{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:37:51Z","timestamp":1792132671108,"version":"4.4.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T00:00:00Z","timestamp":1682985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>NeuroNavigation (NN) is a widely used intraoperative imaging guidance technique in neurosurgical operations; however, its value in brainstem glioma (BSG) surgery is inadequately reported and lacks objective proof. This study aims to investigate the applicational value of NN in BSG surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A retrospective analysis was performed on 155 patients with brainstem gliomas who received craniotomy from May 2019 to January 2022 at Beijing Tiantan Hospital. Eighty-four (54.2%) patients received surgery with NN. Preoperative and postoperative cranial nerve dysfunctions, muscle strength, and Karnofsky (KPS) were evaluated. Patients\u2019 radiological features, tumor volume, and extent of resection (EOR) were obtained from conventional MRI data. Patients\u2019 follow-up data were also collected. Comparative analyses on these variables were made between the NN group and the non-NN group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Result<\/jats:title><jats:p>The usage of NN is independently related to a higher EOR in diffuse intrinsic pontine glioma (DIPG) (p=0.005) and non-DIPG group (p&amp;lt;0.001). It was observed that fewer patients in the NN group suffered from deterioration of KPS (p=0.032) and cranial nerve function (p=0.017) in non-DIPG group, and deterioration of muscle strength (p=0.040) and cranial nerve function (p=0.038) in DIPG group. Moreover, the usage of NN is an independent protective factor for the deterioration of KPS (p=0.04) and cranial nerve function (p=0.026) in non-DIPG patients and the deterioration of muscle strength (p=0.009) in DIPG patients. Furthermore, higher EOR subgroups were found to be independently related to better prognoses in DIPG patients (p=0.008).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>NN has significant value in BSG surgery. With the assistance of NN, BSG surgery achieved higher EOR without deteriorating patients\u2019 functions. In addition, DIPG patients may benefit from the appropriate increase of EOR.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2023.1159230","type":"journal-article","created":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T05:12:05Z","timestamp":1683004325000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Role of neuronavigation in the surgical management of brainstem gliomas"],"prefix":"10.3389","volume":"13","author":[{"given":"Mingxin","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiong","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guocan","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhao","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changcun","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junting","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liwei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,5,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/90.17.1269","article-title":"Trends in reported incidence of primary malignant brain tumors in children in the united states","volume":"90","author":"Smith","year":"1998","journal-title":"J Natl Cancer Inst"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/124.12.2528","article-title":"Brainstem gliomas in adults: prognostic factors and classification","volume":"124","author":"Guillamo","year":"2001","journal-title":"Brain"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-003-0870-6","article-title":"Brainstem gliomas","volume":"20","author":"Jallo","year":"2004","journal-title":"Childs Nerv Syst"},{"key":"B4","doi-asserted-by":"publisher","first-page":"3077","DOI":"10.1038\/s41467-020-16682-y","article-title":"The integrated genomic nd epigenomic landscape of brainstem glioma","volume":"11","author":"Chen","year":"2020","journal-title":"Nat Commun"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(06)70615-5","article-title":"Diffuse brainstem glioma in children: Critical review of clinical trials","volume":"7","author":"Hargrave","year":"2006","journal-title":"Lancet Oncol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.ctrv.2011.06.007","article-title":"Diffuse intrinsic pontine gliomas: A systematic update on clinical trials and biology","volume":"38","author":"Jansen","year":"2012","journal-title":"Cancer Treat Rev"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/ajco.12451","article-title":"Radiotherapy for brainstem gliomas in children and adults: a single-institution experience and literature review","volume":"13","author":"Yoshida","year":"2017","journal-title":"Asia Pac J Clin Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000001897","article-title":"Diffuse midline gliomas with histone H3 K27M mutation in adults and children: a retrospective series of 164 cases","volume":"46","author":"Zheng","year":"2022","journal-title":"Am J Surg Pathol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.692097","article-title":"Epidemiology and survival of patients with brainstem gliomas: A population-based study using the SEER database","volume":"11","author":"Liu","year":"2021","journal-title":"Front Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.566972","article-title":"The survival benefits of surgical resection and adjuvant therapy for patients with brainstem glioma","volume":"11","author":"Liu","year":"2021","journal-title":"Front Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-016-2131-z","article-title":"Brainstem gangliogliomas: Prognostic factors, surgical indications and functional outcomes","volume":"128","author":"Pan","year":"2016","journal-title":"J Neurooncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1660847","article-title":"Fluorescein-guided surgery for pediatric brainstem gliomas: Preliminary study and technical notes","volume":"79","author":"Xue","year":"2018","journal-title":"J Neurol Surg B Skull Base"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000022029","article-title":"Surgical treatment and prognosis of focal brainstem gliomas in children: A 7 year single center experience","volume":"99","author":"Sun","year":"2020","journal-title":"Med (Baltimore)"},{"key":"B14","doi-asserted-by":"publisher","first-page":"E10","DOI":"10.3171\/2020.10.FOCUS20166","article-title":"The role of diffusion tensor imaging and tractography in the surgical management of brainstem gliomas","volume":"50","author":"Xiao","year":"2021","journal-title":"Neurosurg Focus"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.747072","article-title":"Combined application of sodium fluorescein and neuronavigation techniques in the resection of brain gliomas","volume":"12","author":"Xue","year":"2021","journal-title":"Front Neurol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-008-0647-z","article-title":"Radical resection of focal brainstem gliomas: is it worth doing","volume":"24","author":"Teo","year":"2008","journal-title":"Childs Nerv Syst"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3171\/2012.11.PEDS12317","article-title":"Management and outcome of focal low-grade brainstem tumors in pediatric patients: The st. Jude experience","volume":"11","author":"Klimo","year":"2013","journal-title":"J Neurosurg Pediatr"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3109\/02688697.2013.829562","article-title":"Brainstem gliomas: surgical indications and technical considerations in a series of 58 cases","volume":"28","author":"Sinha","year":"2014","journal-title":"Br J Neurosurg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2017.3.JNS162383","article-title":"Threshold of the extent of resection for WHO grade III gliomas: Retrospective volumetric analysis of 122 cases using intraoperative MRI","volume":"129","author":"Fujii","year":"2018","journal-title":"J Neurosurg"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-021-03901-9","article-title":"Intraoperative 5-ALA fluorescence-guided resection of high-grade glioma leads to greater extent of resection with better outcomes: a systematic review","volume":"156","author":"Eatz","year":"2022","journal-title":"J Neurooncol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1998.88.4.0656","article-title":"\"Postimaging brain distortion: Magnitude, correlates, and impact on neuronavigation.\"","volume":"88","author":"Dorward","year":"1998","journal-title":"J Neurosurg"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.media.2004.02.001","article-title":"Strategies for brain shift evaluation","volume":"8","author":"Hastreiter","year":"2004","journal-title":"Med Image Anal"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.media.2016.08.007","article-title":"Brain shift in neuronavigation of brain tumors: A review","volume":"35","author":"Gerard","year":"2017","journal-title":"Med Image Anal"},{"key":"B24","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/s1130-1473(04)70502-3","article-title":"[Brainstem gliomas]","volume":"15","author":"Sousa","year":"2004","journal-title":"Neurocirugia (Astur)"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.mri.2012.05.001","article-title":"3D slicer as an image computing platform for the quantitative imaging network","volume":"30","author":"Fedorov","year":"2012","journal-title":"Magn Reson Imaging"},{"key":"B26","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1227\/01.neu.0000303189.80049.ab","article-title":"Clinical evaluation and follow-up outcome of diffusion tensor imaging-based functional neuronavigation: A prospective, controlled study in patients with gliomas involving pyramidal tracts","volume":"61","author":"Wu","year":"2007","journal-title":"Neurosurgery"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-014-0517-x","article-title":"The value of extent of resection of glioblastomas: Clinical evidence and current approach","volume":"15","author":"Almeida","year":"2015","journal-title":"Curr Neurol Neurosci Rep"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012788.pub2","article-title":"Intraoperative imaging technology to maximise extent of resection for glioma","volume":"1","author":"Jenkinson","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD013630.pub2","article-title":"Intraoperative imaging technology to maximise extent of resection for glioma: A network meta-analysis","volume":"1","author":"Fountain","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3171\/JNS-07\/09\/0488","article-title":"Accuracy of diffusion tensor magnetic resonance imaging tractography assessed using intraoperative subcortical stimulation mapping and magnetic source imaging","volume":"107","author":"Berman","year":"2007","journal-title":"J Neurosurg"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2007.106.4.593","article-title":"Clinical impact of integrated functional neuronavigation and subcortical electrical stimulation to preserve motor function during resection of brain tumors","volume":"106","author":"Mikuni","year":"2007","journal-title":"J Neurosurg"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3171\/2014.10.JNS141289","article-title":"Intraoperative subcortical motor evoked potential stimulation: How close is the corticospinal tract","volume":"123","author":"Shiban","year":"2015","journal-title":"J Neurosurg"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.04.189","article-title":"Neuronavigation-guided corticospinal tract mapping in brainstem tumor surgery: Better preservation of motor function","volume":"116","author":"Li","year":"2018","journal-title":"World Neurosurg"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2021.7.JNS21317","article-title":"Direct brainstem somatosensory evoked potentials for cavernous malformations","volume":"5","author":"Le","year":"2021","journal-title":"J Neurosurg"},{"key":"B35","doi-asserted-by":"publisher","first-page":"597","DOI":"10.3171\/jns.2003.99.3.0597","article-title":"Fluorescence-guided resection of glioblastoma multiforme by using high-dose fluorescein sodium. technical note","volume":"99","author":"Shinoda","year":"2003","journal-title":"J Neurosurg"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2001.95.2.0190","article-title":"A multivariate analysis of 416 patients with glioblastoma multiforme: Prognosis, extent of resection, and survival","volume":"95","author":"Lacroix","year":"2001","journal-title":"J Neurosurg"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1993.79.6.0845","article-title":"Surgical management of brain-stem tumors in children: Results and statistical analysis of 75 cases","volume":"79","author":"Pierre-Kahn","year":"1993","journal-title":"J Neurosurg"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2014.06.009","article-title":"The role of diffusion tensor imaging in brain tumor surgery: A review of the literature","volume":"124","author":"Potgieser","year":"2014","journal-title":"Clin Neurol Neurosurg"},{"key":"B39","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/S1042-3680(18)30566-7","article-title":"Surgical anatomy of the brain stem","volume":"4","author":"Lang","year":"1993","journal-title":"Neurosurg Clin N Am"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2023.1159230\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T05:12:10Z","timestamp":1683004330000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2023.1159230\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,2]]},"references-count":39,"alternative-id":["10.3389\/fonc.2023.1159230"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2023.1159230","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,2]]},"article-number":"1159230"}}