Supratentorial high-grade gliomas: maximal safe anatomical resection guided by augmented reality high-definition fiber tractography and fluorescein

Abstract

OBJECTIVE The theoretical advantages of augmented reality (AR) with diffusion tensor imaging (DTI)–based high-definition fiber tractography (HDFT) and sodium fluorescein (F) in high-grade glioma (HGG) surgery have not been investigated in detail. In this study, the authors aimed to evaluate the safety and efficacy profiles of HDFT-F microscope-based AR cytoreductive surgery for newly diagnosed supratentorial HGGs. METHODS Data of patients with newly diagnosed supratentorial HGGs who underwent surgery using the AR HDFT-F technique were reviewed and compared with those of a cohort of patients who underwent conventional white-light surgery assisted by infrared neuronavigation. The safety and efficacy of the techniques were reported based on the postoperative Neurological Assessment in Neuro-Oncology (NANO) scores, extent of resection (EOR), and Kaplan-Meier curves, respectively. The chi-square test was conducted for categorical variables. A p value < 0.05 was considered statistically significant. RESULTS A total of 54 patients underwent surgery using the AR HDFT-F technique, and 63 underwent conventional white-light surgery assisted by infrared neuronavigation. The mean postoperative NANO scores were 3.8 ± 2 and 5.2 ± 4 in the AR HDFT-F group and control group, respectively (p < 0.05). The EOR was higher in the AR HDFT-F group (p < 0.05) than in the control group. With a mean follow-up of 12.2 months, the rate of progression-free survival (PFS) was longer in the study group (log-rank test, p = 0.006) than in the control group. Moreover, the complication rates were 9.2% and 9.5% in the study and control groups, respectively. CONCLUSIONS Overall, AR HDFT-F–assisted surgery is safe and effective in maximizing the EOR and PFS rate for patients with newly diagnosed supratentorial HGGs, and in optimizing patient functional outcomes.

Motor outcome after resective surgery for the central lobe gliomas

“…[13] According to our results, the EOR for gliomas near the motor tract does not have a relevant impact with the final motor outcome for these patients, as it was established in the previous series. [9,10] In our series, we achieved on average an EOR of 88%, and almost 40% of cases received an EOR of over 95%. ese results are comparable with series from more specialized centers.…”

“…[14] In a recent study, 54 patients that underwent surgery for glioma resection using augmented reality-assisted intraoperative tractography and sodium fluorescein were compared against a group of 63 patients that underwent surgery using conventional white-light surgery assisted by infrared neuronavigation. [10] Patients in the augmented reality group had better outcomes according to the NANO score and recorded better EOR compared to patients in the white-light group. Emphasis has to be made that these techniques must be integrated with intraoperative brain mapping techniques, since the augmented reality DTI tractography technique provides anatomical but not functional information of the underlying fiber tracts, among other technical limitations.…”

“…ese results are comparable with series from more specialized centers. [10] Hence, despite the location of the tumor, we believe that the goal of surgery should always be the GTR of the lesion.…”

Single-stage cranioplasty with customized polyetheretherketone implant after tumor resection using virtual reality and augmented reality for precise implant customization and placement: illustrative case

“…As an example, the implementation of VR/AR has been found to be useful in planning safe surgical approaches for neuro-oncological, cerebrovascular, and spinal diseases as well as across other related specialties, such as maxillofacial and plastic surgery. 11 , 24–27 If in the future these efforts translate to discrete reductions in complications, lengths of stay, surgical procedure times, or readmissions, then a justifiable return of investment could be proved to hospital and surgical practices alike.…”

Augmented and Virtual Reality Usage in Awake Craniotomy: A Systematic Review

“…AR and VR are innovative domains of medicine with growing applications in neurosurgery, including training, patient care, operative planning, intraoperative assessments, and postoperative care [34,[63][64][65][66][67][68][69][70][71]. AR and VR can be used during the preoperative phase of AC (i.e., for example, in training residents and medical students), in the intraoperative phase, (i.e., mapping cognitive functions), and in the postoperative phase, (i.e., patient rehabilitation).…”