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Intraoperative ultrasound for surgical resection of high-grade glioma and glioblastoma: a meta-analysis of 732 patients

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Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusion

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.

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Funding

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Author information

Authors and Affiliations

  1. 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.

    Pavel S. Pichardo-Rojas, Nitin Tandon & Yoshua Esquenazi

  2. Facultad de Medicina, Universidad Autónoma de Baja California, Tijuana, Baja California, México

    Carlos Zarate

  3. University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A.

    Julieta Arguelles-Hernández

  4. Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México

    Aldo Barrón-Lomelí

  5. Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador

    Roberto Sanchez-Velez

  6. Universidad Católica Boliviana “San Pablo” Regional Santa Cruz, Santa Cruz, Bolivia

    Amir Hjeala-Varas

  7. Facultad de Ciencias de la Salud, Universidad Autónoma de Baja California, Tijuana, Baja California, México

    Ernesto Gutierrez-Herrera

Authors
  1. Pavel S. Pichardo-Rojas
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  2. Carlos Zarate
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  3. Julieta Arguelles-Hernández
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  4. Aldo Barrón-Lomelí
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  5. Roberto Sanchez-Velez
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  6. Amir Hjeala-Varas
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  7. Ernesto Gutierrez-Herrera
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  8. Nitin Tandon
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  9. Yoshua Esquenazi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Pavel S. Pichardo-Rojas, Carlos Zarate, Julieta Arguellez-Hernández, Aldo Barrón-Lomelí, Roberto Sanchez-Velez, Amir Hjeala-Varas, and Ernesto Gutierrez-Herrera. The first draft of the manuscript was written by Pavel S. Pichardo-Rojas and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Pavel S. Pichardo-Rojas.

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Pichardo-Rojas, P.S., Zarate, C., Arguelles-Hernández, J. et al. Intraoperative ultrasound for surgical resection of high-grade glioma and glioblastoma: a meta-analysis of 732 patients. Neurosurg Rev 47, 120 (2024). https://doi.org/10.1007/s10143-024-02354-8

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  • DOI: https://doi.org/10.1007/s10143-024-02354-8

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