ReviewNeurosurgery practice2025
Comparing Utility of Intraoperative Magnetic Resonance Imaging and 5-Aminolevulinic Acid in High-Grade Glioma Resection Surgery: A Systematic Review and Meta-Analysis.
Review in Neurosurgery practice, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Neuronavigation-guided precise resection versus conventional glioma surgery: a meta-analysis of clinical outcomes.Frontiers in neurology · 2026Pooled it
- A staged adoption pathway for intraoperative imaging in brain tumor surgery: cost-effectiveness and accessibility in resource-limited neurosurgical settings.Frontiers in surgery · 2026Review
- 3D-printed navigation templates combined with multimodal imaging assist low-grade glioma surgery: a retrospective cohort study.Frontiers in surgery · 2026Article
- Intraoperative ultrasound in spinal surgery for surgical tailoring and control - A single center case series.Brain & spine · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectivesHigh-grade glioma has a poor prognosis despite advancements in histopathological classifications and treatments. Various intraoperative modalities are used to maximize extent of resection (EoR) and intraoperative detection of residual tumor, including 5-aminolevulinic acid (5-ALA) and intraoperative MRI (iMRI). We conducted a systematic review with meta-analysis investigating the efficacy of iMRI vs 5-ALA in maximizing EoR and improving survival outcomes.
methodsA systematic review with meta-analysis was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, PubMed, Embase, Scopus, and ClinicalTrials.gov databases, identifying randomized clinical trials (RCTs) and prospective studies comparing the use of 5-ALA and iMRI in high-grade glioma resection. The primary end points were EoR and survival outcomes. Quality assessment was conducted using the ROBINS-I risk of bias assessment and Jadad scale. Meta-analysis was performed using gross total resection rates, tumor detection sensitivity, and specificity.
resultsFive RCTs and 5 prospective studies were identified. Five RCTs lacked published data, thus only 5 prospective studies were included in the data extraction. Combined 5-ALA with iMRI (100%) was superior to 5-ALA alone (61.7%;
conclusionThere is no clear evidence to suggest iMRI is superior to 5-ALA in maximizing EoR and improving survival. However, combined use of 5-ALA and iMRI may be more effective compared with either modality alone. Larger RCTs are needed to confirm any differences in efficacy between the 2 modalities.
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Registered trials
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