Industry Leaders Present the Technical and Clinical Validation of Integrated Surgery and Radiosurgery for Benign Brain Tumors

Renowned neuro-oncology thought leaders gather for the latest Novalis Circle symposium held at the annual Congress of Neurological Surgeons (CNS) meeting to explore the complex biology, longevity and optimal treatment options for benign skull base tumor patients. Dovetailing with the annual meeting’s focus this year of ‘A Question of Balance,’ the Novalis Circle symposium includes cutting edge technology from Brainlab called Adaptive Hybrid Surgery¹, whereby clinicians can balance surgical risk and radiation toxicity in the treatment of benign skull base tumors.

Patients who are diagnosed with benign tumors generally have long life expectancies and usually seek intervention only when invasive tumor growth becomes symptomatic. While aggressive surgical interventions have long been the standard treatment, today more than half of all cranial benign growths are alleviated using less aggressive approaches, requiring an adjuvant treatment such as stereotactic radiation. However there is no general consent in determining when a resection is sufficient and when follow-up radiosurgery treatment is safe.

“We conducted a post-treatment review of seven patients with a diverse group of neurosurgeons,” explained Isaac Yang, MD, Neurological Surgeon, Ronald Reagan, UCLA Medical Center. “Each surgeon was asked to outline an ideal subtotal surgical resection. When compared side-by-side, the plans were all over the place which confirms the need for objective measures and data on what constitutes an ideal treatment resection for facial nerve preservation in acoustic neuromas.”

“The advent of Adaptive Hybrid Surgery helps us to both control a tumor and preserve function, helping minimize risks during the neurosurgery phase and helping sculpt the radiosurgical target,” presented Andrew Parsa, MD, PhD, Chief of the Department of Neurological Surgery, Northwestern University Medical Center, and Professor of Neurological Surgery and Neurology at Northwestern University Feinberg School of Medicine, Chicago, Illinois. “We can now achieve the desired tumor control while meeting patient demand for preservation of function.”

Adaptive Hybrid Surgery by Brainlab offers an objective measurement for multi-modal treatment of benign skull base tumors, helping clinicians decide between surgical risks and radiosurgical toxicity when determining the extent of resection. Adaptive Hybrid Surgery provides automatic simulation of follow-up radiation plans, allowing clinicians to optimize residuals to fulfill both surgical and radiosurgical constraints. Information such as tumor coverage and critical dose constraints is intuitively visualized and can be assessed at any time throughout surgery.

“Our first clinical experience with the product underlines the value of Adaptive Hybrid Surgery for multidisciplinary treatments,” said Orin Bloch, MD, Khatib Professor of Neurological Surgery at Northwestern University Feinberg School of Medicine. “During the surgical intervention, the software allows for continuous update of the extent of resection, and, in real time simulate the feasibility of adjuvant radiosurgery. With access to this information, we are able to identify an ideal intersection between surgery and radiosurgery, which in turn may allow us to significantly reduce surgical times.”

Prof. Jörg-Christian Tonn, MD, Chief Neurosurgeon, Klinikum der Universität München, LMU, presented patient data demonstrating how the Adaptive Hybrid Surgery software allows clinicians to update a residual tumor volume in real time without the necessity of intraoperative imaging. The data coming out of the first treatments at LMU demonstrated promising results with respect to acquiring intraoperative information about tumor shape and size. He concluded that the new software offers clinicians a good understanding of possible treatment options throughout surgery. 

Presenting during the symposium, Igor Barani, MD, Radiation Oncologist, University of California San Francisco concluded “AHS truly integrates surgery and radiosurgery which may help with achieving desired local control outcomes, compared to either modality employed individually, and may offer superior functional overall outcomes for the patient.”

For more information, visit www.brainlab.com/adaptivehybridsurgery.

¹FDA clearance pending; not available for sale or purchase in the US