Efficacy analysis of neuronavigation combined with intraoperative neurophysiological monitoring for resection of brainstem gliomas in adults

Objective To investigate the application value of diffusion tensor imaging (DTI)-based neuronavigation combined with intraoperative neurophysiological monitoring in the adult brainstem glioma surgery. Methods The clinical data of 39 patients with brainstem glioma admitted to the Department of Neurosurgery, Xiangya Hospital, Central South University from December 2010 to December 2014 were analyzed retrospectively. Among them, 17 used Brainlab neuronavigation combined with intraoperative electrophysiological monitoring techniques (combined group), 22 used traditional imaging techniques and surgery (traditional group). The clinical efficacy of both groups were compared and analyzed. Results Compared with the traditional group, the total tumor removal rate of the combined group was improved significantly (94% [16/17] in the combined group vs. 59% [13/22] in the traditional group; P<0.05); the shortened operation time (282.05± 81.37 min in the combined group vs. 337.18± 75.45 min in the traditional group; P<0.05); and the decreased perioperative mortality rate (0% in the combined group vs. 27% in the traditional group, P<0.05). The postoperative Karnofsky performance status (KPS) scores increased significantly (92.35± 13.00 in the combined group vs. 54.54± 41.60 in the traditional group; P<0.05). The progression-free survival time prolonged obviously (20.17± 5.66 months in the combined group vs. 9.63± 4.16 months in the traditional group; P<0.05). Conclusions In the treatment of adult brainstem gliomas, neuronavigation combined with intraoperative neurophysiological monitoring can improve the degree of tumor resection, reduce surgical trauma, decrease the postoperative disability and mortality, significantly improve the quality of life after procedure, and prolong the survival time. Key words: Brain stem neoplasms; Neuronavigation; Diffusion tensor imaging; Neurophysiological monitoring