• Lucca B Palavani, Márcio Yuri Ferreira, Pedro G L B Borges, Luis Bandeira, da Silva SemioneGabrielGDepartment of Neurosurgery, University of West Santa Catarina, Joacaba, Brazil., Miguel V Almeida, Gabriel Verly, Allan Dias Polverini, Filipi Fim Andreão, Raphael Camerotte, Christian Candido Ferreira, Wellingson Paiva, Raphael Bertani, and John Boockvar.
• Department of Neurosurgery, Max Planck University Center, São Paulo, Brazil. Electronic address: lucca.palavani730@al.unieduk.com.br.
• World Neurosurg. 2024 Jun 1; 186: 172617-26.

BackgroundHigh-grade gliomas (HGGs) present a challenge in neuro-oncology, often necessitating surgical resection for optimal management. Ultrasound holds promise in achieving better gross total resection (GTR) and improving outcomes. This meta-analysis systematically evaluates literature providing robust evidence on the use of intraoperative ultrasonography (iUSG) in HGG resection.MethodsFollowing Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines a comprehensive search was made across PubMed, Embase, Cochrane, and Web of Science utilized terms related to iUSG for HGG resection. The meta-analysis examined randomized trials and observational cohort studies on iUSG-guided HGG resection. GTR, subtotal resection, and postresection complications were assessed. Statistical analysis, employing R software for a single proportion analysis with confidence intervals of 95%, I2 statistics for heterogeneity, and the instrumental variables method with restricted maximum likelihood for a random effects model.ResultsA total of 178 patients were included in our study. The GTR overall rate in patients with iUSG-guided resection was found to be 64% (95% confidence interval: 46%-81%). Two-dimensional ultrasound remains dominant at 80% against other options of ultrasound. Complications were reported at a 15% rate (95% confidence interval: 7%-23%).ConclusionsOur study provided robust data on the utilization of iUSG-guided resection regarding the attainment of GTR and the complications related to resection. However, challenges such as outcome heterogeneity and limited complication reporting highlight the need for further research to optimize iUSG in HGG treatment. Long-term follow-up studies on patient survival and postsurgery quality of life will complement existing literature, guiding clinical practices in managing HGG.Copyright © 2024 Elsevier Inc. All rights reserved.

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