Clinical value of neuronavigation combined with a fluorescent staining technique during microsurgery for treating supratentorial glioma: A case-control observational study

Background and Aim: Many studies have demonstrated the value of neuronavigation guided by fluorescence staining for treating glioma patients. Here, we compared the rate of overall survival (OS) and the extent of tumor resection among patients who underwent surgery with neuronavigation and fluorescence versus conventional techniques. Materials and Methods: In this case-control observational study, data from 162 patients with supratentorial glioma who underwent surgery from January 2016 to November 2017 were retrospectively analyzed, including a neuronavigation and fluorescence treatment group (combined group, n = 53) and a conventional microsurgery group (control group, n = 109). The extent of tumor resection, World Health Organization (WHO) pathological grade, eloquent areas involved, tumor diameter, preoperative Karnofsky Performance Status score, underlying diseases, chemotherapy, hospitalization days, length of operation, intraoperative blood loss, and postoperative molecular pathological indictors were recorded. OS rates were compared using the Cox proportional hazards regression model. The study was approved by the Ethics Committee of Zhongnan Hospital of Wuhan University (approval No. 2019048). Results: The total resection rate was 60.4% in the combined group and 27.5% in the control group. Multivariate logistic regression analysis revealed that involvement of eloquent areas (odds ratio [OR] = 0.455, 95% confidence interval [CI]: 0.214–0.966, P = 0.040) and the use of the combined technique (OR = 3.634, 95% CI: 1.758–7.510, P < 0.001) were independent prognostic factors affecting total glioma resection. Eloquent areas were implicated in 79 patients. Multiple logistic regression analysis revealed that the combined technique (OR = 6.041, 95% CI: 1.705–21.403, P = 0.005) was an independent prognostic factor affecting total resection. The average follow-up period was 16.4 months. Cox regression analysis revealed that the WHO tumor grade (hazard ratio [HR] = 4.782, 95% CI: 1.620-14.119, P = 0.005), chemotherapy regimen (HR = 0.324, 95% CI: 0.181–0.579, P < 0.001), IDH mutation (HR = 0.366, 95% CI: 0.154–0.870, P = 0.023), and total resection (HR = 0.458, 95% CI: 0.248–0.846, P = 0.013) were independent factors affecting the prognosis of glioma patients. Conclusions: The use of neuronavigation with fluorescent staining appears to improve the tumor resection range and the OS rate, which is an independent factor affecting the degree of resection of supratentorial glioma. The WHO tumor grade, chemotherapy regimen, IDH mutation, and total resection were independent factors affecting the prognosis of glioma patients.