Supplementing the Neurosurgical Virtuoso: Evolution of Automation from Mythology to Operating Room Adjunct

Clinical study on the influence of motion and other factors on stereotactic radiotherapy in the treatment of adrenal gland tumor

Background

The aim of this study was to investigate the adrenal tumor motion law and influence factors in the treatment of adrenal gland tumor and provide a reference value basis for determining the planning target volume margins for therapy.

Materials and methods

The subjects considered in this study were 38 adrenal tumor patients treated with CyberKnife with the placement of 45 gold fiducials. Fiducials were implanted into each adrenal tumor using β-ultrasonic guidance. Motion amplitudes of gold fiducials were measured with a Philips SLS simulator and motion data in the left–right, anterior–posterior, and cranio–caudal directions were obtained. Multiple linear regression models were used to analyze influencing factors. t-Test was used for motion amplitude comparison of different tumor locations along the z-axis.

Results

The motion distances were 0.1–0.4 cm (0.27±0.07 cm), 0.1–0.5 cm (0.31±0.11 cm), and 0.5–1.2 cm (0.87±0.21 cm) along the x-, y-, and z-axes, respectively. Motion amplitude along the z-axis may be affected by tumor location, but movement along the other axes was not affected by age, height, body mass, location, and size.

Conclusion

The maximum motion distance was along the z-axis. Therefore, this should be the main consideration when defining the planning target volume safety margin. Due to the proximity of the liver, adrenal gland tumor motion amplitude was smaller on the right than the left. This study analyzed adrenal tumor motion amplitude data to evaluate how motion and other factors influence the treatment of adrenal tumor with a goal of providing a reference for stereotactic radiotherapy boundary determination.

Outpatient neurosurgery

Technological advances in neurosurgery, aided by improvements in anesthesia have resulted in surgery that is faster, simpler and safer with excellent perioperative recovery. As a result of improved outcomes, several centers are performing certain neurosurgical procedures on an outpatient basis; where patients arrive at the hospital the morning of their procedure and leave the hospital the same evening, thus avoiding an overnight stay in the hospital. Apart from the medical benefits of the outpatient procedure, its impact on patient satisfaction is substantial. The economic benefits are extremely favorable for the patient, physician, as well as the hospital. However, due to skepticism surrounding medico-legal aspects, and how radical the concept at first sounds, these procedures have not gained widespread popularity. We provide an overview of outpatient neurosurgery discussing results, outcomes related to patients' quality of life, and impact on the economic burden on currently burgeoning health care costs.