Adaptive Hybrid Surgery

RADIOSURGERY GUIDED SURGERY

Dedicated to multi-modality treatment of benign skull base tumors, Adaptive Hybrid Surgery helps to balance surgical risk with radiosurgical toxicity.

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Dedicated to multi-modality treatment of benign skull base tumors, Adaptive Hybrid Surgery helps to balance surgical risk with radiosurgical toxicity.
Large benign skull base tumor treatment challenges

INTEGRATED TREATMENT: SURGERY AND RADIOSURGERY

Aggressive surgical interventions aiming at gross total resection have long been the standard treatment for most benign brain tumors, despite associated complications including disabling morbidity. Today more than half of all cranial benign growths are alleviated surgically using less aggressive approaches, requiring an adjuvant treatment such as stereotactic radiation to maximize tumor control. However there is no general consent in determining when a resection is sufficient and when follow-up radiosurgery treatment is safe. Striving to achieve the maximum safe surgical resection without any guidance or consent may cause morbidity and irreversible neurological damage. Adaptive Hybrid Surgery Analysis automatically calculates and visualizes SRS/RT treatment plans, offering the ability to combine the benefits of surgery with the benefits of radiosurgery.

• On-the-fly feasibility analysis of adjuvant radiosurgery
• Complete treatment workflow from planning to intraoperative decision making
• Support of interdisciplinary collaboration
• Upfront integration of radiosurgery avoiding late referrals and potentially restricted treatment options

Determining the extent of subtotal resection considering radiation toxicity

OBJECTIVE CRITERIA FOR EXTENT OF SUBTOTAL RESECTION

Brainlab offers a complete set of automated tools that enable neurosurgeons to continuously evaluate the feasibility of complementary radiosurgery at any time, while planning and performing a surgical resection. Rather than relying on intuition, this helps establish the perfect crossing point between the two treatment techniques, balancing surgical risk and radiation toxicity when determining the extent of subtotal resection.

• Assistance in establishing the perfect crossing point between surgery and radiosurgery
• Holistic treatment decisions considering amount of risk to the patient
• New horizons opened up for preservation of function without compromising tumor control rates

Dose distribution visualization for planned tumor residual

SIMULATION AND OPTIMIZATION OF RESIDUAL FOR RADIOSURGERY

First, the surgeon defines what is expected to be reasonable residual based on available pre-operative images. Fully automated treatment plan calculation enables fast simulation and optimization of a tumor residual desired to fulfill both surgical and radiosurgical constraints. Therefore tumor board discussions can be enriched with meaningful information above and beyond the available pre-operative images.

• Automatic segmentation of critical structures
• Dose prescriptions and limits established by expert group
• Automatic calculation of single fraction SRS, hypo-fractionated SRS and conventionally fractioned SRT treatment plans
• Definition of a ‘planned cut’ object that can be exported to cranial navigation

Automated residual tumor calculation based on intraoperative control points

INTRAOPERATIVE UPDATE OF ADJUVANT RADIOSURGERY PLAN

An extension of the image guided feature set allows evaluation of all opportunities throughout surgery. Intraoperative, on-the-fly update of radiosurgery feasibility is possible when the system knows the residual tumors’ properties. Elements Intraoperative Structure Update¹ calculates a residual tumor object based on points acquired inside the resection cavity and automatically transfers such information to Adaptive Hybrid Surgery Analysis.

• Intraoperative point collection with standard navigation instruments
• Full integration with Brainlab cranial navigation software
• Automatic export of updated tumor information to Elements Adaptive Hybrid Surgery Analysis
• Control point exporting for post-surgical evaluation

Intuitive traffic light display visualizes on-the-fly analysis of adjuvant radiosurgery

COMPREHENSIVE VISUALIZATION OF CRITICAL DOSE CONSTRAINTS

Assess all required information instantaneously and simultaneously. An intuitive traffic light display provides comprehensive information about tumor coverage and critical dose constraints for all three calculated treatment plans. Quick plan assessment for non-radiation oncologists is facilitated, while additional information can be accessed for advanced plan assessment.

• Intuitive visualization for result interpretation by neurosurgeons
• Detailed dose information for optional radiation oncologists consulting
• Optimized for Curve™ Dual Display and Brainlab planning stations
• Visualization of complete strategy for treatment discussion with patient