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

Sabino Luzzi, Alice Giotta Lucifero, Andrea Martinelli, Mattia Del Maestro, Gabriele Savioli, Anna Simoncelli, Elvis Lafe, Lorenzo Preda, Renato Galzio

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE The theoretical advantages of augmented reality (AR) with diffusion tensor imaging (DTI)-based highdefinition 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 microscopebased 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.

Original languageEnglish
Pages (from-to)1-12
Number of pages12
JournalNeurosurgical Focus
Volume51
Issue number2
DOIs
Publication statusPublished - Aug 2021

Keywords

  • augmented reality
  • diffusion tensor imaging
  • fiber tractography
  • fluorescein
  • high-grade glioma
  • neuronavigation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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