Application Of Neuronavigation Combine With Intraoperative Neurophysiologic Monitoring In Supratentorial Lesions Surgery

Object: To evaluate the feasibility,safety and clinical efficacy of neuronavigation combined with neurophysiological monitoring in the microsurgical removal of supratentorial lesions.Methods: From January 2013 to June 2016,34 patients whose lesion in supratentorial were resected in neurosurgical procedures applied with neuronavigation and intraoperative neurophysiologic monitoring(IONM).For other previous 34 patients,only microscope used in the neurosurgical procedures.The duration of operation,the two groups were observed and compared intraoperative bleeding,the hospital stays,preoperative bone window design and actual bone window gap,resection extent,relieve symptoms after operation,postoperative complications and follow-up prognosis and recurrence.Results: The patients` baseline characteristics were statistically similar between the 2 groups.For the research group,the preoperative bone window design and actual bone window gap was 23.09±13.46,and for the contrast group,it was 33.68±12.32.The difference had statistical meaning(p<0.05).Compared the volume of bleeding in operation of the research group(219.56±142.76)and the contrast group(427.6±295.1).The t value was-3.879,with a difference having statistical meaning(p<0.05).The hospital stays for the research group and the contrast group was 16.65±9.35 and 22.79±12.28,respectively.The difference had statistical meaning too(p<0.05).For the research group,28 patients are gross total resection,3 patients near total resection,2 patients subtotal resection and 1 patient partial resection.The gross total resection rate is 82.35%.The contrast group includes 19 patients are gross total resection,9 patients near total resection,4 patients subtotal resection and 2 patients partial resection,with a gross total resection rate of 55.88%.The difference had statistical meaning(p < 0.05).For the research group,the preoperative Karnofsky Performance Scale(KPS)value was 75.29±22.60,the postoperative KPS value was 89.12±17.98,the the 3 months after operation KPS value was 89.09±19.90;The contrast group includes the preoperative KPS value was 71.18±26.14,the postoperative KPS value was 75.00±29.57,tthe the 3 months after operation KPS value was 68.48±35.98.Comparing the two groups,the t value was 2.379 and 2.879 in Kpost and K3 mpost,respectively.with a difference having statistical meaning(p<0.05).And there is obvious difference in symptom improved and postoperative deficits.The difference had statistical meaning(p<0.05).Conclusions: It is feasible and safe using the neuronavigation and IONM to guide the operation of supratentorial lesions.The combined application can reduce the bone window;improve the supratentorial lesion resection of the total resection rate,especially glioma,meningioma;reduce the intraoperative bleeding;shorten the postoperative length of hospital stay;postoperative patients can significantly improve the symptoms and reduce complications.