Neuronavigation-guided precise resection versus conventional glioma surgery: a meta-analysis of clinical outcomes.
Neuronavigational surgery has become a cutting-edge technique that improves surgical accuracy, increases tumor excision rates, and preserves neurological function in glioma patients.
This meta-analysis was conducted to assess the efficacy of neuronavigational and advanced imaging-assisted surgery compared to traditional glioma surgery.
In total, 30 articles published between 2006 and 2026, including randomized controlled trials, prospective cohort studies, retrospective cohort studies, and case series, were evaluated. The intervention involved intraoperative MRI (iMRI), ultrasound-guided navigation, functional neuronavigation, and other advanced navigational technologies. Meta-analysis was carried out using random effects models with inverse variance to calculate pooled odds ratios (ORs), 95% confidence intervals (CIs), I 2 and τ 2 measures of heterogeneity, and publication bias using funnel plots and Egger's regression test. The risk of bias was assessed through the Cochrane RoB 2 for 7 randomized controlled trials and ROBINS-I for 23 observational studies.
Overall analysis demonstrated significant improvement with neuronavigation-guided surgery (OR = 2.37, 95% CI: 2.05-2.74, p < 0.05; I 2 = 22.8%). Subgroup analyses showed significant benefits for iMRI-guided surgery (OR = 2.49, 95% CI: 1.92-3.23, z = 6.88, I 2 = 22.6%, τ 2 = 0.0428, p = 0.2286), ultrasound-based navigation (OR = 1.97, 95% CI: 1.47-2.66, z = 4.50, I 2 = 4.9%, τ 2 = 0.0084, p = 0.3685), functional neuronavigation (OR = 2.11, 95% CI: 1.59-2.80, z = 5.17, I 2 = 0%), advanced navigation technologies (OR = 2.33, 95% CI: 1.67-3.25, z = 4.99, I 2 = 16.4%), and other specialized techniques (OR = 2.16, 95% CI: 1.63-2.86, z = 5.34, I 2 = 8.3%). Leave-one-out analysis confirmed the stability of the pooled effect, with minimal changes after exclusion of individual studies.
Neuronavigation-based and image-enhanced surgical procedures can significantly improve glioma surgery outcomes, with low heterogeneity and strong pooled effects. Large-scale multicenter studies are needed in order to prove their efficacy in the long term.
This meta-analysis was conducted to assess the efficacy of neuronavigational and advanced imaging-assisted surgery compared to traditional glioma surgery.
In total, 30 articles published between 2006 and 2026, including randomized controlled trials, prospective cohort studies, retrospective cohort studies, and case series, were evaluated. The intervention involved intraoperative MRI (iMRI), ultrasound-guided navigation, functional neuronavigation, and other advanced navigational technologies. Meta-analysis was carried out using random effects models with inverse variance to calculate pooled odds ratios (ORs), 95% confidence intervals (CIs), I 2 and τ 2 measures of heterogeneity, and publication bias using funnel plots and Egger's regression test. The risk of bias was assessed through the Cochrane RoB 2 for 7 randomized controlled trials and ROBINS-I for 23 observational studies.
Overall analysis demonstrated significant improvement with neuronavigation-guided surgery (OR = 2.37, 95% CI: 2.05-2.74, p < 0.05; I 2 = 22.8%). Subgroup analyses showed significant benefits for iMRI-guided surgery (OR = 2.49, 95% CI: 1.92-3.23, z = 6.88, I 2 = 22.6%, τ 2 = 0.0428, p = 0.2286), ultrasound-based navigation (OR = 1.97, 95% CI: 1.47-2.66, z = 4.50, I 2 = 4.9%, τ 2 = 0.0084, p = 0.3685), functional neuronavigation (OR = 2.11, 95% CI: 1.59-2.80, z = 5.17, I 2 = 0%), advanced navigation technologies (OR = 2.33, 95% CI: 1.67-3.25, z = 4.99, I 2 = 16.4%), and other specialized techniques (OR = 2.16, 95% CI: 1.63-2.86, z = 5.34, I 2 = 8.3%). Leave-one-out analysis confirmed the stability of the pooled effect, with minimal changes after exclusion of individual studies.
Neuronavigation-based and image-enhanced surgical procedures can significantly improve glioma surgery outcomes, with low heterogeneity and strong pooled effects. Large-scale multicenter studies are needed in order to prove their efficacy in the long term.