Kienzler Jenny Christine, Fandino Javier
Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland.
Department of Neurosurgery, Hirslanden Medical Center, 5001 Aarau, Switzerland.
Brain Sci. 2022 Sep 30;12(10):1326. doi: 10.3390/brainsci12101326.
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.
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.
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 cm. The intraoperative residual tumor volume measured with the AHSA software ranged between 2.13-12.17 cm (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.
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.
良性颅底肿瘤的治疗仍然具有挑战性。这些肿瘤通常与关键结构关系密切。因此，这些肿瘤的根治性切除可能会导致高发病率。应考虑多模式治疗方案，包括控制性部分肿瘤切除后行放射外科治疗。
自适应混合手术分析（AHSA）是一种术中工具，已被用于自动评估肿瘤特性、虚拟实时放射外科治疗模拟以及辅助放射外科的连续可行性分析。AHSA方法（德国慕尼黑Brainlab公司）应用于5例接受良性颅底肿瘤部分切除的患者。术前和术后磁共振成像扫描获得肿瘤体积。术前使用图谱映射软件（Elements Segmentation Cranial）自动勾勒出危及器官，并在必要时进行调整。
5例良性颅底病变患者在多模式治疗性手术中进行了计划性部分肿瘤切除，随后接受放射外科治疗。术前肿瘤体积在8.52至25.2立方厘米之间。使用AHSA软件测量的术中残余肿瘤体积在2.13 - 12.17立方厘米之间（占术前肿瘤体积的25% - 52%）。在所有5例患者中，术中对剩余肿瘤体积的自动AHSA计划表明，安全的低分割放疗是可行的。对患者进行了69.6±1.04个月的随访，患者接受放疗后未发生并发症。
在颅底肿瘤切除术中使用AHSA基于体积评估进行术中立体定向放射治疗计划是可行且安全的。AHSA方法使神经外科医生在规划和进行手术切除时能够持续评估辅助放射外科的可行性。该方法支持复杂颅底肿瘤手术切除时的互补性治疗策略，可能有助于预防手术和放射外科并发症。
