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. 2022 Nov 2;24(Suppl 6):S33–S41. doi: 10.1093/neuonc/noac170

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