Planned Subtotal Resection of Vestibular Schwannoma Differs from the Ideal Radiosurgical Target Defined by Adaptive Hybrid Surgery

Sheppard, John P.; Lagman, Carlito; Prashant, Giyarpuram N.; Alkhalid, Yasmine; Nguyen, Thien; Duong, Courtney; Udawatta, Methma; Gaonkar, Bilwaj; Tenn, Stephen; Bloch, Orin; Yang, Isaac

doi:10.1016/j.wneu.2018.03.005

“…Bartek et al investigated the AHSA software, with respect to dose plans with the Leksell Gamma Plan, and confirmed its usability in vestibular schwannoma [ 17 ]. Other authors have shown that the actual and planned postoperative residual tumor volumes were smaller than the ideal radiosurgical target volumes defined by AHSA [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Adaptive Hybrid Surgery Experiences in Benign Skull Base Tumors

Kienzler

¹

,

Fandiño

²

2022

Brain Sciences

0

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Background: The treatment of benign skull base tumors remains challenging. These tumors are often located in close relationship to critical structures. Therefore, radical resection of these tumors can be associated with high morbidity. Multimodal treatment concepts, including controlled partial tumor resection followed by radiosurgery, should be considered. Methods: Adaptive hybrid surgery analysis (AHSA) is an intraoperative tool that has been introduced for the automatic assessment of tumor properties, and virtual real-time radiosurgical treatment simulation and continuous feasibility analysis of adjuvant radiosurgery. The AHSA method (Brainlab®, Munich, Germany) was applied to five patients who underwent partial resection of a benign skull base tumor. Tumor volumetry was obtained on pre- and postoperative MR scans. Organs at risk were, preoperative, automatically delineated with atlas mapping software (Elements® Segmentation Cranial), and adaptations were made if necessary. Results: Five patients with benign skull base lesions underwent planned partial tumor resection in a multimodal therapeutic surgery followed by radiosurgery. The preoperative tumor volumes ranged between 8.52 and 25.2 cm3. The intraoperative residual tumor volume measured with the AHSA® software ranged between 2.13–12.17 cm3 (25–52% of the preoperative tumor volume). The intraoperative automatic AHSA plans of the remaining tumor volume suggested, in all five patients, that safe hypofractionated radiation was feasible. Patients were followed for 69.6 ± 1.04 months, and no complications occurred after the patients were treated with radiation. Conclusions: Intraoperative SRS planning based on volumetric assessments during resection of skull base tumors using AHSA® is feasible and safe. The AHSA method allows the neurosurgeon to continuously evaluate the feasibility of adjuvant radiosurgery while planning and performing a surgical resection. This method supports the treatment strategy of a complementary approach during surgical resection of complex skull base tumors and might contribute to preventing surgical and radiosurgical complications.

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“…Surgery has been the traditional modality of management for VS which may be utilized for upfront, recurrent or salvage settings [9][10][11]. Considering the unfavorable toxicity profile associated with complete surgical resection, utility of less extensive surgery with or without subsequent irradiation has been addressed in several trials [12][13][14][15][16][17]. Despite improvement in surgical techniques over the years, concerns remain regarding quality of life impairment in the postsurgical period for some patients with VS [18][19][20].…”

Section: Changes After Radio Surgical Management Of Vsmentioning

confidence: 99%

Untitled

2020

BJSTR

0

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“…Surgery has been the traditional modality of management for VS which may be utilized for upfront, recurrent or salvage settings [9][10][11]. Considering the unfavorable toxicity profile associated with complete surgical resection, utility of less extensive surgery with or without subsequent irradiation has been addressed in several trials [12][13][14][15][16][17]. Despite improvement in surgical techniques over the years, concerns remain regarding quality of life impairment in the postsurgical period for some patients with VS [18][19][20].…”

Section: Changes After Radio Surgical Management Of Vsmentioning

confidence: 99%