Application of neuronavigation combined with yellow fluorescence staining in the resection of supratentorial glioma

Objective To explore the application of neuronavigation combined with yellow fluorescence staining in the operation of glioma. Methods A retrospective study was conducted on the clinical data of 172 patients with supratentorial glioma who underwent surgical treatment at Department of Neurosurgery, Zhongnan Hospital of Wuhan University from January 2016 to March 2018. Among them, 55 cases were treated with neuronavigation combined with yellow fluorescence staining (navigation + fluorescence group) and 117 cases with conventional surgical techniques (control group). There were 81 patients with tumors involving the eloquent area, and neuroelectrophysiological monitoring and/or intraoperative awake anesthesia were applied in all those patients. Total resection rate was compared between the 2 groups to analyze the factors influencing the total resection rate. Results Total resection was performed in 58 patients confirmed by postoperative imaging. The total resection rate was 45.5%(25/55) in group of neuronavigation + fluorescence and 28.2%(33/117) in the control group. There was statistically significant difference between the 2 groups(P=0.026). Multiple logistic regression analysis revealed that involvement of eloquent area (OR=0.502, 95% CI: 0.253-0.998, P=0.049) and the technique of neuronavigation plus fluorescence (OR=2.173, 95% CI: 1.080-4.371, P=0.030) were independent prognostic factors of the total resection for glioma. Among the 81 patients involving the eloquent area, total resection was achieved in 21 patients(25.9%), of whom 13(61.9%) were treated with fluorescence combined with neuronavigation. Incomplete resection was achieved in 60 patients, of whom 16(26.7%) were treated with fluorescence combined with neuronavigation. There was statistically significant difference between the 2 groups (P=0.004). Multiple logistic regression analysis revealed that the technique of neuronavigation combined with fluorescence (OR=3.896, 95% CI: 1.331-11.405, P=0.013) were independent prognostic factors of total resection. Conclusion Neuronavigation combined with yellow fluorescence staining can be helpful in the total resection of glioma . Key words: Glioma; Neuronavigation; Fluorescence staining; Neurosurgical procedures; Extent of resection