neuronavigation-guided surgery (OR = 2.37, 95% CI: 2.05-2.74, p < 0.05; I 2 = 22.8%). Subgroup analyses showed significant benefits for iMRI-guided surgery (OR = 2.49, 95% CI: 1.92-3.23, z = 6.88, I 2 = 22.6%, τ 2 = 0.0428, p = 0.2286), ultrasound-based navigation (OR = 1.97, 95% CI: 1.47-2.66, z = 4.50, I 2 = 4.9%, τ 2 = 0.0084, p = 0.3685), functional neuronavigation (OR = 2.11, 95% CI: 1.59-2.80, z = 5.17, I 2 = 0%), advanced navigation technologies (OR = 2.33, 95% CI: 1.67-3.25, z = 4.99, I 2 = 16.4%), and other specialized techniques (OR = 2.16, 95% CI: 1.63-2.86, z = 5.34, I 2 = 8.3%). Leave-one-out analysis confirmed the stability of the pooled effect, with minimal changes after exclusion of individual studies.
Conclusion:
Neuronavigation-based and image-enhanced surgical procedures can significantly improve glioma surgery outcomes, with low heterogeneity and strong pooled effects. Large-scale multicenter studies are needed in order to prove their efficacy in the long term.