Evaluation of Neuronavigation Aided Surgery on Diffuse Brain Glioma

Abstract

Abstract Surgical management of Diffuse Low-Grade Gliomas (DLGGs) has radically changed in the last years. Several studies now recommend maximal safe gross total, or even supratotal resection. There has been a change in basic assumptions from watchful waiting to early radical safe resection. Neuronavigation guided diffuse low grade glioma resection is claimed by some authors to play a major role in improving the Extent Of surgical Resection (EOR) whilst decreasing complication rate. The aim: of this study was to evaluate the impact of neuronavigation use during DLGG resection and the surgical outcome. Materials and Methods Thirty one patients affected by DLGG were enrolled undergoing surgical resection with the aim of a maximal safe resectio n using a neuronavigation device with or without other functional, neurophysiological, and neuropsychological modalities. Statistical Analysis Continuous data were presented as ranges, mean and standard deviation (as appropriate), median and SEM (standard error of the mean when relevant). Categorical data were presented as frequencies and percentages. Comparative statistics was used for subgroup analysis evaluating different variables among different groups. Statistical significance was set at P value of 0.05. All statistical calculations were run using SPSS version 22. Frequencies and percentages were calculated for categorical data, and chi-square tests were used for intergroup comparisons. The Chi-square test was used to analyze the differences in the percentage of deterioration of symptoms between groups. Univariate and Multivariate linear and logistic regression were used to analyze the effect of NN on EOR and the deterioration of symptoms, respectively. Kaplan-Meier was used to compare the difference in survival between groups. Univariate and Multivariate Cox regressions were used to determine the relationship between the assistance of NN and survival. The statistically significant was set as a p < 0.05. Results Our results were comparable to those reported in literature. We achieved an average of 78% EOR, with almost even distribution among three groups of resections. STR achieved 35.4%, followed by PR in 32.2% of the cases, finally we achieved an EOR more than 90% (GTR+NTR) in 30.6% of the patients. Our Radiological radicality (GTR) was 25.8% and the NTR was 4.8%. There was as statistically significant direct correlation between EOR and the in the postoperative KPS improvement (p = 0.021). The average hospital days were 5-6 days, and the average blood loss was 250 ml blood. Engel Class I was achieved in eleven (45.83%) patients, while eight (33.33%) patients had rare disabling seizures (Engel Class II). The temporary intraoperative and postoperative complications were noted in 36.67% and 38.71%, respectively, of patients and was noted more in the awake group while the permanent deficits were in 22.58% of the patients and was more noted in the asleep surgery group. Conclusion NVV assisted DLGG resection is a safe and effective method to improve EOR. Additionally, the combination of awake surgery and other neuromonitoring faculties decreases the long term deficits, thus, leading to an increased radicality and safety of DLGG surgery.