Treatment in Germany and Switzerland

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Gamma Knife in Germany

Radiosurgery treatment by means of Leksell Gamma Knife is the “golden standard” and does not come short of the efficiency of direct neurosurgical intervention. Leksell Gamma Knife has some advantages because there is no risk of complications.

Name of the Gamma Knife is conditional and is not a knife in the sense of the word. This set-up is for stereotactic radiosurgery of brain pathologies.

Radio surgical intervention is absolutely painless under local anesthesia without the discission and skull trepanation.

At the present time, the Gamma Knife method is rightly recognized by neurosurgeons and became a part of modern neurosurgery in many countries.

More than 200 installations of Leksell Gamma Knife are used today throughout the world.

Germany is one of the leading European countries that have used Gamma Knife since the early 1990s.

Many years of the German specialists' experience and the availability of Gamma Knife of the latest generation provides successful treatment of brain tumors such as:

  • Meningioma

  • Neurinoma of trigeminal and other cranial nerves

  • Pituitary adenoma

  • Single and multiple metastases of brain cancer

  • Arteriovenous malformations

  • Other brain pathologies in the early stages of the disease in adults and children

Besides, this method is successfully used in the treatment of functional disorders such as:

  • Trigeminal neuralgia

  • Epilepsy

The latest Gamma Knife model - Perfection - allows treating the upper neck, too.

History of Gamma knife

 In the 1950s of the last century, the famous Swedish neurosurgeon Lars Leksell together with physicist Börij Larsson developed the world's first system known as Leksell stereotactic apparatus or Gamma Knife for non-invasive treatment of various types of intracranial pathologies. Already in 1968 the system was first applied in the treatment of pathological formations of the brain.

Initially, Gamma Knife was intended for problem solving associated with functional neurosurgery and was one of the tools supporting the destruction of special divisions of the deep brain structures.

 

 Long enough, the neurosurgeons did not give attention to this method. Only since the mid 1980s of the last century, Gamma Knife has been successfully used in neurooncology and in the treatment of more than 300000 patients with various intracranial pathologies worldwide. The total number of patients receiving treatment with Gamma knife increases by 35000 annually.

 

What is Gamma Knife?

Gamma Knife is the system for the carrying-out of high-precision one-shot irradiation of special brain divisions damaged by various pathologies. It uses the energy gamma radiation of radioactive Cobalt-60. The irradiation is performed using 201 sources located in the tube head to diameter of hemisphere. In this case, the irradiation from each of them separately is small and does not damage healthy brain tissue. But having met in the isocenter, they give the total radiation that is sufficient to cause a desired biological reaction in the pathological focus.

It is necessary to carry out 30-40 irradiation sessions in small doses in radiotherapy in order to achieve desired results. Unlike radiotherapy, the necessary effect of Gamma Knife is achieved after a single procedure, the duration of which varies from one to several hours. And this is an undeniable advantage of this method.

Gamma Knife is the system for the carrying-out of high-precision one-shot irradiation of special brain divisions damaged by various pathologies. It uses the energy gamma radiation of radioactive Cobalt-60. The irradiation is performed using 201 sources located in the tube head to diameter of hemisphere. In this case, the irradiation from each of them separately is small and does not damage healthy brain tissue. But having met in the isocenter, they give the total radiation that is sufficient to cause a desired biological reaction in the pathological focus.

It is necessary to carry out 30-40 irradiation sessions in small doses in radiotherapy in order to achieve desired results. Unlike radiotherapy, the necessary effect of Gamma Knife is achieved after a single procedure, the duration of which varies from one to several hours. And this is an undeniable advantage of this method.


This type of radiation therapy is known as radiosurgery. Powerful irradiation causes damage of the DNA of pathological cells and cell membranes, in consequence of which the tumor growth is stopped. The enlargement in the sheets of squamous cells lining the innerface is in the blood vessel walls. Because of this, the lumen of the vessels is narrowed or even closed. Thus, cell blood supply is dramatically reduced. It means that the tumor is decreased and in some cases, tumors disappear completely.

Because of its high accuracy (average deviation from the target is only 0.3-0.4 mm), Gamma Knife is increasingly used in modern neurosurgery. This quality has an important role in cases of the localization of pathological formations of functionally important areas or close proximity to the radiosensitive structures (e.g., ocular nerve or brain stem). The rigid fixation of the head in the frame, which is an essential part of stereotactic neurosurgery, provides accuracy, too.

Indications for Radiosurgery

Radiosurgery is well tolerated because the duration of the whole procedure is no more than a few hours. The procedure is relatively safe without possible surgical complications: infections, bleeding, swelling, complications associated with anesthesia. The procedure allows patients to quickly return to normal life and can be outpatient or one-day hospitalization in a specialized hospital.

Neurosurgical patients with the following types of intracranial pathology receive radiosurgical treatment with Leksell Gamma Knife®:

  • Acoustic neurilemmoma (acoustic neuroma)

  • Neurinoma of trigeminal and other cranial nerves

  • Meningioma

  • Pituitary adenoma

  • Brain cancer metastasis

  • Arteriovenous malformations

  • Cavernous angioma (cavernoma)

  • Trigeminal neuralgia

  • Glioma, ependymoma, medulloblastoma

  • Pinealoma, chordoma, craniopharyngeoma, hemangioma

  • Other tumors

It is important to consider that the size of pathological formations should not exceed 3.5 cm in diameter; otherwise there is the risk of side effects.


Side effects of treatment include the following symptoms: weakness, headache, localized hair loss, loss of sensitivity of some scalp parts. But all these manifestations pass off after a short period of time after the operation.

The Gamma Knife in the world


Application of Gamma knife of the world


Radiosurgery step by step

Each procedure is preceded by a detailed conversation with your doctor. During this conservation the doctor learns if the patient has allergic reactions to the drugs used in the examination and treatment.


 The first step is the fixation procedure of the stereotactic frame on the patient's head. This frame is fixed under local anesthesia with the help of four special spikes.

Then a diagnostic study (MRI, CT, angiography in the case of vascular pathology, PET in rare cases) is carried out with the use of the localizer put on the stereotactic frame and providing connection of tomographic and frame coordinates.

 

 In respect of the received figures, neurosurgeons together with physicists develop a treatment plan and use a computer system which records the digital information of studies and planning of radiation, as well as manages the system

 

Planning is carried out according to the following factors: the choice of the number of isocenters, their position and weight (relative time of irradiation in each isocenter), angulation of the head, position and shape of the tumor (or tumors), adjacent healthy tissue, the proximity of radiosensitive organs, and the total radiation dose on the patient's head.


 The patient is put on the bed. His head is fixed in position, so that the selected target coincides with the isocenter of the apparatus.

Automatic or manual positioning is used depending on the model of the apparatus and specific features of the patient. 


A check of the position of the isocenters and its accessibility are carried out, then the staff leaves the room and the couch is pushed inside the apparatus where radiation is.

Two-way audio and one-sided video communication is supported during the process of the patient's irradiation. The process of treatment is absolutely painless, just sometimes the patient has a feeling of light prelum of the head which gradually decreases.

The duration of the procedure depends on the type of pathology, the number of tumors, their size and location.

After irradiation, the frame is removed from the patient's head; the places of its fixation are processed by antiseptic (disinfectant) medium. After this the patient can go home.


Read more about: surgical treatment: glioma, neurinoma, meningioma and other brain tumors


If you have any questions about treatment of tumors of the brain and spinal cord, and pituitary adenoma in Germany,
please call us +49 (2283) 77-369-0 or write us a mail