Handheld dual-modality wide-field fluorescent imaging guided dual-axis confocal microscope for fluorescence molecular guidance of precise tumor resection in head and neck surgery (Conference Presentation)

Molecular-Guided Surgery: Molecules, Devices, and Applications IV ◽

10.1117/12.2291986 ◽

2018 ◽

Author(s):

Zhen Qiu ◽

Tarn Teraphongphom ◽

Nynke S. van den Berg ◽

Nathan O. Loewke ◽

Guolan Lu ◽

...

Keyword(s):

Head And Neck ◽

Tumor Resection ◽

Neck Surgery ◽

Confocal Microscope ◽

Head And Neck Surgery ◽

Fluorescent Imaging ◽

Wide Field ◽

Dual Modality ◽

Molecular Guidance

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HEARING PRESERVATION AFTER INTRACANALICULAR VESTIBULAR SCHWANNOMA RADIOSURGERY

Neurosurgery ◽

10.1227/01.neu.0000335783.70079.85 ◽

2008 ◽

Vol 63 (6) ◽

pp. 1054-1063 ◽

Cited By ~ 60

Author(s):

Ajay Niranjan ◽

David Mathieu ◽

John C. Flickinger ◽

Douglas Kondziolka ◽

L. Dade Lunsford

Keyword(s):

American Academy ◽

Head And Neck ◽

Vestibular Schwannoma ◽

Tumor Resection ◽

Hearing Preservation ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Tumor Control ◽

Gamma Knife Stereotactic Radiosurgery

Abstract OBJECTIVE Tumor control, facial function preservation, and hearing preservation are important criteria for successful management of intracanalicular vestibular schwannomas, whether observation, microsurgery, or radiosurgery is chosen. We collected data prospectively to assess hearing preservation after intracanalicular vestibular schwannoma radiosurgery. METHODS Between 1987 and 2003, 96 patients (65 men and 31 women) underwent gamma knife stereotactic radiosurgery (SRS) for intracanalicular tumors. The median patient age was 54 years (range, 22–80 years). Hearing was graded using the Gardner-Robertson (GR) and the American Academy of Otolaryngology–Head and Neck Surgery classifications. Dose planning was performed on intraoperative stereotactic images using multiple 4-mm isocenters. The median tumor volume was 0.112 mm3 (range, 0.05–0.447 mm3), and the median margin dose was 13 Gy (range, 10–18 Gy). RESULTS The mean and median audiologic follow-up periods were 42 months and 28 months (range, 12–144 months), respectively. Serviceable hearing was preserved in 31 of 40 (77.5%) patients with initial American Academy of Otolaryngology–Head and Neck Surgery Class A hearing. Serviceable hearing was preserved in 40 of 79 (64.5%) patients with GR Grade I or II pre-SRS hearing. Ninety-two patients had GR Grade I, II, or III hearing before SRS, and GR Grade I, II, or III hearing was maintained in 78 patients (85%). Hearing grades improved in 7 patients. Facial and trigeminal nerve function was preserved in all patients. The tumor control rate (freedom from additional intervention) was 99.0% (95 of 96) at a median follow-up of 28 months (range, 12–144 months). One patient underwent tumor resection 18 months after radiosurgery. CONCLUSION SRS is a minimally invasive first-line management option for patients with intracanalicular tumors and provides high rates of hearing preservation with minimal morbidity.

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