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

Objectives: In this study, the authors aimed to evaluate the safety and efficacy profiles of HDFT-F microscope- based AR cytoreductive surgery for newly diagnosed supratentorial HGGs. Background: 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. 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, 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-F 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-F group 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. 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-F–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.