| Objective:To evaluate the safety of intraoperative MRI(intraoperative MRI,i MRI)combined with neuronavigation-assisted techniques in glioma microsurgery and its effect on postoperative survival and prognosis.Methods:The neurosurgical tumor database of our institution from January 2019 to March2021 was retrieved,and the data of glioma patients who received intraoperative MRI combined with neuronavigation assistance or only neuronavigation assistance during the screening period were retrieved.Taking the intraoperative MRI combined with neuronavigation-assisted group as the research group and the neuronavigation-assisted group only as the control group,the perioperative conditions,surgical effect analysis,complications and postoperative oncological prognosis of the two groups were analyzed.Results:A total of 98 glioma patients with complete data and successful follow-up were included,including 43 cases in the intraoperative MRI combined with neuronavigation assistance group and 55 cases in the neuronavigation assistance group.There was no significant difference in general baseline data(age,gender,BMI,tumor size,growth site,WHO grade and preoperative KPS function score)between the two groups(P>0.05).Among them,there were 1 case of glioma WHO grade I,14 cases of grade II,12 cases of grade III,and 16 cases of grade IV in the intraoperative MRI combined with neuronavigation-assisted group;3 cases of glioma WHO grade I in the neuronavigation-assisted group only,20 cases of grade II,13 cases of grade III,and 19 cases of grade IV.Comparison of intraoperative surgical conditions between the two groups,the average operation time in the intraoperative MRI combined with neuronavigation-assisted group was about 40 minutes longer than that in the neuronavigation-assisted group,and there was a significant difference between the two groups(P=0.012),but there was no difference in the infection rate between the two groups.Significant difference(P=0.910).Intraoperative MRI combined with neuronavigation-assisted group and neuronavigation-assisted group had 32.56% and27.27% of surgery-related complications,respectively.There was no postoperative death during hospitalization in both groups,and the total postoperative complication rates of both groups were There was no significant difference between the comparisons(P=0.569).In the intraoperative MRI combined with neuronavigation group,38 cases(88.37%)had no change or improvement in KPS function score 3 months after operation,and 5 cases(11.63%)had aggravation;in the neuronavigation group,KPS function 3months after operation The scores remained unchanged or improved in 47 cases(85.45%)compared with those before operation,and were worsened in 8 cases(14.55%).There was no significant difference between the two groups(P=0.673).Compared with the high-grade gliomas in the two groups,there was no significant difference in the tumor recurrence rate at 6 months(P=0.129);in the high-grade gliomas,the intraoperative MRI combined with neuronavigation group had no significant difference in the tumor recurrence rate at 12 months.The recurrence rate was significantly lower than the neuronavigation group(P=0.023).Secondly,the progression-free survival obtained by the follow-up between the two groups was compared and plotted by the Log-Rank test,and the difference was significant(P=0.022).Conclusion:1.The application of intraoperative MRI combined with neuronavigation in glioma microsurgery is safe and feasible.Although it resulted in prolonged operation time,there was no significant increase in infection rate,intraoperative blood loss,and postoperative hospital stay.2.Intraoperative MRI combined with neuronavigation-assisted technology to achieve a wider range of safe resection of gliomas.It can effectively increase the total resection rate of glioma,reduce the residual tumor tissue,reduce the tumor recurrence rate,and prolong the progression-free survival period of patients.While the scope of tumor resection was further expanded,postoperative complications were not increased and postoperative neurological function was not affected,and brain function was preserved to a certain extent. |
