Adaptive Hybrid Surgery Analysis (AHSA) for adjuvant Gamma Knife radiosurgery treatment of Vestibular Schwannoma residuals

Abstract Objectives Adaptive Hybrid Surgery Analysis (AHSA, Brainlab, Munich, Germany) is a software application generating in real-time conceptual dose plans for tumor residuals but has so far not been assessed for usability in a Gamma Knife (Elekta, Stockholm, Sweden) radiosurgery practice. We aimed to compare AHSA stereotactic radiosurgery dose plans with Leksell Gamma Plan (LGP, Elekta, Stockholm, Sweden) plans for adjuvant radiosurgical treatment of Vestibular Schwannoma (VS) residuals. Patients and Methods In this retrospective comparative study, we compared the automatically calculated AHSA dose plans with clinical LGP treatment plans in 13 patients radiosurgically treated for VS residuals. We first created an LGP template based on our specific constraints to organs at risk (OAR), and a tumor prescription volume coverage of minimum 98%. As most proximal anatomy at risk is not manually contoured in our practice, OARs (i.e. brainstem, optic apparatus and cochlea) in the planning images were automatically segmented in Elements Anatomical Mapping and imported into the AHSA software for re-planning and comparison with the LGP dose plans. Results There was no significant difference in tumor coverage and conformity index between the LGP and AHSA dose planning data, with the mean and maximal dose to the brainstem slightly higher in the latter. Conclusion The AHSA dose plans for adjuvant radiosurgical treatment of VS residuals were comparable to those of LGP used in our Gamma Knife practice, confirming the usability of AHSA in for the management of Vestibular Schwannoma in a Gamma Knife practice.