Key Factors for Neuronavigation Use in Skull Lesion Surgery

To identify the determining factors for the use of neuronavigation in the surgical treatment of skull lesions, with the goal of establishing a standardized framework for its application in clinical practice.

A retrospective analysis was conducted on 238 consecutive cases of skull lesions treated at Sir Run Run Shaw Hospital, affiliated with Zhejiang University School of Medicine, from 2017 to 2023. Clinical data, including patient demographics, comorbidities, lesion characteristics (such as size, location, proximity to major vessels, palpable status, and skull layer involvement), and surgical parameters, were collected. First, the correlation coefficients of these variables were calculated to perform an initial screening. Then, the selected variables were incorporated into a Lasso regression model. The optimal regularization parameter (λ) was determined through 10-fold cross-validation to further refine variable selection and calculate the weights of each feature.

By correlation coefficient analysis, the 4 factors If_cranioplasty, If_gen_anesthesia, Max_diameter, and If_invade_meninges were excluded. The optimal penalty coefficient (λ) for the model was determined to be 0.029 through cross-validation. The selected variables, ranked according to their weights, are If_vessels, Max_diam_level, If_palpable, Skull_layer, Bone_location, and Gender.

The factors that influence the decision to use neuronavigation-assisted surgery for skull lesions include whether the lesion invades or is adjacent to major blood vessels, maximum diameter, palpability, skull layer, bone location, and gender. Based on the identified factors, we can develop standardized guidelines for neuronavigation-assisted surgery in patients with skull lesions.