TY - JOUR
T1 - Comparison of fluorescein sodium, 5-ALA, and intraoperative MRI for resection of high-grade gliomas
T2 - A systematic review and network meta-analysis
AU - Naik, Anant
AU - Smith, Emily J.
AU - Barreau, Ariana
AU - Nyaeme, Mark
AU - Cramer, Samuel W.
AU - Najafali, Daniel
AU - Krist, David T.
AU - Arnold, Paul M.
AU - Hassaneen, Wael
N1 - Publisher Copyright:
© 2022
PY - 2022/4
Y1 - 2022/4
N2 - High grade gliomas (HGGs) are aggressive brain tumors associated with poor prognosis despite advances in surgical treatment and therapy. Navigated tumor resection has yielded improved outcomes for patients. We compare 5-ALA, fluorescein sodium (FS), and intraoperative MRI (IMRI) with no image guidance to determine the best intraoperative navigation method to maximize rates of gross total resection (GTR) and outcomes. A frequentist network meta-analysis was performed following standard PRISMA guidelines (PROSPERO registration CRD42021268659). Surface-under-the-cumulative ranking (SUCRA) analysis was executed to hierarchically rank modalities by the outcomes of interest. Heterogeneity was measured by the I2 statistic. Publication bias was assessed by funnel plots and the use of Egger's test. Statistical significance was determined by p < 0.05. Twenty-three studies were included for analysis with a total of 2,643 patients. Network meta-analysis comparing 5-ALA, IMRI, and FS was performed. The primary outcome assessed was the rate of GTR. Analysis revealed the superiority of all intraoperative navigation to control (no navigation). SUCRA analysis revealed the superiority of IMRI + 5-ALA, IMRI alone, followed by FS, and 5-ALA. Overall survival (OS) and progression free survival (PFS) were also examined. FS (vs. control) was associated with improved OS, while IMRI was associated with improved PFS (vs. control, FS, and 5-ALA). Intraoperative navigation using IMRI, FS, and 5-ALA lead to greater rates of GTR in HGGs. FS and 5-ALA also yielded improvement in OS and PFS. Further studies are needed to evaluate differences in survival benefit, operative duration, and cost.
AB - High grade gliomas (HGGs) are aggressive brain tumors associated with poor prognosis despite advances in surgical treatment and therapy. Navigated tumor resection has yielded improved outcomes for patients. We compare 5-ALA, fluorescein sodium (FS), and intraoperative MRI (IMRI) with no image guidance to determine the best intraoperative navigation method to maximize rates of gross total resection (GTR) and outcomes. A frequentist network meta-analysis was performed following standard PRISMA guidelines (PROSPERO registration CRD42021268659). Surface-under-the-cumulative ranking (SUCRA) analysis was executed to hierarchically rank modalities by the outcomes of interest. Heterogeneity was measured by the I2 statistic. Publication bias was assessed by funnel plots and the use of Egger's test. Statistical significance was determined by p < 0.05. Twenty-three studies were included for analysis with a total of 2,643 patients. Network meta-analysis comparing 5-ALA, IMRI, and FS was performed. The primary outcome assessed was the rate of GTR. Analysis revealed the superiority of all intraoperative navigation to control (no navigation). SUCRA analysis revealed the superiority of IMRI + 5-ALA, IMRI alone, followed by FS, and 5-ALA. Overall survival (OS) and progression free survival (PFS) were also examined. FS (vs. control) was associated with improved OS, while IMRI was associated with improved PFS (vs. control, FS, and 5-ALA). Intraoperative navigation using IMRI, FS, and 5-ALA lead to greater rates of GTR in HGGs. FS and 5-ALA also yielded improvement in OS and PFS. Further studies are needed to evaluate differences in survival benefit, operative duration, and cost.
KW - 5-Aminolevulinic acid
KW - Fluorescein-sodium
KW - Glioma
KW - Gross total resection
KW - Intraoperative MRI
KW - Intraoperative navigation
UR - http://www.scopus.com/inward/record.url?scp=85125116138&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85125116138&partnerID=8YFLogxK
U2 - 10.1016/j.jocn.2022.02.028
DO - 10.1016/j.jocn.2022.02.028
M3 - Review article
C2 - 35219089
AN - SCOPUS:85125116138
SN - 0967-5868
VL - 98
SP - 240
EP - 247
JO - Journal of Clinical Neuroscience
JF - Journal of Clinical Neuroscience
ER -