title: Intraoperative MRI-guided resection of glioblastoma multiforme: a systematic review.
abstract: We did a systematic review to address the added value of intraoperative MRI (iMRI)-guided resection of glioblastoma multiforme compared with conventional neuronavigation-guided resection, with respect to extent of tumour resection (EOTR), quality of life, and survival. 12 non-randomised cohort studies matched all selection criteria and were used for qualitative synthesis. Most of the studies included descriptive statistics of patient populations of mixed pathology, and iMRI systems of varying field strengths between 0·15 and 1·5 Tesla. Most studies provided information on EOTR, but did not always mention how iMRI affected the surgical strategy. Only a few studies included information on quality of life or survival for subpopulations with glioblastoma multiforme or high-grade glioma. Several limitations and sources of bias were apparent, which affected the conclusions drawn and might have led to overestimation of the added value of iMRI-guided surgery for resection of glioblastoma multiforme. Based on the available literature, there is, at best, level 2 evidence that iMRI-guided surgery is more effective than conventional neuronavigation-guided surgery in increasing EOTR, enhancing quality of life, or prolonging survival after resection of glioblastoma multiforme.
authors.affiliation: Department of Neurosurgery, Maastricht University Medical Center, AZ Maastricht, Netherlands. pieter@kubben.nl
authors.forename: Pieter L
authors.initials: PL
authors.lastname: Kubben
authors.forename: Karlien J
authors.initials: KJ
authors.lastname: ter Meulen
authors.forename: Olaf E M G
authors.initials: OE
authors.lastname: Schijns
authors.forename: Mariël P
authors.initials: MP
authors.lastname: ter Laak-Poort
authors.forename: Jacobus J
authors.initials: JJ
authors.lastname: van Overbeeke
authors.forename: Henk
authors.initials: H
authors.lastname: van Santbrink
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019317:Evidence-Based Medicine; D005909:Glioblastoma / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053783:Magnetic Resonance Imaging, Interventional; D008866:Microsurgery / Q000009:adverse effects / Q000401:mortality; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000401:mortality; D011788:Quality of Life; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome