title: Impact of intraoperative MRI-guided resection on resection and survival in patient with gliomas: a meta-analysis.
abstract: This study addressed the benefit of intraoperative magnetic resonance imaging (iMRI) compared with conventional neuronavigation-guided resection in patients with gliomas.
  
  
  
  The Medline, PubMed, Cochrane, and Google Scholar databases were searched up to 26 September 2015. Randomized controlled trials (RCTs), two-arm prospective studies, and retrospective studies in patients with glioblastoma/glioma who had received surgical treatment were included.
  
  
  
  The primary outcome measures were the extent of tumor resection and tumor size reduction for using iMRI-guided or conventional neuronavigation-guided neurosurgery. Secondary outcomes included impact of surgery on 6 month progression-free survival (PFS), 12 month overall survival (OS) rates and surgical duration.
  
  
  
  We found that iMRI was associated with greater rate of gross total resection (rGTR) compared with conventional neuronavigation procedures (3.16, 95% confidence interval [CI] 2.07-4.83, P < .001). We found no difference between the two neuronavigation approaches in extent of resection (EOR), tumor size reduction, or time required for surgery (P values ≥.065). Intraoperative MRI was associated with a higher rate of progression-free survival (PFS) compared with conventional neuronavigation (odds ratio, 1.84; 95% CI 1.15-2.95; P = .012), but the rate of overall survival (OS) between groups was similar (P = .799). Limitations of the study included the fact that data from non-RCTs was used, the small study population, and heterogeneity of outcomes across studies.
  
  
  
  Our findings indicate that iMRI more frequently resulted in more complete resections leading to improved PFS in patients with malignant gliomas.
authors.affiliation: a Department of Neurosurgery , Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease , Hefei , Anhui , P.R. China.|b Department of Neurosurgery , South branch of Anhui Provincial Hospital, Anhui Provincial Cardiovascular and Cerebrovascular Hospital , Hefei , Anhui 230001 , P.R. China.
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.affiliation: a Department of Neurosurgery , Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease , Hefei , Anhui , P.R. China.
authors.forename: Ruobing
authors.initials: R
authors.lastname: Qian
authors.affiliation: a Department of Neurosurgery , Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease , Hefei , Anhui , P.R. China.
authors.forename: Chaoshi
authors.initials: C
authors.lastname: Niu
authors.affiliation: a Department of Neurosurgery , Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease , Hefei , Anhui , P.R. China.|b Department of Neurosurgery , South branch of Anhui Provincial Hospital, Anhui Provincial Cardiovascular and Cerebrovascular Hospital , Hefei , Anhui 230001 , P.R. China.
authors.forename: Xianming
authors.initials: X
authors.lastname: Fu
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000601:surgery; D005260:Female; D005910:Glioma / Q000401:mortality / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000401:mortality / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000401:mortality / Q000706:statistics & numerical data; D025321:Surgery, Computer-Assisted / Q000401:mortality / Q000706:statistics & numerical data
keywords: Glioblastoma/glioma; intraoperative; magnetic resonance imaging/MRI; surgical resection; survival