Table 1.
Studies With Level I Evidence for Various Intraoperative Techniques for Brain Tumor Control
| Technique | Authors | Year | Experimental Arms (n) | Cohort Description | Findings |
|---|---|---|---|---|---|
| Awake craniotomies | Gupta et al.4 | 2007 | Awake craniotomy(26) vs Craniotomy under general anesthesia (27) | Patients with intrinsic brain tumors in eloquent regions |
>90% tumor excision:
(Awake) 57% of cohort (Control) 73.7% of cohort Immediate neurologic improvement (P = .03): (Awake) 18.7% of cohort with motor improvement and 14.3% of cohort with speech improvement (Control) 35.7% of cohort with motor improvement and 62.5% with speech improvement |
| Functional pathway maps for surgical planning | Wu et al.10 | 2007 | Diffusion tensor imaging (DTI) (118) vs Conventional neuronavigation (120) | Patients with gliomas |
Gross total resection for high-grade glioma (P < .001): (DTI) 74.4% (Control) 33.3% Postoperative motor deficit for entire cohort (P < .001): (DTI) 15.3% (Control) 32.8% Median survival for high-grade glioma (P = 0.048): (DTI) 21.2 months (Control) 14.0 months |
| Intraoperative MRI | Senft et al.11 | 2011 | Intraoperative MRI-guided surgery (29) vs Conventional microsurgery (29) | Patients with contrast-enhancing gliomas |
Complete tumor resection (P = .023): (MRI) 90% of cohort (Control) 68% of cohort New postoperative deficits (P = 1.0): (MRI) 13% of cohort (Control) 8% of cohort |
| Wu et al.12 | 2014 | Intraoperative MRI-guided surgery (58) vs Conventional neuronavigation (56) | Patients with newly diagnosed WHO grade II-IV gliomas, KPS ≥70 |
Gross total resection (P < .001): (MRI) 86.36% of cohort (Control) 53.49% of cohort |
|
| Fluorescence-guided surgery | Stummer et al.13 | 2006 | 5-ALA fluorescence-guided surgery (139) vs Conventional craniotomy with white light (131) | Patients with newly diagnosed malignant glioma |
Complete resection of contrast-enhancing tumor (P < .0001): (5-ALA) 65% of cohort (Control) 36% of cohort 6-month progression-free survival (P = .0003): (5-ALA) 41.0% of cohort (Control) 21.1% of cohort |
| Brachytherapy | Laperriere et al.14 | 1998 | Conventional radiation + brachytherapy boost (71) vs Conventional external RT (69) | Patients with malignant astrocytoma |
Median survival (P = .49): (Brachytherapy) 13.8 months (Control) 13.2 months |
| Selker et al.15 | 2002 | 125-iodine brachytherapy + external beam RT + BCNU (133) vs External beam RT + BCNU (137) | Patients with newly diagnosed malignant gliomas |
Median survival: (Brachytherapy) 68.1 weeks (Control) 58.8 weeks |
|
| Convection-enhanced delivery | Kunwar et al.16 | 2010 | Convection-enhanced delivery of cintredekin besudotox (183) vs Gliadel wafers (93) | Patients with recurrent GBM |
Median survival (P = .476): (Convection-enhanced delivery) 36.4 weeks (Control) 35.3 weeks |
Abbreviations: 5-ALA, 5-aminolevulinic acid; BCNU, β-chloro-nitrosourea/carmustine; GBM, glioblastoma; KPS, Karnofsky Performance Scale; RT, radiation therapy.
Studies included in this table are randomized controlled trials.5