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

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

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Objective: To retrospectively compare ideal radiosurgical target volumes defined by a manual method (surgeon) to those determined by Adaptive Hybrid Surgery (AHS) operative planning software in 7 patients with vestibular schwannoma (VS). Methods: Four attending surgeons (3 neurosurgeons and 1 ear, nose, and throat surgeon) manually contoured planned residual tumors volumes for 7 consecutive patients with VS. Next, the AHS software determined the ideal radiosurgical target volumes based on a specified radiotherapy plan. Our primary measure was the difference between the average planned residual tumor volumes and the ideal radiosurgical target volumes defined by AHS (dRVAHS-planned). Results: We included 7 consecutive patients with VS in this study. The planned residual tumor volumes were smaller than the ideal radiosurgical target volumes defined by AHS (1.6 vs. 4.5 cm3, P = 0.004). On average, the actual post-operative residual tumor volumes were smaller than the ideal radiosurgical target volumes defined by AHS (2.2 cm3 vs. 4.5 cm3; P = 0.02). The average difference between the ideal radiosurgical target volume defined by AHS and the planned residual tumor volume (dRVAHS-planned) was 2.9 ± 1.7 cm3, and we observed a trend toward larger dRVAHS-planned in patients who lost serviceable facial nerve function compared with patients who maintained serviceable facial nerve function (4.7 cm3 vs. 1.9 cm3; P = 0.06). Conclusions: Planned subtotal resection of VS diverges from the ideal radiosurgical target defined by AHS, but whether that influences clinical outcomes is unclear.

Original languageEnglish (US)
Pages (from-to)e441-e446
JournalWorld Neurosurgery
Volume114
DOIs
StatePublished - Jun 2018
Externally publishedYes

Keywords

  • Neurosurgery
  • Radiosurgery
  • Software
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Sheppard, J. P., Lagman, C., Prashant, G. N., Alkhalid, Y., Nguyen, T., Duong, C., Udawatta, M., Gaonkar, B., Tenn, S. E., Bloch, O., & Yang, I. (2018). Planned Subtotal Resection of Vestibular Schwannoma Differs from the Ideal Radiosurgical Target Defined by Adaptive Hybrid Surgery. World Neurosurgery, 114, e441-e446. https://doi.org/10.1016/j.wneu.2018.03.005