Department of Neurosurgery, Maastricht University Medical Center, AZ Maastricht, Netherlands.
Lancet Oncol. 2011 Oct;12(11):1062-70. doi: 10.1016/S1470-2045(11)70130-9. Epub 2011 Aug 23.
We did a systematic review to address the added value of intraoperative MRI (iMRI)-guided resection of glioblastoma multiforme compared with conventional neuronavigation-guided resection, with respect to extent of tumour resection (EOTR), quality of life, and survival. 12 non-randomised cohort studies matched all selection criteria and were used for qualitative synthesis. Most of the studies included descriptive statistics of patient populations of mixed pathology, and iMRI systems of varying field strengths between 0·15 and 1·5 Tesla. Most studies provided information on EOTR, but did not always mention how iMRI affected the surgical strategy. Only a few studies included information on quality of life or survival for subpopulations with glioblastoma multiforme or high-grade glioma. Several limitations and sources of bias were apparent, which affected the conclusions drawn and might have led to overestimation of the added value of iMRI-guided surgery for resection of glioblastoma multiforme. Based on the available literature, there is, at best, level 2 evidence that iMRI-guided surgery is more effective than conventional neuronavigation-guided surgery in increasing EOTR, enhancing quality of life, or prolonging survival after resection of glioblastoma multiforme.
我们进行了一项系统评价，旨在探讨与传统神经导航引导切除相比，术中磁共振成像（iMRI）引导切除多形性胶质母细胞瘤在肿瘤切除程度（EOTR）、生活质量和生存方面的附加值。12 项非随机队列研究符合所有选择标准，并用于定性综合分析。大多数研究提供了混合病理学患者人群的描述性统计数据，以及场强在 0.15 至 1.5 特斯拉之间的各种 iMRI 系统的信息。大多数研究提供了 EOTR 的信息，但并不总是提到 iMRI 如何影响手术策略。只有少数研究提供了关于生活质量或特定亚组（胶质母细胞瘤或高级别胶质瘤）生存的信息。明显存在多种局限性和偏倚来源，这影响了结论的得出，并可能导致高估 iMRI 引导手术在切除多形性胶质母细胞瘤方面的附加值。根据现有文献，最好的证据水平为 2 级，证明 iMRI 引导手术在增加 EOTR、提高生活质量或延长胶质母细胞瘤切除后的生存方面比传统神经导航引导手术更有效。
