ReviewFrontiers in surgery2026
A staged adoption pathway for intraoperative imaging in brain tumor surgery: cost-effectiveness and accessibility in resource-limited neurosurgical settings.
Review in Frontiers in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Abstract
Maximal safe resection extends progression-free and overall survival in glioma surgery, and intraoperative imaging modalities are the means by which this is operationalized. Seven such modalities are now available: 5-aminolevulinic acid (5-ALA) fluorescence, fluorescein sodium, intraoperative magnetic resonance imaging (iMRI), intraoperative ultrasound (iUS), hyperspectral imaging, Raman spectroscopy and stimulated Raman histology, and augmented reality neuronavigation. Their availability is, however, profoundly unequal across high-income and resource-limited neurosurgical settings. This mini review appraises the comparative cost-effectiveness, accessibility, and adoption barriers of these seven modalities, drawing on randomized controlled trials, systematic reviews, formal health-economic analyses, and Lancet Commission data on global neurosurgical capacity. The evidence supports three arguments. That the cost-effectiveness rank order favors 5-ALA, iUS, and fluorescein over iMRI, inverting the apparent technological hierarchy. That accessibility barriers are dominated by capital infrastructure and regulatory status rather than consumable cost. And that no published cost-effectiveness analysis has yet adopted a low- or middle-income country payer perspective. A four-tier staged adoption pathway is proposed, synthesizing the Global IDEAL Sub-Framework, the NASSS framework, WHO-INTEGRATE, and Lancet Commission on Global Surgery indicators, to guide rational adoption sequences for centers operating under capital constraint.
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