Ultrasound-Guided Resection of High-Grade Gliomas: A Single-Arm Meta-Analysis.

Autor: Palavani LB; Department of Neurosurgery, Max Planck University Center, São Paulo, Brazil. Electronic address: lucca.palavani730@al.unieduk.com.br., Ferreira MY; Faculty of Medicine, Ninth July University, São Paulo, Brazil., Borges PGLB; Department of Neurosurgery, Fundação Técnico-Educacional Souza Marques, Rio de Janeiro, Brazil., Bandeira L; Department of Neurosurgery, University of Pernambuco, Recife, Brazil., da Silva Semione G; Department of Neurosurgery, University of West Santa Catarina, Joacaba, Brazil., Almeida MV; Department of Neurosurgery, State University of Ceará, Fortaleza, Brazil., Verly G; Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil., Polverini AD; Barretos Cancer Hospital, Neurosurgical Oncology Division, São Paulo, Brazil., Andreão FF; Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil., Camerotte R; Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil., Ferreira CC; Department of Neurosurgery, Lenox Hill Hospital, New York, New York, USA., Paiva W; Department of Neurosurgery, University of Sao Paulo Medical School, São Paulo, Brazil., Bertani R; Department of Neurosurgery, University of Sao Paulo Medical School, São Paulo, Brazil., Boockvar J; Department of Neurosurgery, Lenox Hill Hospital, New York, New York, USA.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2024 Jun; Vol. 186, pp. 17-26. Date of Electronic Publication: 2024 Mar 13.
DOI: 10.1016/j.wneu.2024.03.033
Abstrakt: Background: High-grade gliomas (HGGs) present a challenge in neuro-oncology, often necessitating surgical resection for optimal management. Ultrasound holds promise in achieving better gross total resection (GTR) and improving outcomes. This meta-analysis systematically evaluates literature providing robust evidence on the use of intraoperative ultrasonography (iUSG) in HGG resection.
Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines a comprehensive search was made across PubMed, Embase, Cochrane, and Web of Science utilized terms related to iUSG for HGG resection. The meta-analysis examined randomized trials and observational cohort studies on iUSG-guided HGG resection. GTR, subtotal resection, and postresection complications were assessed. Statistical analysis, employing R software for a single proportion analysis with confidence intervals of 95%, I 2 statistics for heterogeneity, and the instrumental variables method with restricted maximum likelihood for a random effects model.
Results: A total of 178 patients were included in our study. The GTR overall rate in patients with iUSG-guided resection was found to be 64% (95% confidence interval: 46%-81%). Two-dimensional ultrasound remains dominant at 80% against other options of ultrasound. Complications were reported at a 15% rate (95% confidence interval: 7%-23%).
Conclusions: Our study provided robust data on the utilization of iUSG-guided resection regarding the attainment of GTR and the complications related to resection. However, challenges such as outcome heterogeneity and limited complication reporting highlight the need for further research to optimize iUSG in HGG treatment. Long-term follow-up studies on patient survival and postsurgery quality of life will complement existing literature, guiding clinical practices in managing HGG.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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