Application Of Intraoperative Neuronavigation System In Resection Of Intracranial Glioma

Objective:To evaluate the clinical value of intraoperative neuronavigation in the resection of intracranial gliomas by reviewing the difference of lesion resection rate and postoperative prognosis between patients who underwent intracranial gliomas resection with navigation system and traditional surgery.Methods:The clinical data of 86 patients with glioma who underwent intracranial glioma resection in the first hospital of Jilin University from January 2021 to December 2021 were analyzed retrospectively.The experimental group used intraoperative neuronavigation system to assist in the surgical resection of the lesions,and the control group underwent routine craniotomy,and the lesions were removed according to the experience of the operator.The resection rate and prognosis were compared.After excluding 15 cases of secondary surgery,86 cases were included,including 42 cases in the experimental group and 44 cases in the control group.Among the 42 patients in the intraoperative neuronavigation group,there were 24 males and 18 females,aged 15-77 years,with an average of（50 ± 15.1）years.Pathological classification: astrocytoma in 5 cases,oligodendroglioma in 3 cases,glioblastoma in 21 cases,mixed glioma（oligodendroglioma）in 13 cases.Pathological grade: Grade II in 7 cases,grade II ～ III in 10 cases,grade III in 1 case,grade III ～ IV in 2 cases;Grade IV: 22 cases.Course of disease: from 1 day to 36 months,with an average of（2.6 ± 6）months.Clinical manifestations: increased intracranial pressure（headache,vomiting,papilledema（visual field change and diplopia））in 14 cases;Local symptoms:（decreased or lost limbactivity,unilateral physical sensory impairment,aphasia,epilepsy）28 cases.Among the 44 patients in the conventional operation group,there were 21 males and 23 females,aged from 24 to 70 years,with an average of（50.8 ± 12.3）years.Pathological classification: astrocytoma in 5 cases,oligodendroglioma in 3 cases,glioblastoma in 25 cases,mixed glioma（astrocytoma + oligodendrocyte）in 11 cases.Pathological grade: 9 cases of grade II,4 cases of grade II ～ III,5 cases of grade III,1case of grade III ～ IV;Grade IV: 25 cases.Course of disease: 1 day to 120 months,with an average of（4 ± 18.5）months.The clinical manifestations of visual acuity and visual acuity（including papilledema and vomiting）were increased in 19 cases;Local symptoms:（decreased or lost limb activity,unilateral physical sensory impairment,aphasia,epilepsy）25 cases.There was no significant difference in gender,age,pathological classification,pathological grade,onset symptoms and course time between the two groups.All patients with gliomas underwent cranial MRI or CT before operation,and all patients underwent CT or MRI after operation.The residual tumor volume was calculated according to the imaging results after operation.The total resection rates of the two groups were compared.Evaluation of surgical efficacy: there are few complications（fever,infection,cerebrospinal fluid leakage,paralysis,sensory impairment and aphasia）after operation,the KPS score is improved or unchanged compared with that before operation,and the symptoms after operation are improved or unchanged compared with that before operation;There are many complications after operation.KPS score is lower than that before operation.There are no symptoms before operation or the clinical symptoms before operation are aggravated after operation,and even the patient’s death is the deterioration of the disease.Result:In the intraoperative neuronavigation group,37 cases of gliomas were completely removed,and the total resection rate was 88.1%;In the routine group,31 cases of gliomas were completely removed,and the total resection rate was 70%.The difference between the two groups was statistically significant（P < 0.05）.In the intraoperative neuronavigation group,36 cases had a good prognosis and 6 cases had deterioration.The good prognosis rate was 85.7%;In the conventional craniotomy group,there were28 cases with good prognosis and 16 cases with deterioration.The good prognosis rate was 63.6%.The difference between the two groups was statistically significant（P <0.05）.Conclusion:1.Intraoperative neuronavigation system assisted resection of gliomas can improve the total resection rate and significantly improve the prognosis of patients.2.Intraoperative neuronavigation can reduce surgical trauma and postoperative complications.