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Intraoperative MRI versus 5-ALA in high-grade glioma resection: a network meta-analysis

Al's Comment:

 This article compares using intraoperative MRI to Gleolan (5-ALA) as to the abilty to maximize extent of resection, overall survival and progression free survival. 

 Intraoperative MRI is just what it sounds like - a machine that is able to do an MRI right in the operating room while you are having a surgery.  It is important because when they use navigation systems they use the scans to see where they are on the brain.  After they remove most of the tumor, the brain shifts a little, so the pre-op scan is no longer accurate.  They can compensate for that by doing another scan while you are in surgery, and it also can see large areas of remaining tumor. 

 Gleolan is an fda approved dye, taken orally before surgery. During the surgery, when viewed under a special light, any remaining tumor glows and the surgeon can see what needs to be removed.

The study finds that both of these significantly improve survival and all of the other endpoints.  It is not clear which one is better, with a hint that the intraoperative MRI is slightly better.  I do not see why they can't use both and make it even better.  Most hospitals do not have an intraoperative MRI.  Any hospital can use Gleolan - a special attachment to an operating microscope is required but the cost is nothing compared to the cost of an MRI machine.

Posted on: 03/14/2020

Intraoperative MRI versus 5-ALA in high-grade glioma resection: a network meta-analysis


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