Contribution of Virtual Reality to Surgical Decision-Making for Evaluating Vascular Contraindications in Malignant Head and Neck Tumors

Introduction Virtual reality (VR) is increasingly used in medicine for preoperative planning. This study evaluated the role of 3D-VR reconstruction in assessing contraindications and surgical failure risks in head and neck cancers (HNC) with peri-carotid involvement. Methods In this retrospective, single-center study (2004-2024), adult patients with cervical metastases from HNC involving the peri-carotid region were included. Assessments used contrast-enhanced cervico-thoracic CT scans reviewed in 2D and analyzed with 3D-VR, focusing on lesion location, vascular encasement, and multifocal/bilateral features. The primary endpoint was to identify predictive factors of surgical contraindication or failure; the secondary endpoint examined VR’s impact on resectability through surgeon questionnaires and multidisciplinary tumor board (MTB) decisions. Results Twenty-seven patients were included; 20 had 3D-VR analysis. Mean age was 66 years, with hypopharyngeal (41%) and oropharyngeal (38%) sites predominating. Sixteen patients underwent surgery. No anatomical factor in 2D or 3D significantly predicted failure or contraindication. Preservation of a fat plane in 3D showed a trend toward lower surgical failure (OR = 0.5, P = 0.12). From 111 surgeon questionnaires, 86% of decisions remained unchanged between 2D and 3D, with 15 changes (9 toward indication, 6 toward contraindication). In MTB, 1 of 20 decisions (5%) was modified after 3D review. Conclusion No anatomical factor predicted outcomes, but fat plane preservation is a potentially valuable and easily seen 3D sign. VR influenced some individual decisions but had minimal impact on collective MDT decisions. It primarily functions as an interactive educational tool supplementing traditional imaging in complex surgical planning.