Supratentorial High-Grade Gliomas: Maximal Safe Anatomical Resection guided by Augmented Reality High-Definition Fiber Tractography and Fluorescein

Objective: The theoretical advantages of augmented reality (AR) with diffusion tensor imaging (DTI) based high-definition fiber tractography (HDFT) and sodium fluorescein (F) in high-grade glioma (HGG) surgery have not been investigated in detail. The present study aimed to evaluate the safety and efficacy profiles of HDFT-F microscope-based AR cytoreductive surgery for newly diagnosed supratentorial HGGs. Methods: The overall data of patients with newly diagnosed supratentorial HGGs that were operated using the AR HDFT-F technique were reviewed and compared with that of a cohort of patients who underwent conventional white-light surgery assisted by infrared neuronavigation. The safety and efficacy of the techniques were reported based on the postoperative Neurologic Assessment in Neuro-Oncology (NANO) scores, the extent of resection (EOR), and the Kaplan-Meier curves, respectively. A chi-squared test was conducted for categorical variables. A p-value < 0.05 was considered statistically significant. Results: A total of 54 patients were operated using the AR HDFT-F technique, and 63 underwent conventional white-light surgery assisted by infrared neuronavigation. The average postoperative NANO scores were 3.8 ± 2 and 5.2 ± 4 in the AR HDFT-F and control group, respectively (p < 0.05). The EOR was higher in the AR HDFT-F group (p < 0.05) than in the control group. On an average follow-up of 12.2 months, the rate of progression-free survival (PFS) was longer in the study group (log-rank p = 0.006) than in the control group. Moreover, the complication rates were 9.2% and 9.5% in the study and control groups, respectively. Conclusions: Overall, AR HDFT-F assisted surgery is safe and effective in maximizing the EOR and PFS rate of newly diagnosed supratentorial HGGs as well as in optimizing the patient's functional outcomes.