The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Jesse H. Jones Building, 1133 John Freeman Blvd, Suite 431.1, 77030, Houston, TX, U.S.A..
Facultad de Medicina, Universidad Autónoma de Baja California, Tijuana, Baja California, México.
Neurosurg Rev. 2024 Mar 18;47(1):120. doi: 10.1007/s10143-024-02354-8.
Here, we conducted a meta-analysis to explore the use of intraoperative ultrasound (iUS)-guided resection in patients diagnosed with high-grade glioma (HGG) or glioblastoma (GBM). Our aim was to determine whether iUS improves clinical outcomes compared to conventional neuronavigation (CNN).
Databases were searched until April 21, 2023 for randomized controlled trials (RCTs) and observational cohort studies that compared surgical outcomes for patients with HGG or GBM with the use of either iUS in addition to standard approach or CNN. The primary outcome was overall survival (OS). Secondary outcomes include volumetric extent of resection (EOR), gross total resection (GTR), and progression-free survival (PFS). Outcomes were analyzed by determining pooled relative risk ratios (RR), mean difference (MD), and standardized mean difference (SMD) using random-effects model.
Of the initial 867 articles, only 7 articles specifically met the inclusion criteria (1 RCT and 6 retrospective cohorts). The analysis included 732 patients. Compared to CNN, the use of iUS was associated with higher OS (SMD = 0.26,95%CI=[0.12,0.39]) and GTR (RR = 2.02; 95% CI=[1.31,3.1]) for both HGG and GBM. There was no significant difference in PFS or EOR.
The use of iUS in surgical resections for HGG and GBM can improve OS and GTR compared to CNN, but it did not affect PFS. These results suggest that iUS reduces mortality associated with HGG and GBM but not the risk of recurrence. These results can provide valuable cost-effective interventions for neurosurgeons in HGG and GBM surgery.
本研究通过荟萃分析探讨术中超声（iUS）引导切除在高级别胶质瘤（HGG）或胶质母细胞瘤（GBM）患者中的应用。我们旨在确定与常规神经导航（CNN）相比，iUS 是否能改善临床结局。
截至 2023 年 4 月 21 日，我们检索了数据库，纳入了比较 HGG 或 GBM 患者在标准治疗基础上联合 iUS 或 CNN 手术的随机对照试验（RCT）和观察性队列研究。主要结局为总生存期（OS）。次要结局包括肿瘤全切除程度（EOR）、大体全切率（GTR）和无进展生存期（PFS）。采用随机效应模型，计算汇总相对危险比（RR）、均数差（MD）和标准化均数差（SMD）来分析结局。
在最初的 867 篇文章中，仅有 7 篇符合纳入标准（1 项 RCT 和 6 项回顾性队列研究），共纳入 732 例患者。与 CNN 相比，iUS 应用于 HGG 和 GBM 的患者，OS（SMD=0.26，95%CI=[0.12,0.39]）和 GTR（RR=2.02；95%CI=[1.31,3.1]）更高。但在 PFS 和 EOR 方面无显著差异。
与 CNN 相比，iUS 应用于 HGG 和 GBM 的手术切除可改善 OS 和 GTR，但不影响 PFS。这些结果提示 iUS 可降低 HGG 和 GBM 患者的死亡率，但不降低复发风险。这些结果可为 HGG 和 GBM 手术的神经外科医生提供有价值的、具有成本效益的干预措施。
