Clinical Report: A Phased Approach to Implementing Intraoperative Imaging

Background

Maximal safe resection is crucial for improving survival in glioma surgery, with intraoperative imaging playing a key role in achieving this goal. However, access to these imaging modalities is uneven, particularly in low- and middle-income countries, where the need for neurosurgical care is high. Understanding the cost-effectiveness and barriers to adoption of these technologies is essential.

Data Highlights

No specific numerical data provided in the source material.

Key Findings

• Five billion people lack access to safe surgical care globally.
• Only 25.3% of sub-Saharan Africans live within two hours of a neurosurgical center.
• The cost-effectiveness rank order favors 5-ALA, iUS, and fluorescein over iMRI.
• Accessibility barriers are primarily due to capital infrastructure and regulatory status.
• No existing cost-effectiveness analysis has adopted a low- or middle-income country payer perspective.

Clinical Implications

Healthcare professionals should consider the varying availability of intraoperative imaging modalities when planning glioma surgeries. The proposed adoption pathway can guide resource-limited centers in implementing these technologies effectively.

Conclusion

The disparities in access to intraoperative imaging modalities necessitate a structured approach to their adoption, particularly in low-resource settings, to enhance surgical outcomes for glioma patients.

Related Resources & Content

1. Lacroix et al., 2001 -- Extent of resection and survival in glioblastoma
2. Sanai et al., 2008 -- Resection of gliomas: a systematic review
3. Molinaro et al., 2020 -- Maximal resection and survival in glioblastoma
4. Lancet Commission on Global Surgery, 2015 -- Global surgical care access
5. Evaluating the Role of Augmented Reality Visualization in Brain Lesions: A Prospective Randomized Controlled Study on Its Benefits and Current Challenges in Navigated Microneurosurgery
6. A Workflow for Glial Tumor Surgery Utilizing Intraoperative MRI Without a Dedicated Suite
7. The Impact of Mixed Reality Technology on the Workflow of Complex Neurooncological Surgeries: Insights from Thalamic Surgery Case Study
8. Advanced Image-Guided Navigation for Neurosurgical Procedures: An Open-Source Software Solution Utilizing Cutting-Edge Clinical Technology
9. EANS-EANO guidelines on the extent of resection in gliomas
10. Intraoperative ultrasound in brain tumor surgery: A review and implementation guide
11. Congress of Neurological Surgeons systematic review and evidence-based guidelines for the role of surgery in the management of patients with diffuse low grade glioma: update - PubMed