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Adaptive Hybrid Surgery: Paradigm Shift for Patient-centered Neurosurgery.

Or Cohen-Inbar1,2, Gil E Sviri1

  • 1Department of Neurological Surgery, Rambam Maimonides Health Care Campus, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

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|August 9, 2018
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Summary
This summary is machine-generated.

Adaptive hybrid surgery (AHS), combining subtotal resection with stereotactic radiosurgery, offers a promising multimodal approach for large brain and skull base tumors. This strategy aims to reduce surgical morbidity while maintaining tumor control, addressing challenges of traditional maximal resection or radiosurgery alone.

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Area of Science:

  • Neurosurgery
  • Radiation Oncology
  • Oncology

Background:

  • Surgical management of cerebral and skull base lesions has advanced, but complete resection of tumors near critical neurovascular structures remains challenging due to high morbidity.
  • Stereotactic radiosurgery (SRS) is effective for moderate-sized tumors, offering excellent control and low complication rates.
  • Large cerebral and skull base tumors pose a significant management challenge, with radical surgery risking neurological deficits and SRS alone increasing radiation-induced complications.

Purpose of the Study:

  • To review and discuss adaptive hybrid surgery (AHS) as a modern, multidisciplinary treatment approach for large cerebral and skull base tumors.
  • To evaluate the safety and efficacy of combining planned subtotal resection (STR) with adjuvant SRS.
  • To explore the paradigm shift from maximal resection towards a multimodal strategy balancing surgical and radiation benefits.

Main Methods:

  • Review of available data and expert views on AHS.
  • Discussion of AHS as a multimodal approach combining open microsurgery and SRS.
  • Case examples, including vestibular schwannoma (VS), to illustrate AHS principles and outcomes.

Main Results:

  • AHS, involving planned STR followed by adjuvant SRS, is gaining interest as a way to decrease surgical morbidity while achieving tumor control.
  • This hybrid approach aims to leverage the advantages of both surgical resection and radiosurgery.
  • Successful application of AHS requires a thorough understanding of both surgical and SRS modalities and their safety-efficacy profiles.

Conclusions:

  • Adaptive hybrid surgery represents a viable, multidisciplinary strategy for managing large cerebral and skull base tumors, offering a balance between maximal tumor removal and minimizing treatment-related complications.
  • While intuitive, the adoption of AHS requires a shift in traditional surgical philosophy.
  • Further data and discussion are needed to solidify AHS as a standard treatment option, with vestibular schwannoma serving as a key example.