Supratentorial High-Grade Gliomas: Maximal Safe Anatomical Resection Guided by Intraoperative Augmented Reality High-Definition Fiber Tractography

Introduction The theoretical advantages of augmented reality (AR) with diffusion tensor imaging (DTI)–based high- definition fiber tractography (HDFT) in high-grade glioma (HGG) surgery have not been investigated in detail. Objectives In this study, the authors aimed to evaluate the safety and efficacy profiles of HDFT microscope-based AR cytoreductive surgery for newly diagnosed supratentorial HGGs. Methods Data of patients with newly diagnosed supratentorial HGGs who underwent surgery using the AR HDFT-F technique were reviewed and compared with those 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 Neurological Assessment in Neuro-Oncology (NANO) scores, the extent of resection (EOR), and Kaplan-Mei- er curves, respectively. The chi-square test was conducted for categorical variables. A p-value < 0.05 was considered statistically significant. Results A total of 54 patients underwent surgery using the AR HDFT technique, and 63 underwent conventional white-light surgery assisted by infrared neuronavigation. The mean postoperative NANO scores were 3.8 ± 2 and 5.2 ± 4 in the AR HDFT group and control group, respectively (p < 0.05). The EOR was higher in the AR HDFT group (p< 0.05) than in the control group. With a mean follow-up of 12.2 months, the rate of progression-free survival (PFS) was longer in the study group (log-rank test, 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–assisted surgery is safe and effective in maximizing the EOR and PFS rate for patients with newly diagnosed supratentorial HGGs, and in optimizing patient functional outcomes.