Neurosurgery Service, "Dr Alejandro Dávila Bolaños" Military Hospital, Managua, Nicaragua.
Neurosurgery Service, "Dr Alejandro Dávila Bolaños" Military Hospital, Managua, Nicaragua.
World Neurosurg. 2024 Jul;187:e860-e869. doi: 10.1016/j.wneu.2024.05.002. Epub 2024 May 9.
Despite the growing acceptance of neuronavigation in the field of neurosurgery, there is limited comparative research with contradictory results. This study aimed to compare the effectiveness (tumor resection rate and survival) and safety (frequency of neurological complications) of surgery for brain gliomas with or without neuronavigation.
This retrospective cohort study evaluated data obtained from electronic records of patients who underwent surgery for gliomas at Dr. Alejandro Dávila Bolaños Military Hospital and the Clinic Hospital of Barcelona between July 2016 and September 2022. The preoperative and postoperative clinical and radiologic characteristics were analyzed and compared according to the use of neuronavigation.
This study included 110 patients, of whom 79 underwent surgery with neuronavigation. Neuronavigation increased gross total resection by 57% in patients in whom it was used; gross total resection was performed in 56% of patients who underwent surgery with neuronavigation as compared with 35.5% in those who underwent surgery without neuronavigation (risk ratio [RR], 1.57; P=0.056). The incidence of postoperative neurologic deficits (transient and permanent) decreased by 79% with the use of neuronavigation, (12% vs. 33.3%; RR, 0.21; P=0.0003). Neuronavigation improved survival in patients with grade IV gliomas (15 months vs. 13.8 months), but it was not statistically significant (odds ratio (OR), 0.19; P=0.13).
Neuronavigation improved the effectiveness (greater gross total resection of tumors) and safety (fewer neurological deficits) of brain glioma surgery. However, neuronavigation does not significantly influence the survival of patients with grade IV gliomas.
尽管神经导航在神经外科领域的接受度不断提高，但相关比较研究仍较少且结果存在争议。本研究旨在比较有或无神经导航的脑胶质瘤手术的有效性（肿瘤切除率和生存率）和安全性（神经并发症发生率）。
本回顾性队列研究评估了 2016 年 7 月至 2022 年 9 月期间在亚历杭德罗·达维拉·博拉尼奥斯军事医院和巴塞罗那诊所医院接受脑胶质瘤手术的患者的电子病历数据。根据是否使用神经导航，对患者的术前和术后临床及影像学特征进行分析和比较。
本研究共纳入 110 例患者，其中 79 例行神经导航手术。神经导航可将使用组患者的大体全切除率提高 57%；行神经导航手术的患者中，有 56%进行了大体全切除，而未行神经导航手术的患者中，这一比例为 35.5%（风险比 [RR]，1.57；P=0.056）。使用神经导航可使术后神经功能缺损（一过性和永久性）的发生率降低 79%（12%比 33.3%；RR，0.21；P=0.0003）。神经导航可提高 IV 级胶质瘤患者的生存率（15 个月比 13.8 个月），但无统计学意义（比值比 [OR]，0.19；P=0.13）。
神经导航可提高脑胶质瘤手术的有效性（肿瘤更大程度的全切除）和安全性（神经并发症更少）。然而，神经导航对 IV 级胶质瘤患者的生存率无显著影响。
