Did Survival Improve after the Implementation of Intraoperative Neuronavigation and 3D Ultrasound in Glioblastoma Surgery? A Retrospective Analysis of 192 Primary Operations

Abstract

Our study demonstrates that survival has improved within the same period that intraoperative ultrasound and neuronavigation was introduced and established in our department. The demonstrated association is a necessity for causation, but given the nature of this study, one must be cautious to claim causality. The improvement was, however, significant after adjustment for known major prognostic factors.

Contrast-enhanced MR Imaging versus Contrast-enhanced US: A Comparison in Glioblastoma Surgery by Using Intraoperative Fusion Imaging

“…A more practical and cost-efficient tool for planning and guiding surgeries is intraoperative US (7,(12)(13)(14)(15). It enables acquisition of real-time information during and after tumor resection but suffers from several artifacts and lack of training by most neurosurgeons.…”

“…It enables acquisition of real-time information during and after tumor resection but suffers from several artifacts and lack of training by most neurosurgeons. However, when coupled with navigation systems, orientation is improved and the brain shift can be compensated for, with improved orientation and image interpretation (7,(12)(13)(14)(15)(16). Some investigators have shown that US applied to neuronavigation systems improves patient survival in the resection of GBM (13,17).…”

“…However, when coupled with navigation systems, orientation is improved and the brain shift can be compensated for, with improved orientation and image interpretation (7,(12)(13)(14)(15)(16). Some investigators have shown that US applied to neuronavigation systems improves patient survival in the resection of GBM (13,17). With fusion imaging for virtual navigation, preoperative MR images and real-time intraoperative US scans can be displayed in a coplanar fashion, leading to the direct comparison of the two imaging modalities in terms of dimension, with a continuous updated scaling (7,15,(18)(19)(20).…”

Gliomas: Motexafin Gadolinium-enhanced Molecular MR Imaging and Optical Imaging for Potential Intraoperative Delineation of Tumor Margins

“…To achieve the most durable long-term survival benefit for patients with gliomas, complete eradication of tumors while sparing the normal brain parenchyma remains the most challenging task for neurosurgeons (3,6,14,15). Because of this daunting task in patients with gliomas, numerous intraoperative imaging-guided surgical techniques have been developed in an effort to extend survival and improve quality of life (5,6,12,25,26). Use of a single imaging modality to guide surgery has inherent limitations and disadvantages.…”

Intraoperative assistive technologies—the way ahead

“…Further, as rightly pointed out by Barbosa et al, cost-effectiveness studies are crucial especially when the other objective benefits are limited. In this context, it may be appropriate to note that intraoperative ultrasound has emerged as a potentially useful cost-effective alternative to IOMR [6,5]. Further well-designed, prospective studies evaluating IOUS as well as comparing IOMR and IOUS are warranted.…”