Gamma Knife Surgery And Radiosurgery: What’s The Difference?

If you or a loved one has been diagnosed with a brain tumour, vascular malformation, or neurological condition, you may be exploring various treatment options. During your research or discussions with your medical team, you might have heard terms such as ‘radiosurgery’, ‘stereotactic radiosurgery’, or ‘Gamma Knife radiosurgery.’

They might sound similar, but understanding the differences can empower you to make a well-informed decision about your treatment. It also helps to demystify the process of treating neurological conditions at a time that patients and their families may find distressing and overwhelming. 

Here’s a look at the key distinctions between them.

What is radiosurgery?

Radiosurgery isn’t a traditional type of surgery in that it doesn’t involve making incisions with a scalpel. Instead, it’s a non-invasive medical procedure that uses precisely targeted beams of radiation to treat abnormalities in the brain or spine. It may also be used to treat conditions in other parts of the body. 

The aim of traditional open surgery is to physically remove as much of the tumour or lesion as possible, whereas radiosurgery is designed to disrupt the ability of abnormal cells to grow. 

Radiosurgery for brain tumours is usually considered as a treatment option when a physical operation is not possible, which may be due to the health of the patient or the type, size or location of the tumour. It may also be used after traditional surgery to destroy any remaining abnormal tissue.

Radiosurgery is most often an option to treat:

  • Benign and malignant brain tumours
  • Brain metastases
  • Arteriovenous malformations (AVMs)
  • Trigeminal neuralgia
  • Acoustic neuromas
  • Pituitary adenomas
  • Certain spinal conditions

What is stereotactic radiosurgery?

Stereotactic radiosurgery (SRS) is a form of radiotherapy that uses very tightly focused beams of radiation at a higher dose than is used for standard radiosurgery. This means that the treatment is more accurately targeted, and the risk of damaging the surrounding healthy brain tissue is minimised. 

Another advantage of SRS is that it is usually delivered in one single treatment, rather than multiple sessions across a number of weeks. This minimises the stress and disruption of the treatment for patients and their families. 

SRS is most suited to treating small tumours that are in an easily accessible part of the brain. It may not be suitable for larger tumours or those without clearly defined boundaries, such as gliomas.

What is Gamma Knife surgery?

Gamma Knife is a form of SRS that has been specifically developed to treat conditions in the brain, head and neck. The term ‘knife’ refers to the precision and accuracy of the radiation beams rather than a surgical knife. 

Gamma Knife technology was invented in 1967 by Swedish neurosurgeon Dr. Lars Leksell, who also coined the term “radiosurgery.” Since then, it has come to be regarded as one of the safest and most effective tools for treating small to medium-sized brain lesions. 

The Gamma Knife machine delivers up to 192 beams of gamma radiation from multiple angles, that are targeted with sub-millimetre accuracy to converge on the site of the tumour or lesion. Individually, each beam is too weak to cause damage as it crosses the brain tissue, but collectively they are powerful enough to destroy abnormal cells. 

Which treatment is right for you?

The best treatment option depends on your condition, the size and location of the lesion, your general health, and the availability of technologies at your treatment centre. 

For small brain tumours, AVMs, and trigeminal neuralgia, Gamma Knife is often the preferred choice. Larger or irregular-shaped lesions may require traditional open surgery, or another form of stereotactic radiotherapy to reduce risk to surrounding tissues.

Your specialist team – usually including a neurosurgeon, oncologist, and radiologist – will help determine the most appropriate option based on clinical evidence and your specific needs.

At Amethyst Radiotherapy, we have specialist medical teams who care for patients with brain tumours and other neurological conditions at the UK’s only dedicated NHS approved Gamma Knife centres. These include Queen Square Radiosurgery Centre in London, and Thornbury Radiosurgery Centre in Sheffield. 

 

If you would like to find out more about Gamma Knife treatment, please contact us today.

The Story Of How Gamma Knife Radiosurgery Was Developed

Gamma Knife surgery is an innovative type of stereotactic radiosurgery, which uses gamma rays to treat certain types of brain tumours and other neurological conditions. It can be used as an alternative to risky and invasive open surgery using a scalpel, or to remove pieces of tumour that couldn’t be removed with traditional surgery.

This advanced technology has saved, improved or extended the lives of many people who are living with brain conditions. 

Here’s a look at who invented the Gamma Knife technique and how it was introduced to hospitals around the world, including our Centres of Excellence at Queen Square in London and Thornbury in Sheffield. 

The remarkable Prof Lars Leksell

The story begins in Sweden in the 1950s, when Professor Borje Larsson (a physicist) of the Gustaf Werner Institute, University of Uppsala, and Professor Lars Leksell (a neurosurgeon) at the Karolinska Institute in Stockholm began to investigate ways to treat brain disorders without the risky process of opening up the skull.

The first attempt involved combining proton beams with stereotactic devices to target areas in the brain. The approach proved to be unworkable, but it led to the development of the first prototype Gamma Knife device in 1967. It was not used to treat brain tumours, but patients with pain or movement disorders. 

The concept of the device was to use cobalt-60 as an energy source to produce multiple beams of gamma radiation, which were directed at a target in the brain from various angles. By itself, each beam was too weak to cause any harm to the brain cells, but when they converged, the combined energy was enough to destroy abnormal tissue. 

The effect was to block the abnormal nerve impulses that caused symptoms such as tremor or pain. Professor Leksell realised the potential of the technique for treating brain tumours, and he went on to develop a second version of the machine to do this in 1975. The first unit was installed at the Karolinska institute, and was successfully used to treat brain tumours.

During the 1980s, further Gamma Knife units went on to be installed in Buenos Aires, Argentina, and Sheffield, England, at The National Centre for Stereotactic Radiosurgery. The technique was pioneering due to being minimally invasive, extremely precise, and safer than conventional surgical techniques.

The conditions treated with early Gamma Knife surgery

Gamma Knife was used to treat brain conditions that were considered too difficult or risky to access surgically. These included arteriovenous malformations (AVMs), which are tangled blood vessels that can disrupt the flow of oxygen to the brain tissues. Sometimes AVMs do not cause symptoms, but there is a risk of haemorrhage.

AVMs can also cause a range of symptoms including headaches, nausea and vomiting, seizures, vision problems, cognitive difficulties and muscle weakness. Gamma Knife was also used to treat trigeminal neuralgia, a debilitating facial pain disorder, and benign brain tumours such as acoustic neuromas. 

The continuing development of Gamma Knife

Throughout the 1980s and 1990s, the technology of Gamma Knife continued to evolve, alongside the conditions it could treat. A US neurosurgeon named Dr. L. Dade Lunsford was an early adopter of the device, and he headed up the University of Pittsburgh Medical Center, which became a leader in Gamma Knife research and training. 

Advancements in magnetic resonance imaging and computed tomography scan technology led to the development of more sophisticated and accurate treatments, resulting in greater levels of efficacy and safety. The type of conditions it can treat also expanded to include metastatic brain tumours, pituitary tumours and some types of paediatric cases.

2000s onwards

The 2000s brought further developments, including new models of Gamma Knife machines that could treat multiple brain lesions in a single session. Some models were introduced that operated with frameless systems, replacing the metal head frame with a custom-fitted mask. Most patients could be treated as outpatients and return home on the same day. 

Today, Gamma Knife treatment is safer, more accurate and more effective than ever, and continues to evolve. AI technology and robotics are being integrated into the treatment planning and operative stage, for a more personalised approach that is backed by sophisticated data analysis and advanced imaging analysis.

If you would like to find out more information about Gamma Knife surgery, please get in touch with our team today. 

Gamma Knife Surgery For Brain Tumour Treatment: An Overview

If you are unfamiliar with Gamma Knife surgery, you might assume that it’s a procedure involving scalpels, a high level of risk and long recovery times. However, despite the name, it does not involve any incisions with a knife. Here’s a look at exactly what Gamma Knife is, how it works and what conditions it treats. 

What is Gamma Knife surgery?

Gamma Knife is a form of stereotactic radiosurgery that uses focused beams of gamma radiation to target abnormal tissue with pinpoint accuracy. Compared to open brain surgery, it’s a non-invasive treatment, and in most cases no general anaesthetic is required. Recovery time is minimal, and most patients can go home the same day. 

The name ‘Gamma Knife’ refers to the precision of the procedure, rather than a literal surgical knife. 

How does it work?

The Gamma Knife machine delivers up to 192 tiny beams of gamma radiation from different angles that intersect at a single target inside the brain. Individually, each beam is too weak to harm healthy brain tissue, but at the intersection point, the combined radiation is powerful enough to damage or destroy abnormal cells. 

Gamma Knife surgery is often used to treat brain tumours or lesions that are in a hard-to-reach position, or if the patient is unable to undergo regular neurosurgery. It can also be used to treat any parts of a tumour that couldn’t be removed by open surgery.  

What type of conditions can be treated?

Gamma Knife can treat both benign and malignant brain tumours, and other small nerve and blood vessel abnormalities. 

Brain tumours

The most common types of brain tumour treated with Gamma Knife surgery are meningiomas, acoustic neuromas (vestibular schwannomas), pituitary adenomas and metastatic brain tumours (that have spread from a primary cancer elsewhere in the body, most often from the breast, lung or melanoma).  

Vascular conditions

Arteriovenous malformations, which are tangled blood vessels in the brain that pose a risk of bleeding, can sometimes be treated with Gamma Knife.

Neurological disorders

Gamma Knife can also treat rare neurological disorders such as trigeminal neuralgia, trigeminal autonomic cephalgias, and chronic cluster headache. It’s also an emerging treatment for essential tremor and some symptoms of Parkinson’s disease. 

What are the benefits of Gamma Knife surgery?

For many patients, Gamma Knife is a safer and more effective alternative to open surgery. It is a non-invasive procedure without the high surgical risks of infection, bleeding, or cerebrospinal fluid leaks. It is usually performed as a day procedure, and most patients are able to resume their usual activities within a day or two. 

Advanced MRI contour profiling techniques are used to create an extremely accurate 3D image of the tumour or lesion, allowing for highly precise delivery of the radiation dose. This minimises the risk of damage to the surrounding tissues that could result in issues such as facial nerve injury.

What to expect during treatment

Gamma Knife treatment typically involves the following steps:

  1. Planning and imaging

You’ll have an MRI or CT scan to precisely locate the area to be treated. This information is used to develop a highly detailed 3D treatment plan.

  1. Head frame or mask

In some cases, a lightweight head frame is used to keep your head perfectly still. In others, a custom-fitted mask is sufficient, depending on the machine and condition being treated.

  1. Treatment

You’ll lie on a comfortable table while the machine delivers the radiation. It’s completely painless, although you might hear some mechanical noises. The entire session may last from 30 minutes to a few hours.

  1. Aftercare

Once finished, you’re typically observed for a short time and can go home the same day. There may be mild fatigue or headache afterward, but most patients recover quickly. 

The future of Gamma Knife treatment

Since the technique was pioneered in the late 1960s, Gamma Knife has stood out as one of the safest and most advanced ways for treating certain types of brain tumour and vascular malformations. The technology continues to evolve, with advances such as AI-driven auto-contouring for even greater precision. 

This reduces the incidences of human error and lowers the risk of inaccuracies. It also speeds up the treatment timeline, helping patients to access potentially life-saving treatment sooner, and minimising the stress and uncertainty of living with a brain tumour. 

If you would like to find out more about Gamma Knife surgery at our sites at Queen Square in London or Thornbury in Sheffield, please contact our team today.

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How AI Is Reshaping Neurosurgery: A Podcast with Mr Patrick Grover

Neurosurgery is one of the most demanding fields in medicine, requiring not only intricate diagnostic expertise but also swift, highly precise treatment. As the volume of clinical data and advanced technologies such as Gamma Knife surgery continue to expand, the way we interpret and apply this information is undergoing a significant transformation. Historically, this interpretation relied almost entirely on human judgement — but that is changing.

Artificial intelligence (AI) and robotic systems are now beginning to reshape neurosurgical practice. While the high-stakes nature of the discipline initially slowed AI adoption, recent years have seen remarkable progress, led by specialists who understand both the technological and clinical complexities involved.

Leading the Change: Mr Patrick Grover

At the forefront of this transformation is Mr Patrick Grover, Consultant Neurosurgeon and Clinical Director at the National Hospital for Neurology and Neurosurgery (NHNN) and the Queen Square Radiosurgery Centre. Specialising in skull-base and vascular neurosurgery, he also leads research into how AI technologies can be used to improve surgical outcomes, operative training, and decision-making pathways.

In a recent podcast interview with Future Medicine AI (FMAI), Mr Grover explored how artificial intelligence is transitioning from theoretical promise to practical application in clinical neurosurgery. The conversation highlights three major areas where AI is making a real impact:

1. Natural Language Processing (NLP) for Clinical Insights

One major challenge in modern medicine is the sheer volume of unstructured clinical documentation. Mr Grover’s team is applying natural language processing (NLP) to extract meaningful insights from anonymised patient notes. These tools can reveal hidden patterns in clinical histories, helping to refine risk assessments, guide diagnosis, and personalise treatment pathways.

Importantly, Mr Grover emphasises the ongoing challenge of accessing well-annotated datasets – a prerequisite for effective training of AI models – while ensuring that patient confidentiality is preserved at all stages.

2. Computer Vision and Video-Based Learning

Another exciting area of development is the use of computer vision in operative video analysis. By teaching AI systems to interpret surgical footage, Mr Grover and his colleagues aim to provide real-time procedural support and post-operative feedback. This not only enhances surgical precision but also offers valuable learning tools for neurosurgical training programmes.

Annotated videos can help identify crucial steps in surgery, benchmark performance, and reduce complications – such as facial nerve injury or cerebrospinal fluid leaks – which are risks in delicate cranial procedures.

3. Advanced Imaging Analysis for Treatment Planning

AI is revolutionising how imaging informs neurosurgical treatment. At Queen Square, Mr Grover and his team are using AI to map tumour contours, distinguish tissue types, and guide treatment planning with greater precision.

“We developed an algorithm that can automatically contour benign brain tumours on scans,” explains Mr Grover. “Next, we’re applying it to more complex shapes, like post-operative residuals, and using radiomics to identify tumour features linked to growth or treatment response – helping us build predictive models to guide decision-making.”

By combining imaging data with AI-driven analysis, clinicians can create more accurate, personalised treatment plans – including when and how to use Gamma Knife radiosurgery.

The Role of Transparency and Clinical Oversight

Mr Grover explains that despite the great advancements of AI, it is still essential to maintain a level of clinical oversight. He also emphasises the importance of collaboration, so that worldwide medical centres are sharing research findings and a consistent approach is maintained, and findings can be successfully integrated into current clinical practice. However, he acknowledges that even experts can disagree, and data is often unstructured.

While AI can provide more measured and objective insights, there are still some limitations when it comes to applying technology to highly complex medical procedures. It is crucial that clinicians always understand the reasoning behind AI driven directions so they can be validated, and a high level of transparency is maintained in neurosurgical practice.

Shaping the Future of Neurosurgical Care

AI is no longer limited to academic labs or future-facing white papers. It is now being shaped into functional tools that support safer surgeries, better patient outcomes, and more efficient training systems. For clinicians like Mr Grover, the goal is not to replace surgical expertise but to enhance it with intelligent, accountable systems that work alongside human decision-makers.

Contact the Queen Square team for a consultation to learn more about personalised treatment pathways today.

Why NHS And Private Collaboration Is Key For Complex Care

On 5th July, the National Health Service (NHS) celebrated its 77th anniversary. Since its inception in 1948, it has provided vital healthcare that is free at point of use to millions of UK citizens. While it continues to deliver essential care to millions, it now faces growing pressure from limited budgets, rising demand and workforce shortages.

While still delivering world leading healthcare, the NHS is under huge pressure from stretched budgets, rising demand, ageing populations, and staff shortages. These challenges are particularly acute when it comes to the diagnosis and treatment of rare and complex conditions such as brain tumours.

These cases require specialist consultants, multidisciplinary teams and advanced diagnostics and equipment. In today’s NHS, this means that collaboration is playing an increasingly important role. This is why Amethyst Radiotherapy is committed to strengthening its public-private partnerships as part of a long-term strategy.

Here’s a look at how we work together with the NHS to provide world-leading brain tumour treatment.

The challenges of brain tumour care

Brain tumours account for just three per cent of all cancers but, according to the Brain Tumour Charity, just one per cent of the national spend on cancer research has been allocated to brain tumours since records began in 2002.

This means that the NHS often lacks the specialist knowledge and resources to diagnose and treat brain tumours in a timely manner, or to put in place the most effective treatment pathways for individual patients.

Because they affect relatively few people, GPs can misdiagnose symptoms of brain tumours, leading to the loss of potentially life-extending treatment time. There is also a disparity in access to the best quality care around the UK. Some hospitals may lack staff with experience and expertise in rarer types of tumour, and treatment options are limited.

This is why Amethyst Radiotherapy is committed to working with the NHS to provide first-class care for patients with brain tumours and other neurological conditions at its centres of excellence in Queen Square, London, and Thornbury in Sheffield.

Queen Square, London

The Queen Square Radiosurgery Centre is part of the The National Hospital for Neurology and Neurosurgery (NHNN), which is the UK’s largest dedicated neurological and neurosurgical hospital. It is a major international Centre of Excellence for Neuroscience teaching, training, and research.

The NHNN is part of the University College London Hospitals NHS Foundation Trust. The Radiosurgery Centre was established in 2012, and became part of the Amethyst Group in 2020.

The combination of specialist technology such as Gamma Knife provided by Amethyst, and the long-standing expertise of the NHNN, results in first class care for rare and complex neurological conditions.

Thornbury, Sheffield

The Thornbury Radiosurgery Centre is located within Circle Health Group Thornbury Hospital in Sheffield, and treats both private and NHS patients. Along with Queen Square, it is one of just two National Centres of Excellence in the UK providing specialist treatment for rare and complex neurological conditions.

What is Gamma Knife?

Gamma Knife surgery is a non-invasive form of stereotactic radiosurgery that doesn’t involve making any incisions with a knife. Instead, it delivers precise gamma radiation to a targeted area of the brain. This destroys the abnormal cells while sparing the surrounding healthy tissue.

It’s used to treat some types of brain tumours, vascular malformations and nerve conditions. These can include metastatic, cancerous or benign tumours; arteriovenous malformations (AVMs); trigeminal neuralgia, and acoustic neuromas.

The future of public-private partnerships (PPPs) in healthcare

Amethyst is committed to widening access to excellent healthcare for cancer and complex conditions across Europe and beyond through collaboration with public healthcare systems.

In an era when rapid medical advancements are being made and all public healthcare systems are facing limited budgets, higher patient demand, and more complex illnesses, PPPs can ensure that patients continue to have equal and timely access to the best care available.

The expertise, experience and infrastructure of the NHS, combined with the innovation, leading edge technology, and funding of private groups is helping the healthcare system adapt to the needs of the 21st century.

If you would like to find out more about our brain tumour treatment sites at Queen Square in London or Thornbury in Sheffield, please get in touch with the team today.

Rare Brain Conditions: Why Cavernoma Awareness Month Matters

During June, Cavernoma Awareness Month has been shining a spotlight on a brain condition that is rare. However, it’s estimated that one in every 600 people in the UK has a cavernoma that doesn’t cause symptoms, and every year about 160 people are diagnosed with symptomatic cavernoma.

Many people have never heard of the condition until they, or someone close to them, is diagnosed with it. This can make the shock of a serious health condition even more difficult and distressing to deal with. In fact, awareness of the condition in the medical community was limited until the development of Magnetic Resonance Imaging (MRI) in the 1980s.

This means that the causes, symptoms and treatment pathways for cavernoma are only just beginning to be widely understood. Over the past four decades, patient groups and healthcare organisations have worked together to create a global knowledge sharing community, and advance research and care of this rare condition.

Understanding cavernomas

Cavernoma, also known as cerebral cavernous malformation (CCM), involves clusters of abnormal blood vessels in the brain or spinal cord. It’s not a tumour and is not cancerous, although it can grow bigger over time. One of the major risks of growing cavernomas is blood leakage (haemorrhage) from the weak malformed vessels.

Other serious symptoms of a cavernoma include seizures and neurological defects such as vision disturbances, dizziness, memory and concentration difficulties, and limb weakness. Patients may also experience frequent headaches. The type and severity of the symptoms depend on where the cavernoma is located, and if it is pressing on other parts of the brain.

The causes of cavernoma are not fully understood, but in about 20 per cent of cases it is a hereditary condition that can be caused by a genetic mutation. This most often results in multiple cavernomas forming. Non-hereditary cavernomas are more likely to occur singly, and appear to form by chance.

The challenges of living with a rare condition

Being diagnosed with a cavernoma can sometimes be a long and frustrating journey. Lack of awareness of the condition both among the public and clinicians and symptoms that mimic other conditions can mean that it’s often misdiagnosed. Even after a correct diagnosis, patients can feel isolated, and the treatment pathway can seem complex and daunting.

Coping with life-disrupting symptoms such as seizures, limb weakness and memory loss can be stressful, and patients may not know how to access support and advice. Because it’s a rare condition, GPs and even some neurological specialists may not have much experience of managing them.

Why Cavernoma Awareness Month matters

In common with many brain conditions, cavernoma has historically been under-researched and underfunded. There have only been a limited number of large-scale clinical studies and not a great deal of pharmaceutical investment. This means that the treatment options are currently limited and there are disparities in patient access to the best treatment.

Greater visibility of the condition through initiatives such as Cavernoma Awareness Month brings the potential for increased research funding, faster diagnosis times, more effective treatments, and stronger patient support networks.

Cavernoma treatment pathways

Not all cavernomas require direct treatment, but are actively monitored for signs of change with regular MRI scans. If the patient is experiencing seizures, these may be treated with epilepsy medication. Headaches can be managed with painkillers.

However, if the cavernoma is causing bleeds or pressing on an important area of the brain, then surgical removal may be necessary. Traditionally, open surgery has been used to remove cavernomas that are in an accessible area of the brain. However, this carries significant risks and can lead to further complications.

Stereotactic radiosurgery

Stereotactic radiosurgery (SRS) involves directing multiple beams of radiation at the cavernoma from different angles to destroy the damaged blood vessels. One of the most accurate and effective forms of SRS is Gamma Knife surgery. This may be considered as a treatment option when open surgery is deemed too risky.

One of the advantages of Gamma Knife treatment is that it can usually be delivered in a single session, and the patient can go home on the same day. It does not involve making any incisions, and no anaesthetic is required, so recovery times are minimal.

The future of cavernoma care

Currently, there is still a lot of uncertainty around how best to treat cavernomas, or what the long-term outlook is for people who opt not to treat them. More research is needed into how cavernomas are formed and more clinical trials are needed to investigate the best treatments. That’s why the June awareness raising campaign is so important.

If you or a loved one has been diagnosed with cavernoma, learn more about how Gamma Knife surgery at Amethyst can help.

Amethyst Teams Participate In Innovative NHS ConfedExpo 2025

Amethyst Radiotherapy were pleased to participate in the NHS ConfedExpo 2025 in Manchester on 11 and 12 June. The event is the biggest UK health and care conference, attracting over 5,000 professionals and partners from across the sector to share insights and discuss new innovations.

Two of the main topics on the agenda were “Digital, AI, data and technology” and “Collaboration and partnerships.” As leading providers of cancer care and public-private partnerships, Amethyst are committed to investing in cutting-edge technologies that improve outcomes, widen access and enable more personalised treatment plans.

Here’s a look at the new possibilities AI and digital technology and PPPs are opening up for Amethyst’s Gamma Knife centres in London and Sheffield.

What is Gamma Knife surgery?

Contrary to what the name suggests, Gamma Knife surgery does not involve making any incisions with a blade, as required for traditional open surgery. It’s a form of stereotactic radiosurgery (SRS) that uses focused beams of radiation to target and destroy tumour cells without damaging the surrounding healthy area of brain tissue.

The treatment is already considered to be one of the safest and most effective types of SRS, particularly for patients with small to medium sized brain tumours, arteriovenous malformations, and some forms of trigeminal neuralgia.

Gamma Knife is often used in cases of meningioma and acoustic neuroma, sometimes in conjunction with regular neurosurgery, or as an alternative if the patient is not a suitable candidate for open surgery. It is highly accurate, which minimises the risks of side effects and complications.

Now, the next era of Gamma Knife technology is evolving. It is highly compatible with AI and data driven innovations, and this is shaping the future of SRS treatments to be more precise, personalised and beneficial than ever before. This can make the treatment process even more streamlined and effective.

Earlier and more accurate diagnosis

The signs of a brain tumour on MRI scans can sometimes be misinterpreted by human radiologists. Research has shown that machine learning is able to distinguish between hundreds of different types of lesions and accurately detect very tiny or complex changes around tumour boundaries.

It is also faster than human analysis, and can even be used to predict the rate of tumour growth. This leads to earlier detection and better information for clinicians to plan the most appropriate treatments, which improves the likelihood of successful patient outcomes.

More precise tumour contouring

Gamma knife treatment requires an exact map of the brain structure and tumour boundaries. AI tools can be used to provide auto-contouring, which gives an extremely accurate and detailed annotation of the tumour boundaries. When done manually, this process is very time-consuming and subject to human error or variations in interpretation.

AI contouring methods are much quicker and potentially more accurate at mapping brain tumours, leading to more effective treatments with fewer side effects.

Calculating effective biological dose

Research is currently ongoing into the use of AI for optimising the biological effective dose of radiation and exposure times. Furthermore, AI can be integrated into image-guided therapy platforms to allow neurosurgeons to monitor the radiation delivery and tumour response in real-time, and make adjustments if necessary.

This will minimise the risk of side effects caused by damage to the surrounding brain tissue.

Predictive outcomes

AI tools are trained through exposure to vast amounts of patient data, and this helps clinicians to better predict how a patient might respond to a specific treatment. This means that patients benefit from more personalised and effective treatment plans.

The future of PPPs and brain tumour treatment

Demand for brain tumour treatments is set to increase in the future as the population ages and lives longer than previous generations. Age is one of the risk factors for brain cancer, so the healthcare sector can expect to see a corresponding rise in diagnosis.

There is also a growing awareness among the public and GPs of the signs and symptoms of brain tumours, leading to more referrals to specialist healthcare teams.

As the NHS is under continuing pressure with tight budgets, growing demand and staff shortages, public-private partnerships (PPPs) are set to play a key role in shaping the future of healthcare in the UK. Amethyst is positioning itself as a leading provider of PPPs throughout Europe.

As an internationally successful private cancer care provider, we already work closely with the NHS at our two radiotherapy centres of excellence in London and Sheffield. In the future, we intend to position Amethyst as the go-to choice for PPPs, expanding patient access to the innovative treatments and experienced and knowledgeable clinicians.

Cavernoma Awareness Month: Symptoms And Treatment Options

June is Cavernoma Awareness Month, which aims to widen the public understanding of this rare but potentially serious neurological condition. Here’s a look at what cavernoma is, what the symptoms are, and what the main cavernoma treatment options are.

What is a cavernoma?

A cavernoma (also known as a cavernous angioma or cerebral cavernous malformation) is a cluster of abnormal blood vessels in the brain or spinal cord. It is described as having the appearance of a raspberry, and can range in size from a few millimeters to several centimetres.

A cavernoma can increase in size, but it is not cancerous and cannot spread to other parts of the body. The blood vessels that make up the cavernoma have unusually thin walls, and they can be prone to small leaks, either inwardly or outwardly into the surrounding tissue.

Occasionally, a more severe haemorrhage may occur, which can cause serious complications or even be life threatening. Cavernomas most commonly occur in the brain, but it’s estimated that about five per cent occur in the spinal cord. They may also occasionally occur in the brainstem, which can be particularly risky.

What causes a cavernoma?

Most cavernomas occur spontaneously with no clear cause. However, some cavernomas run in families, and genetic testing may be carried out to determine if this is the case. Other risk factors include radiation therapy to the brain, particularly in childhood, and a history of brain hemorrhages.

It’s estimated that about one in every 600 people is affected by a cavernoma, but as they do not always cause symptoms, this figure may be higher. According to the NHS, the most common age for a cavernoma to occur is between 20 and 40.

What are the symptoms of cavernoma?

The type and severity of cavernoma symptoms will vary depending on the location in the brain. Sometimes they can be asymptomatic, but if symptoms are present they may include:

  • Haemorrhage
  • Seizure (fits)
  • Headaches
  • Vision or speech problems
  • Dizziness, tremor, or problems with coordination or balance
  • Weakness or numbness
  • Memory problems
  • Tiredness
  • Difficulty concentrating
  • Slurred speech or double vision

How is cavernoma diagnosed?

The main method for diagnosing cavernoma is via a magnetic resonance imaging (MRI) scan. Sometimes, the condition will be picked up if the patient is having a scan for another reason, because it does not always have noticeable symptoms.

What are the treatment options for cavanoma?

The treatment pathway for cavernoma will depend on the number, size, and  location, and the type and severity of the symptoms. Cavernomas do not always require active treatment, and instead the focus will be on managing or treating any symptoms. The patient will have regular MRI scans to monitor the cavernoma for any changes.

Medication

If the patient is experiencing headaches or seizures, these may be controlled with medication.

Surgery

If the patient is considered to be at risk of a haemorrhage, then neurosurgery may be recommended to remove the cavernoma. This is a major operation with a high risk of complications and side affects, so the potential benefits need to be carefully weighed up against the potential dangers.

Stereotactic radiosurgery

If neurosurgery is considered to be too difficult or dangerous, then stereotactic radiosurgery (SRS) may be considered. This is a relatively new method of treating cavernomas, but there is evidence to suggest that it is a safe and effective treatment that is less invasive than conventional surgery.

SRS involves delivering high doses of radiation to the site of the lesions to destroy the abnormal blood vessels, eliminating the risk of a future haemorrhage.  It may be an option for high-risk cavernomas that are deeply located in the brain, or near to critical nerves that would make neurosurgery too dangerous.

Gamma Knife surgery

Gamma Knife surgery is a form of SRS that doesn’t involve surgical incision, but delivers precisely focused radiation beams from multiple angles to the cavernoma. The individual beams are low intensity, but multiple beams converge at the target to enable a powerful dose of radiation that is usually delivered in a single session.

Patients experience minimal downtime, and can usually return to their normal activities within a few hours of treatment, requiring no overnight stay in hospital. Gamma Knife may be considered as a treatment option if multiple cavernomas are present, or if the lesion is in an area that is difficult to reach.

Outlook for cavernoma

Cavernoma is a lifelong condition, but with proper care and management, many people can live full and active lives.

Raising awareness of the symptoms and treatment options can help patients to access the best quality of advice, support and treatment. Get in touch with the Amethyst Radiotherapy team today to find out more.

Understanding The Link Between MS And Trigeminal Neuralgia

May 30 is World Multiple Sclerosis Day, which is a day to raise awareness and bring the global multiple sclerosis (MS) community together. MS is a condition that affects the brain and spinal cord, and can lead to a wide range of symptoms. One of the lesser-known symptoms of MS that can affect quality of life is trigeminal neuralgia (TN).

Here’s a more detailed look at these conditions, including the options for trigeminal neuralgia treatment.

What Is Multiple Sclerosis (MS)?

MS is an autoimmune condition that causes the body’s immune system to mistakenly attack the myelin sheath, which is the protective covering around the nerves in the central nervous system. This disrupts the flow of information within the brain and between the brain and the body, resulting in a range of symptoms.

What are the symptoms of MS?

MS can affect different parts of the central nervous system, so everyone’s experience of it will be different. The symptoms can wax and wane (Relapsing-remitting MS or RRMS) or get progressively worse over time. Some people move into this phase after the RRMS stage, or it begins as soon as the symptoms first begin to appear.

The most common symptoms include:

  • Fatigue – one of the most disabling symptoms, often not visible to others
  • Vision problems – blurred or double vision, or even temporary loss of vision
  • Muscle weakness and spasms – especially in the legs or arms
  • Balance and coordination issues – leading to unsteadiness or falls
  • Numbness or tingling – often starting in the face, arms, or legs
  • Bladder and bowel problems – urgency or difficulty emptying the bladder
  • Cognitive changes – such as memory issues or slowed thinking
  • Pain – including nerve pain, which is where trigeminal neuralgia can come in

What is trigeminal neuralgia?

Trigeminal neuralgia (TN) is a chronic pain condition that affects the trigeminal nerve, which carries sensation from the face to the brain. It is often described as a stabbing or burning sensation in one side of the face, and can occur in brief bursts that may repeat several times during an attack. Some people with TN experience continual pain.

According to the MS Society, TN affects about two to five per cent of people with MS at some point, and it can also affect people who do not have MS. The level of pain experienced with TN can be excruciating, and even when it recedes, patients experience a dull burning sensation in the affected area.

TN attacks can be unpredictable and intense, which makes it a very difficult and distressing condition to live with. The pain can be triggered by regular activities such as eating, talking or any physical contact with the face. It can sometimes be mistaken for dental pain, so instances of TN may be underdiagnosed in the general population.

What causes TN?

In cases where TN is related to MS, it is caused by nerve damage around the trigeminal nerve root. There is a trigeminal nerve path on each side of the face, with three main branches. The exact location of the face pain will depend on which trigeminal branch or branches are affected.

In cases where TN occurs in people without MS, it’s most often caused by a blood vessel pressing on the nerve inside the skull.

What are the treatment options for TN?

The first line of treatment for TN is usually prescription painkillers (regular painkillers such as paracetamol and ibuprofen are ineffective for treating nerve pain). If drug treatment is ineffective, then surgical options might be considered. In this case, the patient will be referred to a neurosurgeon who will determine the best treatment pathway.

Stereotactic radiosurgery

One treatment option that might be considered is stereotactic radiosurgery (SRS). One of the most highly regarded forms of SRS is Gamma Knife surgery. This is a non-invasive procedure that uses highly focused beams of radiation to target the trigeminal nerve root, disrupting the pain signals.

Gamma Knife has a high success rate and a lower risk of side effects than many other forms of surgery, making it the preferred option for leading neurosurgeons. It is usually delivered in a single session, and involves minimal recovery time.

If you or a loved one is experiencing facial pain with MS or has a diagnosis of TN and you are interested in finding out more about Gamma Knife treatment, please talk to our team today.

Amethyst To Host Webinar On Vestibular Schwannoma Management

Amethyst Radiotherapy is pleased to host a live webinar on 5 June on the topic of Modern Management of Vestibular Schwannoma. The discussion will address the current management of small and medium-sized vestibular schwannomas (VS), and will also explore the emerging role of AI and technology in future methods of VS care.

The webinar will be led by two members of our expert medical team, including Mr Patrick Grover and Mr Matthias Radatz.

Mr Grover is a Consultant Skull Base and Vascular Neurosurgeon, with expertise in skull base tumors and vascular conditions, serving as the Cranial Neurosurgery Lead at the National Hospital in London, and recognised for his work in research and advanced surgical techniques.

Mr Radatz is a Consultant Neurosurgeon at Sheffield Teaching NHS Hospital and Medical Director of Thornbury Radiosurgery Centre, and a leading practitioner of Gamma Knife in stereotactic neurosurgery, treating cranial and extra-cranial CNS lesions.

Here’s an overview of vestibular schwannoma treatment, and the topics that will be discussed on the day.

Understanding vestibular schwannomas

Vestibular schwannoma (VS) are also known as acoustic neuroma. They are a fairly rare and usually non-cancerous type of tumour that grows on the vestibular nerve, which connects the inner ear to the brain. This nerve controls hearing and balance, and the main nerve that controls facial movement runs close to it.

Typically, a VS only affects the hearing and balance nerve on one side of the head. However, if the patient has a rare genetic condition called NF2-related schwannomatosis, it can affect both sides. Although VS is a benign tumour and does not spread to other parts of the brain, it can cause serious problems if it grows and puts pressure on the brain.

What are the symptoms of VS?

A VS is typically slow growing, so it can be present for years before any symptoms emerge. These may include loss of hearing in the affected ear; tinnitus (a persistent ringing or buzzing noise in the ear), and dizziness or vertigo.

The NHS explains that a larger VS may also cause persistent headaches, numbness, pain or weakness on one side of the face; difficulties with limb coordination, temporary blurred vision, voice changes or difficulty swallowing.

What is the modern treatment pathway for VS?

There is no fixed treatment pathway for VS, because the best approach depends on variables including:

  • Tumour size and growth rate
  • Patient age and general health
  • Presence of symptoms (like hearing loss, vertigo, or facial numbness)
  • Patient preferences

The watchful waiting approach

If the VS is small and slow-growing, it may be actively monitored with regular scans for signs of growth or other issues, rather than directly treated. This is sometimes referred to as the ‘watchful waiting’ approach.

Surgical removal

Larger or fast growing tumours, or those that are causing serious side effects, may need to be removed with open surgery. However, this is a major procedure with a risk of complications such as damage to the facial nerves or permanent hearing loss.

Stereotactic radiotherapy or radiosurgery

Stereotactic radiotherapy (SRT) or stereotactic radiosurgery (SRS) are the most common treatment pathways for smaller cases of VS. SRT refers to a course of multiple radiotherapy sessions carried out over a number of weeks. SRS typically refers to a single treatment session, and is often used in the case of smaller tumours.

Gamma Knife surgery

One of the most advanced types of SRS is Gamma Knife surgery. Despite the name, it does not involve any physical incisions into the brain. Instead, it delivers highly focused beams of radiation directed from multiple angles to target the tumour site.

Individually, the beams are too weak to cause any damage as they pass through the brain tissue to the tumour, but collectively the radiation intersects at the location of the tumour, causing the cells to die.

It’s up to 95 per cent effective at slowing or preventing further growth of the tumour, and has minimal downtime. It also has a lower risk of complications compared to conventional surgery.

How AI and emerging technology are shaping the future of VS care

Emerging technologies are making considerable advancements in the way that VS are diagnosed and treated. For example, machine learning algorithms can be used to analyse MRI scans more accurately and quickly than the human eye.

This reduces the margin of error and detects tiny details that would otherwise not be picked up, and speeds up the treatment pathway. Predictive tools can also be used to identify probable future growth patterns of tumours, leading to more accurate and personalised treatment plans for patients.