1Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia.
2Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia.
Neurosurg Focus. 2021 Aug;51(2):E5. doi: 10.3171/2021.5.FOCUS21185.
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.
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.
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.
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.
基于扩散张量成像（DTI）的高清晰度纤维束成像（HDFT）和荧光素钠（F）的增强现实（AR）在高级别胶质瘤（HGG）手术中的理论优势尚未得到详细研究。在这项研究中，作者旨在评估基于高清纤维束成像-荧光素钠显微镜的 AR 细胞减少术在新诊断的幕上 HGG 中的安全性和疗效。
回顾性分析了采用 AR HDFT-F 技术治疗新诊断的幕上 HGG 患者的数据，并与接受传统的基于红外神经导航的白光手术治疗的患者进行比较。根据术后神经肿瘤学评估（NANO）评分、切除程度（EOR）和 Kaplan-Meier 曲线分别报告了两种技术的安全性和疗效。采用卡方检验对分类变量进行分析。p 值<0.05 为统计学差异有意义。
共有 54 例患者接受了 AR HDFT-F 技术手术，63 例患者接受了传统的基于红外神经导航的白光手术。AR HDFT-F 组和对照组的平均术后 NANO 评分分别为 3.8±2 和 5.2±4（p<0.05）。AR HDFT-F 组的 EOR 更高（p<0.05）。在平均随访 12.2 个月后，研究组的无进展生存率（PFS）较长（对数秩检验，p=0.006）。此外，研究组和对照组的并发症发生率分别为 9.2%和 9.5%。
总体而言，AR HDFT-F 辅助手术在最大限度地提高新诊断的幕上 HGG 患者的 EOR 和 PFS 率以及优化患者功能预后方面是安全有效的。
