Abstract
Achieving total glioma resection represents a major challenge to neurosurgeons with no distinct margin between tumor and surrounding brain tissue. Many imaging methods are employed in surgery visualization and resection control. We performed this meta-analysis to assess the diagnosis value of intraoperative ultrasound and judged whether ultrasound is a suitable tool in detecting glioma residual. The databases including PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang and Weipu were systematically searched to find out relevant studies and published up to May 5, 2017. A total of 14 studies involving 542 participants met the selection criteria and bivariate mixed effects models were used for analysis. The parameters and their corresponding 95% confidence interval (CI) were computed on Stata 12.0 software. The pooled sensitivity was 0.75 (95%CI: 0.62–0.84), specificity was 0.88 (95%CI: 0.79–0.94), positive likelihood ratios was 6.27 (95%CI: 3.76–10.47), negative likelihood ratios was 0.29 (95%CI: 0.20–0.42), diagnostic odds ratios was 21.83 (95%CI: 14.20–33.55) and area under the curve of summary receiver operator characteristic was 0.89. Stratified meta-analysis showed sensitivity and area under the curve in low-grade glioma were both higher than high-grade glioma. The Deek's plot showed no significant publication bias (t = −1.03, P = 0.33). Intraoperative ultrasound has high overall diagnostic value to identify glioma remnants, especially in low-grade glioma, which shows a benefit for prognosis and life quality of patients. In general, Intraoperative ultrasound is an effective tool for maximizing the extent of glioma resection.
Highlights
Glioma is the most common primary intracranial tumor account for about 40% of central nervous system tumors and 70% of malignant brain tumors [1], Whose treatment protocols are mostly based on surgical treatment, radiation therapy or temozolomide adjuvant chemotherapy [2]
A total of 542 articles were yielded in primary literature search, which included 147 records identified from PubMed, 36 records from Embase, 90 records from Web of Science, 106 records from China National Knowledge Infrastructure (CNKI), 88 records from Wanfang and 75 records from Weipu
More fully precise excision of glioma is a challenge for neurosurgeons, the large extent of tumor resection could influence the prognosis and quality of life for patients
Summary
Glioma is the most common primary intracranial tumor account for about 40% of central nervous system tumors and 70% of malignant brain tumors [1], Whose treatment protocols are mostly based on surgical treatment, radiation therapy or temozolomide adjuvant chemotherapy [2]. The primary treatment of glioma is microscopic surgical resection, which must be maximally remove the tumor tissues and preserving normal nerve function. Intraoperative magnetic resonance imaging (iMRI) and navigational positioning system are limited by the expensive facility and need to avoid bias of brain transformation or shifting after skull opening in detecting intracranial glioma remnants[7,8]. A point of ongoing discussion of iMRI, PET and navigational positioning system are superior to IOUS with insufficient data supporting. We performed this systematical review and meta-analysis to investigate the diagnostic values of IOUS in glioma operation
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