Surgical resection of high-grade gliomas using modern techniques: intraoperative ultrasonography, neuronavigation, and 3D robotic microscopy

Over the last two decades, substantial progress has been achieved in basic tumour research. However, advances in the management of high-grade gliomas have remained limited compared with other oncological diseases. The improvement in clinical outcomes observed during this period has largely resulted from the integration of advanced surgical techniques, improved neuroimaging methods, and multimodal adjuvant therapies rather than from a fundamental change in tumour biology. The purpose of this study was to evaluate the impact of modern surgical techniques on the resection of high-grade gliomas. A retrospective analysis was performed on patients undergoing cranial surgery for brain tumours over 5 years (2020–2024). A total of 241 brain tumour operations were reviewed, including 99 glioma cases (19 low-grade gliomas and 80 high-grade gliomas). The present study included only patients with high-grade gliomas who underwent primary surgical resection using modern intraoperative techniques, including intraoperative ultrasonography, neuronavigation, and 3D robot-assisted surgical visualisation. Statistical analysis included Kaplan–Meier survival analysis and chi-square tests for categorical variables. Survival differences between groups were evaluated using the log-rank test. The evaluated outcome parameters included extent of tumour resection, postoperative new neurological deficit, overall survival, and time to tumour recurrence, defined as the tumour -free survival period. In the modern surgical era, the extent of resection was not significantly associated with the occurrence of permanent new neurological deficits (p = 0.09). The extent of resection was significantly associated with overall survival (p < 0.001).