SURG-66. Evaluation of a navigated suction for glioma resection: a propensity score matched analysis

Abstract BACKGROUND Maximal safe glioma resection can be difficult as tumors infiltrate normal brain. We evaluated the safety and effectiveness of using a neuronavigation-integrated suction device compared to conventional surgery with navigation. METHODS We developed a protocol using a navigated suction device and used it in 33 HGG (WHO grade III/IV) resections. Data were retrospectively collected on 174 HGG resections using standard neuronavigation during the same period. We 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), 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 minutes, P=0.009). Intended gross total resection (GTR) was more common with use of the navigated suction (95% vs. 65.2%, P=0.017). LOS was shorter in the that 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 (362 [110.5, 498.8] vs. 428 [177.5, 536] days, P = 0.237). CONCLUSION In this small study, the navigated suction device improved operative efficiency, facilitated extent of resection, and reduced complications and hospital stay. As neuronavigation and real-time intraoperative technologies advance, integrating such tools may improve extent of resection and patient outcomes for infiltrative gliomas. Future studies are warranted in pursuit of maximal safe resection for gliomas.