Impact of Neuronavigation and Image-Guided Extensive Resection for Adult Patients with Supratentorial Malignant Astrocytomas: A Single-Institution Retrospective Study

Abstract

Neuronavigation has become an effective therapeutic modality and is used routinely for intra-axial tumor removal. This retrospective study was conducted to evaluate the clinical impact of neuronavigation and image-guided extensive resection for adult patients with supratentorial malignant astrocytomas. Between 1990 and 2002, 76 adult patients with pathologically confirmed malignant astrocytomas underwent craniotomy and removal of the tumors at the Toyama Medical and Pharmaceutical University Hospital. Of these 76 patients, 42 were treated using neuronavigation with conventional microneurosurgery and the other 34 were treated with conventional microneurosurgery alone. Postoperative early MRI with contrast enhancement was done, and gross total resection was defined as the complete absence of residual tumor. Survival time was analyzed with the Kaplan-Meier method. Prognostic factors were obtained from the Cox proportional hazards model. In univariate analysis, age (< 65), grade 3, preoperative KPS (>/= 80), use of neuronavigation, and gross total resection were significantly associated with longer survival. However, when the data were submitted to multivariate analysis, grade 3, preoperative KPS (>/= 80), and gross total resection were independent prognostic factors. The median survival periods of patients receiving gross total resection (vs. partial resection) and neuronavigation (vs. no neuronavigation) were 16 (vs. 9) months and 16 (vs. 10) months, respectively. The percentage of a gross total resection was significantly higher in the neuronavigation group compared to that in the no-navigation group (64.3 % vs. 38.2 %, p < 0.05). Neurological deterioration occurred in 4 of 42 (9.5 %) and in 6 of 34 (17.6 %) patients after surgery with neuronavigation and surgery without neuronavigation, respectively, although this difference was not statistically significant. Our results showed that neuronavigation increases the radicality in the resection of malignant astrocytomas and is objectively useful for improving survival time.

Same-day discharge after craniotomy for supratentorial tumour surgery: a retrospective observational single-centre study

“…5,6 The advent of intraoperative neuronavigation has helped in planning a more precise surgical approach to the targeted lesion and thus the use of a minimally invasive craniotomy. 7 A smaller craniotomy flap allows for a shorter duration of anesthesia and surgery, faster recovery, and less need for postoperative admission to the ICU. 8 As well, an awake craniotomy (AC) can be safely used for many supratentorial tumours, allowing for a potentially faster recovery and discharge from the hospital, as short stay or even as day surgery.…”

Survival rates in patients with the newly diagnosed glioblastoma: Data from the National Cancer Registry of Ukraine, 2008-2016

“…As well as using of intraoperative neuroimaging technique facilitates performing of safer and complete resection it also reduces hazard ratios. The using of intraoperative neuromonitoring and neuroimaging tools provides high rates of complete resection with low rates of neurological disorders [6,8,10,18,19].…”

Intraoperative Navigation and Fluorescence Imagings in Malignant Glioma Surgery

“…Actually, it has been reported that intraoperative neuronavigation in glioma surgery improves functional outcomes of glioma patients. 24,25 However, there are still problems that remain to be resolved. The biggest of these is that navigation surgery can only minimally deal with 'brain shift'.…”