Effectiveness of neuronavigation in resecting solitary intracerebral contrast-enhancing tumors: a randomized controlled trial

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Object

The goal of this study was to assess the impact of neuronavigation on the cytoreductive treatment of solitary contrast-enhancing intracerebral tumors and outcomes of this treatment in cases in which neuronavigation was preoperatively judged to be redundant.

Methods

The authors conducted a prospective randomized study in which 45 patients, each harboring a solitary contrast-enhancing intracerebral tumor, were randomized for surgery with or without neuronavigation. Peri- and postoperative parameters under investigation included the following: duration of the procedure; surgeon’s estimate of the usefulness of neuronavigation; quantification of the extent of resection, determined using magnetic resonance imaging; and the postoperative course, as evaluated by neurological examinations, the patient’s quality-of-life self-assessment, application of the Barthel index and the Karnofsky Performance Scale score, and the patient’s time of death.

The mean amount of residual tumor tissue was 28.9% for standard surgery (SS) and 13.8% for surgery involving neuronavigation (SN). The corresponding mean amounts of residual contrast-enhancing tumor tissue were 29.2 and 24.4%, respectively. These differences were not significant. Gross-total removal (GTR) was achieved in five patients who underwent SS and in three who underwent SN. Median survival was significantly shorter in the SN group (5.6 months compared with 9 months, unadjusted hazard ratio = 1.6); however, this difference may be attributable to the coincidental early death of three patients in the SN group. No discernible important effect on the patients’ 3-month postoperative course was identified.

Conclusions

There is no rationale for the routine use of neuronavigation to improve the extent of tumor resection and prognosis in patients harboring a solitary enhancing intracerebral lesion when neuronavigation is not already deemed advantageous because of the size or location of the lesion.

Abbreviations used in this paper: ACC = Anderson Cancer Center; BI = Barthel index; GBM = glioblastoma multiforme; GTR = gross-total removal; HR = hazards ratio; KPS = Karnofsky Performance Scale; MR = magnetic resonance; QOL = quality of life; SD = standard deviation; SN = surgery involving neuronavigation; SS = standard surgery.
Article Information

Contributor Notes

Address reprint requests to: Peter W. A. Willems, M.D., Heidel-berglaan 10, 3584 CX Utrecht, The Netherlands. email: p.willems@neuro.azu.nl.Dr. Willems is financially supported by the Schumacher-Kramer and Vanderes Foundations, both located in The Netherlands.DisclaimerNone of the authors has any personal or institutional financial interest in the devices described in this manuscript.
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