How does it work?
Gamma Knife directs rays from hundreds of cobalt sources to a point target. Although each source sends low-energy beams, it is possible to transfer a great amount of energy to the target as a result of combining hundreds of beams in a single focus.
It is thought that the effect of Gamma Knife treatment is the result of damage to the genetic code of the masses in the brain. The effect of this damage is observed in two different ways in different brain diseases.
The aim of the treatment; complete elimination of fast-growing tumors and cerebral vascular tangles; In slow-growing tumor types, it is the cessation of growth. By using Gamma Knife, diseases of bones, vessels, nerves, skin and other tissues located both in and around the brain can be treated.
The disease in which Gamma Knife is used most frequently in the world is metastases of different cancers to the brain, AVMs, metastatic brain tumors and vestibular schwannomas and meningiomas, which are benign brain tumors.
Gamma Knife is a method that has been used in the treatment of more than one million patients in three hundred different centers all over the world to date. It is a standard in the treatment of intracranial diseases.
In Which Organs Is Gamma Knife Used For?
Gamma Knife is designed and developed for intracranial diseases. By using Gamma Knife, diseases of bones, vessels, nerves, eyes, skin and other tissues located both in and around the brain can be treated.
Different technologies are used to treat diseases in other parts of the body. Gamma Knife is a method that has been used in the treatment of more than one million patients in three hundred different centers all over the world to date. It is a standard in the treatment of intracranial diseases.
The Areas Gamma Knife Being Used
Gamma Knife is a method that has been used in the treatment of more than one million patients in three hundred different centers all over the world to date. It is a standard in the treatment of intracranial diseases. The use of Gamma Knife technology has increased every year since 1968, when it was introduced into daily use. Statistics have shown that more than one million patients worldwide are treated with Gamma Knife for various brain diseases.
Cerebrovascular Diseases
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Hemangioblastoma
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Pineal region tumors
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Craniopharyngioma
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Glomus jugulare tumor
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Metastases
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Uveal Melanoma
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Some glial tumors
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Hemangiopericytoma
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Nasopharyngeal Carcinoma
Patients with Motion Sickness
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Parkinson's disease-related tremor (tremor)
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Essential tremor
Patients with Functional Diseases
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Trigeminal neuralgia
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Patients with tumors located in hard-to-reach and deep regions of the brain
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Patients who cannot tolerate surgical intervention due to age, medical condition, general health condition
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Patients who refuse open surgery.
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Parkinson's disease-related tremor (tremor)
Apart from these, Gamma Knife Icon is also used in the treatment of the following diseases:
Brain Tumors
Brain tumor is a condition that originates from the brain and surrounding tissues and occurs when certain foci grow uncontrollably in these tissues. The uncontrolled growing tissue can not perform the function it should fulfill, and causes problems by occupying space in the skull, which is a closed volume.
Brain Tumor Treatment
The most important step in the treatment of brain tumors is to determine the type of tumor to be treated. Because different brain tumors are treated with different treatment methods and combinations. When all brain tumors are reviewed, it is seen that the treatment methods are surgery, radiotherapy, chemotherapy and Gamma Knife.
Acromegaly
Acromegaly is caused by benign tumors of the pituitary gland that secrete growth hormone. It is a difficult disease to treat. Gamma Knife in acromegaly disease is an effective treatment method for preventing tumor growth, shrinking and reducing hormone levels to normal in case the tumor remains behind after surgery or if the tumor recurs.
Cerebrovascular Diseases
Cerebrovascular diseases are diseases that directly affect the vascular system that provides blood to the brain. Most of the time, they present with sudden brain crises called strokes. They can also occur with clinical pictures that affect the blood supply to the brain as a slowly developing and chronic disease. The treatment of these diseases begins with the clear identification of the underlying vascular disorder. Different vascular disorders are treated with drug therapy, surgery, endovascular therapy or methods such as Gamma Knife.
Arteriovenous Malformation (AVM)
Arteriovenous malformations (abbreviation A.V.M.) are diseases caused by disorders that occur during the development of brain vessels. In this disease, vascular tangles that occur as a result of excessive vascularization in different parts of the brain are observed. These vascular disorders lead to bleeding, epileptic seizures and deterioration of regional brain functions. Since they can be life-threatening, they should be evaluated in terms of treatment. Gamma Knife is one of the effective treatment methods used today in the treatment of AVMs.
Astrocytomas
Astrocytomas are the most common type of tumors arising from the brain's own tissue. They occur in two types: The classic example of the type that grows without invading the surrounding tissue is pilocytic astrocytomas. Pilocytic astrocytomas according to the age and location are a type of tumor that can be treated with Gamma Knife, radiotherapy or chemotherapy. In contrast, the group known as diffuse astrocytomas grows by invading normally functioning brain tissue and therefore can only be treated with a combination of multiple treatments.
Brain Hemorrhages
Brain hemorrhages present with sudden brain crises called strokes. Although the most common cause of bleeding is systemic diseases such as hypertension, bleeding can also be caused by problems such as aneurysm affecting the vessel wall or diseases such as arteriovenous malformations in which the structure of the vessel is damaged. The treatment of these diseases begins with the clear identification of the underlying vascular disorder. Different vascular disorders are treated with drug therapy, surgery, endovascular therapy or methods such as Gamma Knife.
Brain Cancer
Cancer in the brain is monitored in two ways. The spread of cancers of other tissues to the brain is the most common form and is called brain metastasis. In contrast, brain cancer is cancer that originates from the brain tissue and the supporting tissues of the brain (such as vessels, meninges). Among these, the most common type in the adult age group is a rare but malignant type of cancer called glioblastoma.
Brain Cancer Treatment
Treatment of brain cancer is complex and challenging due to the growth of this disease by invading normally functioning brain tissue and requires the use of multiple treatment methods.
Brainstem Tumor
Brainstem tumors are very diverse and vary greatly in patient age, anatomical location, and growth patterns. Surgery, Gamma Knife, Radiotherapy and their combinations are used in the treatment of these different tumors.
Brain Tumor
Brain tumor is a condition that originates from the brain and surrounding tissues and occurs when certain foci grow uncontrollably in these tissues. The uncontrolled growing tissue can not perform the function it should fulfill, and causes problems by occupying space in the skull, which is a closed volume.
Brain Tumor Symptoms
Brain tumors present in three ways. The most common findings are headache, nausea, vomiting and changes in consciousness due to increased intracranial pressure. Brain tumors can also cause epileptic attacks. The third most common finding is dysfunction in the area directly affected by tumor growth (loss of strength, speech impairment, visual disturbances, personality changes, etc.).
Types of Brain Tumors
Brain tumors are one of the rare tumors seen in the body. Most of these tumors are benign tumors. On the other hand, malignant tumors of the brain are the worst of all cancers of the human body. The most common brain tumors are metastases from cancers of other tissues of the body, meningiomas that are tumors of the meninges, glial tumors that originate from the brain's own tissue, adenomas that are benign tumors of the pituitary gland, and vestibular schwannomas that originate from the balance nerve.
Brain Tumor Treatment
The most important step in the treatment of brain tumors is to determine the type of tumor to be treated. Because different brain tumors are treated with different treatment methods and combinations. When all brain tumors are reviewed, it is seen that the treatment methods are surgery, radiotherapy, chemotherapy and Gamma Knife.
Gamma Knife in Brain Tumor Treatment
Gamma Knife is a technology developed to provide surgical treatment with less risk in various diseases of the brain. Tumors constitute one of the most important uses of this technology. The most common diseases in which Gamma Knife therapy is used worldwide are metastatic brain tumors and vestibular schwannomas and meningiomas, which are benign brain tumor types.
Radiation Therapy in Brain Tumor
Radiation therapy can be used if brain tumors spread into normally functioning brain tissue. The aim of this treatment is to kill tumor cells in the area where it is applied, but not to damage normal brain tissue. This treatment can be applied to the whole brain, as well as with Gamma Knife, which is a very focused form of radiation therapy, or stereotactic radiosurgery methods.
Veins in the Brain
Arteriovenous malformations (abbreviation A.V.M.) are diseases caused by disorders that occur during the development of brain vessels. In this disease, vascular tangles that occur as a result of excessive vascularization in different parts of the brain are observed. They cause vascular tangles, hemorrhage, epileptic seizures and deterioration of regional brain functions in the brain. Since they can be life-threatening, they should be evaluated in terms of treatment. Gamma Knife is one of the effective treatment methods used today in the treatment of AVMs
Cancer in the Brain
Cancer in the brain is monitored in two ways. The spread of cancers of other tissues to the brain is the most common form and is called brain metastasis. In contrast, brain cancer is cancer that originates from the brain tissue and the supporting tissues of the brain (such as vessels, meninges). Among these, the most common type in the adult age group is glioblastoma (GBM), a rare but malignant type of cancer.
Chondrosarcoma
Chordoma (chordoma) and Chondrosarcoma (Chondrosarcoma) are types of slow-growing tumors that originate from cartilage tissue and its precursors, but grow by invading the bone. Since chordomas and chondrosarcomas located in the skull generally grow in the central regions of the skull, surrounded by important vascular and nerve structures, their treatment is extremely difficult and complex. Surgery, Gamma Knife, radiotherapy and particle radiation (proton beam, carbon ion) methods are used in the treatment.
Cushing's Disease
Cushing's disease is caused by benign tumors of the pituitary gland that secrete the hormone cortisone. It is a very difficult disease to treat. In Cushing's disease, Gamma Knife is a treatment method for preventing tumor growth, shrinking and reducing hormone values to normal in case the tumor remains after surgery or if the tumor recurs.
Vein Bundle
Arteriovenous malformations (abbreviation A.V.M.) are diseases caused by disorders that occur during the development of brain vessels. In this disease, vascular tangles that occur as a result of excessive vascularization in different parts of the brain are observed. Vein balls in the brain lead to hemorrhage, epileptic seizures and regional brain functional deterioration. Since they can be life-threatening, they should be evaluated in terms of treatment. Gamma Knife is one of the treatment methods used today in the treatment of AVMs.
Balance Nerve Tumor
It is used for vestibular schwannoma (or formerly Acoustic Neuroma or Acoustic Schwannoma), a benign balance nerve tumor. In patients who do not have to be treated surgically, tumor growth can be controlled with the Gamma Knife.
Low Grade Glial Tumor
Low-grade glial tumors are the most common type among tumors originating from the brain's own tissue. They occur in two types: The classic example of the type that grows without invading the surrounding tissue is pilocytic astrocytomas. Pilocytic astrocytomas are tumors that can be treated with surgery, Gamma Knife, Radiotherapy or Chemotherapy according to age and location. In contrast, the group known as diffuse gliomas (astrocytoma or oligodendroglioma) grows by invading normally functioning brain tissue and therefore can only be treated with a combination of multiple treatments.
Movement Disorders
Parkinson's disease, multiple sclerosis (MS), and trauma-related or essential (unknown cause, seen in the elderly) tremor (tremor) is a health problem that affects the patient's quality of life. In the treatment of these diseases, Gamma Knife thalamotomy can be applied in addition to drugs.
Pituitary adenomas (Pituitary Gland Uru)
Pituitary adenomas, which are benign tumors originating from the pituitary gland, give clinical findings by secreting hormones or by pressing on important tissues such as the surrounding optic nerves. Pituitary adenomas that both secrete hormones and only compress can be treated with the Gamma Knife. Whether or not Gamma Knife treatment is appropriate for patients followed up in the endocrinology department is determined by their doctors. Gamma Knife radiosurgery can be used alone or in addition to drug therapy and surgical therapy. With Gamma Knife radiosurgery, 95-98 percent growth control can be achieved in pituitary tumors.
Auditory Nerve Tumor
Today, Gamma Knife is used for vestibular schwannoma (or formerly Acoustic Neuroma or Acoustic Schwannoma), a benign tumor arising from the balance nerve. In patients who do not require surgical treatment, tumor growth can be controlled with the Gamma Knife.
Benign Brain Tumor
Benign tumors are tumors that grow slowly over years. In these tumors, the aim of Gamma Knife treatment is to prevent the growth of the tumor.
Chordoma and Chondrosarcoma
Chordoma (chordoma) and Chondrosarcoma (Chondrosarcoma) are types of slow-growing tumors that originate from cartilage tissue and its precursors, but grow by invading the bone. Since chordomas and chondrosarcomas located in the skull generally grow in the central regions of the skull, surrounded by important vascular and nerve structures, their treatment is extremely difficult and complex. Surgery, Gamma Knife, radiotherapy and particle radiation (proton beam, carbon ion) methods are used in the treatment.
Malignant Tumors
Malignant, that is, malignant tumors, are tumors that have the ability to grow rapidly. The effect of Gamma Knife treatment on these tumors is rapid and observed within months. In malignant tumors, Gamma Knife can often completely eliminate the tumor. Brain vascular tangles (arteriovenous malformation-AVM) also shrink and disappear after Gamma Knife, but this effect occurs more slowly, within a few years.
Meningiomas
​Meningiomas are slow-growing and mostly benign tumors that originate from the membranes that surround the brain. They show signs and symptoms with their masses.
Treatment of Meningiomas
Surgery is the first option in their treatment. However, some meningiomas may not be completely removed. Sometimes, the risks of a surgical intervention may be high. In this case, Gamma Knife radiosurgery can be a useful option. It can also be used in patients who have residual or re-growth tumors after surgery. The aim of Gamma Knife therapy for meningiomas is to prevent the growth of these tumors. Tumor growth inhibition is achieved in the vast majority of patients. With the Gamma Knife, it is possible to stop tumor growth in meningiomas and reduce it over time at a rate of 95 percent.
Oligodendroglioma and Pilocytic Astrocytoma
Low-grade glial tumors are the most common type among tumors originating from the brain's own tissue. It is seen in two types: The classic example of the type that grows without invading the surrounding tissue is pilocytic astrocytomas. Pilocytic astrocytomas are tumors that can be treated with surgery, Gamma Knife, Radiotherapy or Chemotherapy according to age and location. In contrast, the group known as diffuse gliomas (astrocytoma or oligodendroglioma) grows by invading normally functioning brain tissue and therefore can only be treated with a combination of multiple treatments.
Trigeminal Schwannoma
Trigeminal schwannoma is a benign tumor arising from the trigeminal nerve, which is the sensory nerve of the face.
Trigeminal Neuralgia
Trigeminal neuralgia mostly occurs with unilateral facial pain in the form of electric shock. Pain is felt mostly in the nose, mouth and jaw. Usually, what the patient tells during the examination enables the diagnosis to be made.
Trigeminal Neuralgia Treatment
Medications are the first line of treatment. If there is no benefit, various surgical interventions can be applied. Surgical intervention options include Gamma Knife treatment. The rate of pain relief is the same as other percutaneous methods, but it can be an alternative, especially in elderly patients.
Vestibular Schwannoma or Vestibular Schwannoma (Hearing - Balance Nerve Tumor)
Vestibular schwannomas are benign tumors arising from the sheath of the auditory and balance nerves. It ranks fifth among the most common brain tumors. It is most commonly seen in middle and advanced ages, but it can be seen at any age. Patients most frequently apply to the clinic with hearing loss and tinnitus. Over time, they cause problems such as hearing loss, imbalance, facial paralysis, loss of sensation on the face, and threaten the patient's life by compressing the brain stem.
Vestibular Schwannoma Treatment
Today, Gamma Knife is used for vestibular schwannoma (or formerly Acoustic Neuroma or Acoustic Schwannoma), a benign tumor originating from the balance nerve. In patients who do not have to be treated surgically, tumor growth can be controlled with the Gamma Knife.
How is it applied?
Application of the Stereotactic Framework
The Lexel stereotactic frame is fixed to the patient's head so that the treatment can be applied with the most precision and millimeter reliability. Local anesthesia is applied to be painless. In children, the procedure is performed in the company of an anesthesiologist, if necessary, by putting the pediatric patients to sleep.
Mask Application
In the Gamma Knife Icon device, patients can also be treated with a mask instead of a stereotactic frame. Thus, the treatment can be given in fractions, spread over several days. In this way, sensitive structures such as optic nerves and brain stem in the vicinity of tumors can be protected. In addition, a mask can be used in cases where it is not possible or risky to wear a frame.
Neuroradiological Imaging
After the frame is attached, the imaging method suitable for the patient's pathology is applied. Today, all patients undergo MRI. Angiography is performed with stereotactic frame in AVM cases. Sometimes computed tomography is also used in treatment planning in skull base tumors or in patients who cannot undergo MRI.
Dose Planning
Thanks to special computerized planning programs, the target tissue to be treated is delimited with a sharp precision and the radiation dose to be applied is determined. With the application of blocking in tumors adjacent to sensitive structures, the rays can be prevented from reaching normal tissues from some directions.
Application of the Ray
After the treatment plan is made on the computer, the application is made in the treatment unit, which is a separate part. Its duration is 15 minutes. It can vary between 1-2 hours. The volume of the tumor and the amount of radiation dose to be applied constitute the determining factors in the treatment period.
Gamma Knife Tomography
Even millimetric movements of the head are shown with this tomography before the patient starts the treatment and during the treatment. Thus, it is ensured that the treatment can be given sensitively and safely. In addition, thanks to this tomography, it is possible to treat with a mask.
Patient Monitoring During Treatment
Gamma Knife lcon monitors the application of the treatment with tomography and infrared motion tracker. The tomography device measures the exact location of the skull in mask or frame treatments, allowing the target in the head to be determined clearly. If necessary, tomography examination is repeated during the treatment. In addition, the patient's movement for reasons such as breathing is constantly monitored with the infrared motion tracker.
End of Treatment
Gamma Knife is applied to most of the patients in a single session. The treatment, which starts early in the morning, often ends within hours and the patient can return home after discharge. Intercity travel is possible immediately after the treatment by plane or land. The patient continues his daily life after the treatment.
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