title: Intraoperative Ultrasound-Guided Resection of Gliomas: A Meta-Analysis and Review of the Literature.
abstract: BACKGROUND
  Image-guided surgery has become standard practice during surgical resection, using preoperative magnetic resonance imaging. Intraoperative ultrasound (IoUS) has attracted interest because of its perceived safety, portability, and real-time imaging. This report is a meta-analysis of intraoperative ultrasound in gliomas.
  
  
  METHODS
  Critical literature review and meta-analyses, using the MEDLINE/PubMed service. The list of references in each article was double-checked for any missing references. We included all studies that reported the use of ultrasound to guide glioma-surgery. The meta-analyses were conducted according to statistical heterogeneity between the studies using Open MetaAnalyst Software. If there was no heterogeneity, fixed effects model was used for meta-analysis; otherwise, a random effect model was used. Statistical heterogeneity was explored by χ(2) and inconsistency (I(2)) statistics; an I(2) value of 50% or more represented substantial heterogeneity.
  
  
  RESULTS
  A wide search yielded 19,109 studies that might be relevant, of which 4819 were ultrasound in neurosurgery; 756 studies used ultrasound in cranial surgery, of which 24 studies used intraoperative ultrasound to guide surgical resection and 74 studies used it to guide biopsy. Fifteen studies fulfilled our stringent inclusion criteria, giving a total of 739 patients. The estimated average gross total resection rate was 77%. Furthermore, the relationship between extent of surgical resection and study population was not linear. Gross total resection was more likely under IoUS when the lesion was solitary and subcortical, with no history of surgery or radiotherapy. IoUS image quality, sensitivity, specificity, and positive and negative predictive values deteriorated as surgical resection proceeded.
  
  
  CONCLUSIONS
  IoUS-guided surgical resection of gliomas is a useful tool for guiding the resection and for improving the extent of resection. IoUS can be used in conjunction with other complementary technologies that can improve anatomic orientation during surgery. Real-time imaging, improved image quality, small probe sizes, repeatability, portability, and relatively low cost make IoUS a realistic, cost-effective tool that complements any existing tools in any neurosurgical operating environment.
authors.affiliation: Division of Neuroscience, University of Dundee and Ninewells Hospital, Dundee, United Kingdom.
authors.forename: Syed
authors.initials: S
authors.lastname: Mahboob
authors.affiliation: Division of Cancer Research, University of Dundee, Dundee, United Kingdom.
authors.forename: Rachael
authors.initials: R
authors.lastname: McPhillips
authors.affiliation: Institute of Medical Science and Technology, University of Dundee, Dundee, United Kingdom.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Qiu
authors.affiliation: Applied Functional Materials Ltd, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Yun
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Applied Functional Materials Ltd, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Carl
authors.initials: C
authors.lastname: Meggs
authors.affiliation: Research Institute in Signals, Sensors and Systems, Heriot Watt University, Edinburgh, United Kingdom.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Schiavone
authors.affiliation: Applied Functional Materials Ltd, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Tim
authors.initials: T
authors.lastname: Button
authors.affiliation: Research Institute in Signals, Sensors and Systems, Heriot Watt University, Edinburgh, United Kingdom.
authors.forename: Marc
authors.initials: M
authors.lastname: Desmulliez
authors.affiliation: Division of Cancer Research, University of Dundee, Dundee, United Kingdom.
authors.forename: Christine
authors.initials: C
authors.lastname: Demore
authors.affiliation: Division of Imaging and Technology, University of Dundee, Dundee, United Kingdom.
authors.forename: Sandy
authors.initials: S
authors.lastname: Cochran
authors.affiliation: Department of Neurosurgery, University of Dundee and Ninewells Hospital, Dundee, United Kingdom. Electronic address: professor.ms.eljamel@gmail.com.
authors.forename: Sam
authors.initials: S
authors.lastname: Eljamel
mesh_terms: D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D005910:Glioma / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D016343:Monitoring, Intraoperative; D019635:Neurosurgical Procedures / Q000379:methods*; D014463:Ultrasonography
keywords: Glioma; Image-guided surgery; Intraoperative ultrasound; Neuronavigation