title: Utility of Neuronavigation in Intracranial Meningioma Resection: A Single-Center Retrospective Study.
abstract: OBJECTIVE
  In this study, we validate the utility of navigation in intracranial meningioma excision and evaluate the effectiveness of image guidance surgery based on clinical outcome, extent of resection, and recurrence-free survival (RFS).
  
  
  METHODS
  Information related to clinical history, use of neuronavigation, neuroimaging, microsurgical dissection, and outcomes of 517 consecutive cases with meningiomas between January 1995 and June 2015 was collected retrospectively. A Cox proportional hazards regression model was used to determine independent predictors of RFS.
  
  
  RESULTS
  In this study, overall recurrence rate after tumor excision with or without neuronavigation was 17.7% and 31.2%, respectively (P = 0.03). Based on neuronavigation use, RFS of the patients with meningiomas in different locations also varied significantly (skull base; with, 110 months vs. without, 157 months; P = 0.02). The median RFS for patients operated on with or without use of neuronavigation during resection of tumors was 167 and 97 months, respectively, (log-rank P =0.0001). In Cox regression multivariate analysis, use of neuronavigation (P = 0.0001), gross total resection (Simpson grade I-II; P = 0.001), and World Health Organization grade I tumor (P = 0.0001) were revealed as significant predictors of RFS. In addition, mean blood loss (P = 0.005) and average length of stay (P = 0.008) in the hospital were significantly reduced and performance status was improved using neuronavigation during resection of meningiomas.
  
  
  CONCLUSIONS
  Interactive surgical navigation is a useful tool in the operative management of intracranial meningiomas to decrease recurrence rate, blood loss, and length of stay, and to improve RFS and performance status. Therefore, use of neuronavigation should be ensured during resection of intracranial meningiomas.
authors.affiliation: Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, USA.
authors.forename: Shyamal C
authors.initials: SC
authors.lastname: Bir
authors.affiliation: Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, USA.
authors.forename: Subhas K
authors.initials: SK
authors.lastname: Konar
authors.affiliation: Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, USA.
authors.forename: Tanmoy K
authors.initials: TK
authors.lastname: Maiti
authors.affiliation: Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, USA.
authors.forename: Jai Deep
authors.initials: JD
authors.lastname: Thakur
authors.affiliation: Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, USA.
authors.forename: Bharat
authors.initials: B
authors.lastname: Guthikonda
authors.affiliation: Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, USA. Electronic address: ananda@lsuhsc.edu.
authors.forename: Anil
authors.initials: A
authors.lastname: Nanda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control*; D038361:Neuronavigation / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Meningiomas; Neuronavigation; Resection; Utility