Internal medicine

Radiology

Clinical endpoint

Meta-analysis

Magnetic resonance imaging

Surgery

Oncology

Subgroup analysis

Randomized controlled trial

Interventional magnetic resonance imaging

Intraoperative MRI

Neuronavigation

Glioma

Cancer research

Medicine

Journal of neurosurgery

High-grade gliomas (HGGs) continue to carry poor prognoses, and patient outcomes depend heavily on the extent of resection (EOR). The utility of conventional image-guided surgery is limited by intraoperative brain shift. More recent techniques to maximize EOR, including intraoperative imaging and the use of fluorescent dyes, combat these limitations. However, the relative efficacy of these two techniques has never been systematically compared. Thus, the authors performed an exhaustive systematic review in conjunction with quantitative network meta-analyses to evaluate the comparative effectiveness of 5-aminolevulinic acid (5-ALA) and intraoperative MRI (IMRI) in optimizing EOR in HGG. They secondarily analyzed associated progression-free and overall survival and performed subgroup analyses by level of evidence.

Intraoperative MRI versus 5-ALA in high-grade glioma resection: a network meta-analysis