Is Gamma Knife surgery the best non-invasive treatment to remove brain tumours without a skull incision?

Gamma Knife surgery is a non-invasive treatment that uses radiation to remove brain tumours without cutting into the skull, which can significantly reduce the burden on the patient. The precise irradiation removes the tumour with minimal damage to normal cells, with fewer side effects and a faster recovery than surgery.

 

Brain tumours are any tumour that develops within the skull and are rare, accounting for only 0.9% of all cancer cases. However, the main surgical treatment for brain tumours involves opening the skull and cutting out parts of the brain, which is very painful for the patient. Therefore, gamma knife surgery, a radiosurgery that uses radiation to destroy tumour cells, has recently gained attention.
Radiosurgery is a treatment method that removes tumours by focusing radiation only on the targeted tumour cells. To understand this, think of stage lights. The light from a single light is weak, but when several lights are combined, the centre of the stage is illuminated with a very bright light. Similarly, radiation from a single light source is weak and has little effect on normal cells. However, at a focal point, where radiation from multiple directions converges on a single point, the intensity is strong enough to destroy the targeted tumour cells. Radiotherapy, the use of radiation to remove tumours, has been around for a long time, but it differs from radiosurgery in that it does not distinguish between normal and tumour cells, but rather irradiates a wide area.
Gamma knife surgery is a radiosurgery that uses gamma radiation from the isotope cobalt-60 to treat brain tumours. The Gamma Knife uses cobalt-60 arranged in a hemispherical pattern around the head, which emits gamma rays from more than 200 different directions to form a focus in the centre of which the tumour is placed to kill tumour cells. In this process, the tumour is removed without opening the skull and with minimal damage to normal cells.
Gamma knife surgery involves precisely locating the tumour and then determining the area to be irradiated and the intensity of the radiation. First, a device called a stereotactic frame is attached to the patient’s head and the tumour’s location is analysed in three dimensions using MRI, CT, angiography, etc. The stereotactic collar holds the patient’s head still during surgery and must remain in place from the beginning to the end of the procedure. The imaging images taken are reconstructed in three dimensions, which the surgeon uses to determine the extent and intensity of radiation, taking into account critical tissues such as the optic nerve around the tumour.
The surgery is performed with the patient lying on the operating table and receiving a fixed dose of radiation according to pre-planned coordinates. There is no pain or noise, and the patient is free to move the rest of the body, except the head, during the procedure. The surgery can take anywhere from 30 minutes to several hours, depending on the size and shape of the tumour, and at the end of the procedure, the stereotaxic brace is removed and the patient is discharged home after stabilisation.
There are some clear differences between radiosurgery and traditional surgery. Surgical procedures can provide immediate results due to the direct removal of the tumour, but the risks associated with opening the brain and cutting through tissue are significant. Radiosurgery, on the other hand, removes the tumour in a non-invasive way, so there is little risk of bleeding or infection. However, patients may need to be patient as surgery can remove the tumour in a single procedure, whereas radiosurgery involves a slow process of shrinking the tumour, requiring patients to observe the results over several months.
The simplicity of the Gamma Knife procedure compared to surgical treatment reduces the burden on the patient in several ways. First and foremost, there is no need to make an incision in the skull, so patients can undergo surgery with only local anaesthesia, and they can go home the same day after surgery, reducing the financial and psychological burden. In addition, the Gamma Knife delivers precisely calculated radiation doses by computer, making it the most precise radiosurgery device available today.
Of course, there is still work to be done. The main limitation of Gamma Knife surgery is that the treatment is limited to the inside of the skull. If the tumour is located below the neck, it is difficult to perform radiosurgery. This is because the rib cage and internal organs move as the patient breathes, making accurate radiological imaging difficult. However, the makers of the Gamma Knife are working to overcome this limitation, and it is expected that more precise radiosurgery will be possible in the future.
As medical technology advances in the future, radiosurgery such as Gamma Knife is expected to become more precise and have a wider range of applications. Currently, researchers are investigating how radiosurgery can be used to treat not only tumours but also neurological diseases of the brain, cardiovascular diseases, etc. In addition, new imaging techniques combined with artificial intelligence could enable personalised treatment for patients. In the coming years, radiosurgery is likely to become even more precise, making non-invasive treatments for a wide range of conditions outside the skull and throughout the body more common.
With further research into radiosurgery, including the Gamma Knife, the medical breakthrough of removing tumours without cutting through the skin could become a reality.