Preliminary evaluation of a neuronavigation-integrated suction device for intracranial infiltrative high-grade glioma resection: A propensity score-matched analysis

Abstract

Objective: Navigated suction devices may enhance intraoperative efficiency and maximize safe resection of infiltrative gliomas by providing real-time anatomical guidance. However, their use and safety in high-grade glioma (HGG) surgery is unreported. We evaluated the safety and feasibility of a neuronavigation-integrated suction (NIS) device compared to conventional neuronavigation in patients undergoing resection for HGGs.

Methods: We utilized an NIS device in 33 HGG (WHO grade III/IV) resections. We retrospectively collected data on 174 HGG resections using standard neuronavigation during the same period, then performed propensity score matching (age, sex, prior treatment, tumor grade, tumor location, IDH status) to create 33 matched pairs (NIS vs. control, n = 66). Outcomes included extent of resection, operative time, estimated blood loss (EBL), complications, and length of stay (LOS).

Results: Baseline characteristics, including age (P = 0.299), sex (P = 0.319), tumor laterality (P = 0.196), anatomic location (P = 0.861), eloquent area (P = 0.769), tumor grade (P = 1.000), IDH mutation status (P = 0.415), prior resection (P = 0.602), and prior radiation therapy (P = 0.071), were comparable between groups. The NIS group had shorter operative times (193.7 ± 52.0 vs. 230.5 ± 69.2 min, P = 0.009). Intended GTR was more common with NIS (95 % vs. 65.2 %, P = 0.017). LOS was shorter in the NIS group (median 2.0 [1.75, 2.25] vs. 2.0 [1.5, 13.0] days, P = 0.030) with fewer postoperative complications (6.1 % vs. 30.3 %, P = 0.011). EBL (P = 0.418) and intraoperative complications (P = 0.314) were similar. Recurrence (57.6 %) and six-month mortality (21.2 %) were similar; there was no significant difference in median overall survival (control: 362 [110.5, 498.8] vs. NIS: 428 [177.5, 536] days, P = 0.237).

Conclusion: The NIS device was feasible to use in high-grade glioma surgery, and its use did not appear to compromise resection quality, complication rates, or oncologic outcomes. As neuronavigation and real-time intraoperative technologies advance, integrating such tools may further enhance surgical precision and patient outcomes for infiltrative gliomas. Future prospective, randomized studies should refine this technology and explore its broader impact on neurosurgical practice.

Keywords: Glioma; Gross total resection; Neuronavigation; Real-time; Suction device.