Intraoperative Augmented Reality High-Definition Fiber Tractography for High-Grade Gliomas of The Primary Motor Area

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 The present study aimed to evaluate the safety and efficacy profiles of HDFT-F microscope-based AR cytoreductive surgery for newly diagnosed HGGs involving the primary motor area. Methods A consecutive institutional series of patients with newly diagnosed HGGs of the central lobe that were operated on using the AR HDFT 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 technique 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 11 patients were operated on using the AR HDFT-F technique, and 9 underwent conventional white-light surgery. The average postoperative NANO scores were 5.4 ± 2 and 5.7 ± 3 in the AR HDFT-F and control group, respectively. The EOR was higher in the AR HDFT group than in the control group. On an average follow-up of 10.9 months, the rate of progression-free survival (PFS) was longer in the study group than in the control group (log-rank p = 0.045). Conclusions AR HDFT assisted surgery is safe and effective in maximizing the EOR and PFS rate, as well as in optimizing the patient’s functional outcomes, of newly diagnosed HGGs of the primary motor area.