Summary of findings 3. Neuronavigation image‐guided surgery compared to standard surgery for high‐grade glioma.
| Neuronavigation image‐guided surgery compared to standard surgery for high‐grade glioma | ||||||
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Patient or population: high‐grade glioma Settings: specialist centres Intervention: neuronavigation image‐guided surgery (based on postoperative MRI) Comparison: standard surgery | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Neuronavigation image‐guided surgery | |||||
| Extent of resection: incomplete resection | Not estimable | Not estimable | Not reported | 45 participants (1 study) | ⊕⊝⊝⊝a,b,c Verylow | Small study of highly selected participants at very high risk of allocation bias. Complete resection was achieved in 3 participants in the control group and 5 participants in the neuronavigation group. However, there was significant attrition, with not all participants completing imaging, and the denominators for these figures were not stated, precluding formal analysis. |
| Adverse events | Inadequately and inconsistently reported in the trial | ⊕⊝⊝⊝c Verylow | Adverse events were reported in an inconsistent manner and not according to the manner prespecified in our protocol. | |||
| Overall survival | Not estimable | ⊕⊝⊝⊝d Verylow | Not reported by trial authors so graded as very low‐quality evidence. | |||
| Progression‐free survival | Not estimable | ⊕⊝⊝⊝c Verylow | Progression‐free survival or time to progression was not reported in the trial. | |||
| Quality of life | Inadequately reported or not assessed at all in the included trials | ⊕⊝⊝⊝d Verylow | Quality of life was reported in the trial but only 19 participants (8 in the neuronavigation arm and 11 in the standard surgery arm) completed questionnaires postoperatively at 3 months, constituting only 64.5% of all eligible participants, and no statistical analysis was presented. | |||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval. | ||||||
| GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. | ||||||
aSmall trial so quality of the evidence downgraded by one level. b cHighly selected participants with potential bias in allocation and performance as well as in other 'Risk of bias' domains, thus downgraded by two levels. dOutcome was not reported (or inadequately reported for meaningful conclusions to be drawn), therefore giving lowest quality of evidence judgement.