Radiosurgery (radiation therapy, or irradiation) is a minimally invasive treatment of tumors, vascular malformations, and neuropathic pain.
Stereotactic radiosurgery is an alternative method of surgery, when instead of a scalpel our surgeons use ionizing radiation of high intensity from an external source, which is very precisely aimed at the target (tumor or abnormal tissue) located inside the body, skull or spine, with minimal risk to healthy tissue. The fluorescence intensity is so high that it can in a short time destroy the target.
Radiation therapy may be used as a primary treatment instead of surgery, or as an adjunctive therapy for traditional surgery. It is very effective in removing tumors located within the area, where open surgery is too risky or impossible.
In some cases, the effect of radiosurgery shows 90% success rate of treatment.
Radiosurgery is effective and safe in the following cases:
♦ Benign tumors.
♦ Metastatic process in the brain, spinal cord, inner organs, head and neck area.
♦ Arterial-venous malformation (AVM).
♦ One-way face severe pain (trigeminal neuralgia).
Stages of treatment:
1. Radiosurgery specialist conducts a preliminary assessment, considering the images CT or MRI examination of the patient, medical history, including all methods of treatment in the past, especially the patient condition, medicines sensitivity, and related diseases.
After a preliminary examination CT simulation (definition of fields for radiation exposure) should be carried out. The process takes 30-45 minutes.
This is a very important process, in which a multidisciplinary team of physicians and oncologists, neurosurgeons and medical nuclear physics is involved.
2. Radiation therapy. Treatment is carried out directly on the treatment table, under the influence of rays, with the fixation of the patient on the table. The treatment itself takes about an hour. The patient does not feel pain, but can hear a buzzing sound. After treatment, patients are followed up for more than two hours, and then can leave the clinic.
Radiotherapy procedure, in most cases, carried out daily, excluding weekends, at the same time, within 2-3 weeks.
Radiation therapy is best suited for the destruction of primary brain tumors (gliomas), and metastatic tumors, formed as a result of cancer processes in various organs including kidney cancer, colon cancer, skin cancer (melanoma), breast cancer and lung cancer, where this method is more efficient than conventional surgery, in some cases with a 90% success rate.
When the disease attacks the brain tissue metastases, they often are multilateral, thus, for technical reasons, the synchronous surgically resected in different brain areas is cumbersome and complicated as well as it can lead to significant functional disorders.
The classic technique for treating such a condition is the study of the brain tissue and determination of the brain areas that need to be exposed to high doses of radiation.
The new method RapidArc radiosurgery has revolutionized the treatment of these tumors, because it can handle a lot of metastatic lesions in the brain without damage to healthy tissue. Radiation leads to the elimination of tumor cells, whereby the natural mechanisms are activated immediately and lead to the gradual removal of malignant cells.
Malignant metastatic tumors disappear, usually within a few weeks.
Radiosurgery performance indicators are very high in the treatment of benign tumors – about 95% in the long term.
Radiotherapy is appropriate for the destruction of small tumors. Large tumors, due to their volume, have a significant pressure on the surrounding brain tissue and cause dysfunction. In this case, radiosurgery applied after a standard surgical operation such as addition and completion of resection. It is a specialized combination therapy surgical resection and radiosurgery for complex tumors.
Purpose is radio surgical treatment is to prevent further growth of benign tumors, and thus excluding the risk of deterioration of the function or life-threatening.
A benign tumor may remain the same size after treatment without affecting the patient’s ability to live a full life. However, in most patients the tumor is reduced gradually, over many years.
Patient should undergo regular imaging (MRI), usually once a year, so our experts monitor the changes in the tumor.
The most common types of benign tumors which are treated with radiosurgery are:
♦ Meningioma. This is about 20% of intracranial tumors formed from the tissue surrounding the brain and spinal cord. The most effective method is that meningiomas form at the skull base where it is not possible to apply an open surgical method, due to the involvement of this region in vital structures, such as arteries supplying the brain tissue or nerves emanating from the base of the brain. Radiosurgery can successfully affect such tumors and prevent complications.
Under the combined method there is also meningioma sagittal region (sagittal sinus in the upper region located on the main line of blood flow from the head to the heart). Meningiomas in this place are the most common, and the open surgery in this case often jeopardizes the integrity of the sinuses and can cause functional impairment. Nevertheless, radiosurgery can successfully affect a part in which the tumor is located without damaging the sinus itself.
♦ Acoustic neuroma. It is a benign tumor that develops in the inner ear canal and grows over the years in a pear of the skull near the brain stem. This tumor may disrupt the balance and hearing, and later the function of the facial nerve. In the treatment of a tumor by radiation therapy the risk of facial nerve injury is extremely low – about 1.5%. This is much less than the risk of the surgical intervention.
Radiosurgery is also effective in the treatment of pituitary tumors.
Arteriovenous malformations (AVMs)
Congenital malformation of the brain AVM is a relatively rare defect which is characterized by a direct connection between the arteries and veins without the normal capillaries network between them.
Birth defects grow at a slow pace over the years. They are manifested by spontaneous bleeding which can cause severe disability and even death, cramps and headaches.
Existing methods for treating AVMs is surgical removal, embolization (blockage using a unique adhesive by catheterization) and radiosurgery. The decision to use any particular method or combination of methods, carried out on an individual basis.
Radiosurgery is different from the other two methods that the result appears gradually and lasts from one to four years.
Since this method is non-invasive and can be applied to any part of the body, it is extremely effective in the treatment of congenital amputation, or as adjuvant therapy after surgery or embolization of amputated limbs. Radiotherapy generates the acceleration of atherosclerotic vascular wall defect in order to complete blockade of malformations. Unlike other methods, radiosurgery does not affect the normal blood vessel wall adjacent to the AVM.
Trigeminal neuralgia is a chronic disease characterized by the onset and acute pain on one side of the face. This disease affects primarily women, aged 50 – 60 years.
When drug therapy fails to suppress the pain or the patient develops tolerance to the drug, radiosurgery cam help.
There are several invasive treatment of trigeminal neuralgia:
1. Operations using electrodes.
2. Microvascular decompression of the trigeminal root surgery. This is an operation under general anesthesia through the ear. The purpose is to find a blood vessel, which presses the nerves and causes neuralgia in most patients. This method results in a cure of the disease in approximately 90% of patients. Operation provides postoperative hospitalization for several days.
3. Radiosurgery is one of the conventional methods of treatment of this disease. It is intended for patients who, because of their state of health, unable to withstand surgery or refuse surgery.
During the procedure, the rays are designed specifically and accurately to the root of the trigeminal nerve in the back of the skull. Radiation, mainly affecting nerve fibers associated with the transmission of pain, which leads to the cessation of pain in a high percentage of patients.
Adjusting method depends on the nature of the disease, patient’s age and his general condition.
Dr. Raphael Pfeffer – expert in radiotherapy. Head of the Radiology Department, Assuta Medical Center.
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