gamma knife - Medical professionals examining magnetic resonance imaging scans

The comedian Miles Jupp has discussed his recovery from a brain tumour, as he prepares to take to the stage again in January. Jupp is well loved for his comedy performances and also his acting roles in the CBeebies show Balamory, the Harry Potter films, The Thick of It, and Rev.

Jupp is appearing in the upcoming Ridley Scott film about the life of Napoleon, The Emperor of Austria, and is also about to embark on an extensive stand up tour of the UK between January and May.  He uses some of his recent experiences in the medical sector as inspiration for his comedy material.

In 2021, Jupp was diagnosed with a benign brain tumour after having a seizure. He subsequently underwent surgery to remove a tumour the size of a cherry tomato.

Although benign tumours are non-cancerous and unlikely to spread, they can press on important nerves in the brain and cause serious side effects such as seizures, vision disturbances, fatigue, loss of coordination, memory problems, and muscle weakness.

Jupp said of using his experience as stand up material: “I found being in hospital very uplifting, partly because you’re just surrounded by people who are very caring. It’s not me moaning about unsatisfactory customer experience. Hopefully it’s pure storytelling with a beginning, a middle and an end.”

Jupp has since made a good recovery from the neurosurgery, which is the main treatment for non-cancerous brain tumours. If it is not possible to remove the entire tumour, further treatment involving chemotherapy or radiotherapy may be undertaken.

Radiosurgery involves targeting the tumour with highly controlled doses of high-energy radiation to kill the tumour cells. It causes minimum damage to the surrounding cells, and avoids the need for invasive traditional surgery that involves cutting into the skull.

There are different types of radiotherapy machines, which generally either deliver standard external beam radiotherapy or stereotactic radiotherapy (SRT). The latter is used to deliver highly targeted beams that may be of a higher dose, which means that the treatment can be carried out in fewer sessions.

Some radiotherapy machines, such as Gamma Knife, are designed specifically to deliver SRT treatment.

Jupp discussed his experience further in an interview with Virgin Radio: “It’s terrifying. I sort of wrote it down after a while because, when I was first getting better, I was struggling to put things in order. At one point, I’d have to think for ages to remember the word ‘tumour’, which was, at that point, quite central to my life. So I thought I better start writing it down.”

Miles continued: “Every aspect of normal life when you go back, it scares you to do something for the first time. There was a period where I was doing things for the first time since the operation and thinking, ‘Will I still be able to do this particular thing? Will I still be able to ride a bike?'”

Jupp has fortunately recovered well and has used the experience as the basis of his new stand up routine.

For more information about brain tumour treatment, please contact Mr Andrew McAvoy of Amethyst Radiotherapy.

Gamma Knife surgery - Woman Experiencing Hot Flush From Menopause

A woman who needed surgery to remove a benign meningioma initially had her symptoms dismissed by doctors as being the effects of the  menopause. The Argus reports that Karen Griffiths from Eastbourne first visited her GP when she began to suffer from tinnitus in one ear during 2018.

Karen, now aged 60, was also suffering from morning headaches and experienced problems with coordination, speech, and thinking and memory. These are all common symptoms of a meningioma. Other signs may include a loss of smell, changes in vision, seizures, and weakness in the arms and legs.

A memingnoma starts to develop in the layers of tissue that cover the brain and spinal cord, known as the meninges. This type of tumour is mostly benign (non cancerous), and it is common, accounting for about 27% of all brain tumours diagnosed in England and Wales.

They are more common in women than men, possibly because of hormone levels. Some research suggests that there may be a link to breast cancer and possibly birth control or hormone replacement therapy. There may also be a link to obesity, and they are more common in older people.

Karen began to hear her heartbeat in one ear, a condition known as one-sided pulsatile tinnitus. However, she was told by her GP that this, and other symptoms such as headaches and brain fog, were down to the menopause. Eventually, the tinnitus grew so loud that Karen was referred to an ear, nose and throat specialist, who sent her for an MRI scan.

The scan revealed that Karen had a large meningioma that was pressing on a major nerve in her brain, causing the symptoms.

She told the Argus: “I was suffering with symptoms for over three years and it gradually got worse. Alongside that I was going through menopause and it is very well known that it can create headaches, brain fog and difficulty concentrating.”

She added: “One of the key things that got missed was that I was having headaches in the morning when I woke up. The one-sider pulsatile tinnitus got worse and worse but I was told not to worry about it. In my experience, they all too readily disregard them and blame them on something else instead.”

“My symptoms were disregarded for a long time, despite things getting steadily worse. I ended up feeling like a time waster. Looking back, it was quite dangerous.”

Karen had surgery to partially remove the tumour in March 2022. However, due to its location, some of the tumour had to be left in place. This means that she now has to regularly attend MRI scans to check that it is not growing in size.

Meanwhile, Karen reports that her speech, memory and balance are gradually improving, and she hopes to return to her job in insurance shortly.

For more information about meningioma treatment and Gamma Knife surgery, please contact Mr Patrick Grover of Amethyst Radiotherapy.

acoustic neuroma treatment - woman suffering headache

Acoustic neuroma, also known as a vestibular schwannoma, is a benign (non-cancerous) tumour that develops on the cranial nerve. This is the nerve that runs from the inner ear to the brain and controls the hearing and balance. Therefore although it is non-cancerous it can have serious side-effects and symptoms, and may require treatment.

The tumour will not spread to other parts of the body, but it can disrupt the ability of the eighth cranial nerve to transmit signals to the brain, resulting in problems with balance and hearing. It may also affect the facial nerves, making it difficult for patients to move facial muscles and carry out functions such as swallowing.

They are a rare type of tumour, and in many cases the typical symptoms have another cause of explanation. However, if symptoms such as hearing loss (often in one ear more than the other), tinnitus (a persistent ringing sound in the ears) or dizziness and difficulty with balance are present, these should be investigated further by a doctor.

The doctor may arrange an MRI scan to confirm or rule out the presence of an acoustic neuroma. If the diagnosis is positive, it can be an overwhelming experience. If the symptoms are not causing serious problems, it may be decided to actively monitor the tumour with regular scans but carry out no further treatment.

An acoustic neuroma that is causing troublesome symptoms may be removed with surgery or treated with radiation therapy to curb its growth. The type of treatment may depend on the size of the tumour, the severity of the symptoms, and the general age and state of health of the patient.

When the tumour has been successfully treated, this is often just the first step in the journey, as most patients will need to go through a process of rehabilitation and recovery. This process is multi-focused and will depend on the symptoms and side effects that are present. It will be tailored to individual patients, but may involve the following:

Neuro physiotherapy to regain balance and mobility. This may involve learning how to sit up straight and walk using supports, and eventually regaining the ability to walk independently.

Speech and language therapy to improve swallow function and vocal strength, and facial physiotherapy to improve facial function. It may also include occupational therapy to help the patient regain full control of their upper limbs and improve coordination, and specialist vestibular therapy to help regain control over balance.

The patient may also require neuropsychology if they have experienced issues with cognitive function and memory processing. These can be huge hurdles that require a lot of hard work and determination to overcome.

For more information about acoustic neuroma treatment, please contact Mr Patrick Grover of Amethyst Radiotherapy.

brain tumour treatment - CT Scan brain

Tributes have poured in for the prominent writer, performer and poet Benjamin Zephaniah, who died in December at the age of 65, just two months after being diagnosed with a brain tumour. Zephaniah was born in Birmingham in 1958, where he began his career as a performance poet during his teenage years.

He moved to London in his early twenties, where he developed his trademark ‘dub poetry’ style. His work tackled issues such as racism and class politics, and it often responded to current or historical events. His style was influenced by Jamaican culture and he went on to record with the Wailers after the death of Bob Marley.

A post on his Instagram page stated: “Benjamin’s wife was by his side throughout and was with him when he passed. We shared him with the world and we know many will be shocked and saddened by this news.”

“Benjamin was a true pioneer and innovator, he gave the world so much. Through an amazing career including a huge body of poems, literature, music, television and radio, Benjamin leaves us with a joyful and fantastic legacy”.

About 16,000 people in the UK are diagnosed with a brain tumour each year. Sometimes, the warning signs can go unnoticed, or be wrongly attributed to other causes by doctors or the patients themselves. However, early diagnosis brings the best chance of successful treatment.

The most common signs of a brain tumour include memory loss, vision problems, fatigue, seizures, communication difficulties, and changes in personality. Anyone with any concerns about themselves or a loved one is advised to contact a medical professional straight away.

For more information about brain tumour treatment, please contact Mr Andrew McAvoy of Amethyst Radiotherapy.

brain metastases treatment - Syringe and vaccine with drugs

A review of papers for brain cancer that has spread from the lungs (known as secondary cancer or metastases) has led to hopes that already licensed drugs could be used to treat the condition. Researchers at the University of Bristol have published the results of their findings in Neuro-Oncology Advances.

The researchers also discovered that there were genetic differences between smokers and non-smokers. Any type of cancer can spread to the brain, but the most common causes of brain metastases are lung cancer and breast cancer. As the cancerous cells grow in the brain to form a tumour, it can put pressure on the surrounding brain tissue.

Common signs of brain metastasis include headache, changes in personality, numbness or tingling, confusion, memory loss and seizures. Anyone with suspected symptoms is advised to consult an oncologist as soon as possible. Treatments typically include neurosurgery, radiotherapy, stereotactic surgery, chemotherapy, or a combination of all these approaches. 

There is no cure for metastatic brain cancer and sadly most patients die within one year of diagnosis. The research team led by Bristol University wanted to discover more about how lung cancers behave once they reach the brain, which is currently an under researched area. 

They studied records of genetic mutations from 72 research papers on the topic of brain metastasis and non-small cell lung cancer (NSCLC). From this they were able to identify five of the most commonly mutated genes. They also looked at data regarding smoking history, genomic data, and demographics. 

The studies suggested that in cases where the most commonly mutated genes were present, the cancer could be treated with drugs that were already approved and licensed by regulatory agencies. 

Kathreena Kurian, Professor of Neuropathology and Honorary Consultant at North Bristol NHS Trust, Head of the Brain Tumour Research Centre at the University of Bristol and co-author of the paper, said: 

“Our research recommends that all patients should have their brain metastasis examined for mutations in addition to their primary lung cancer because they may be different. This evidence could form the backbone for new clinical trials for patients with brain metastasis in non-small cell lung cancer using drugs that are already available.”

About 25,000 patients in the UK suffer from cancer that has spread from the brain. The research was partly funded by Cancer Research UK, who support ongoing work to understand more about how secondary cancer develops and why a treatment might stop working. 

A diagnosis of secondary brain cancer can be a stressful and distressing experience for both patients and their families. Everyone’s reactions are unique, but it is normal to experience emotions such as anger, sadness, loss, fear, and anxiety.

Some people prefer to turn to close family members and friends for support, while others may reach out to counselling services, mental health charities, or local organisations such as religious groups or support groups. 

 

For more information about brain tumour treatment, please contact Mr Andrew McAvoy of Amethyst Radiotherapy.

Gamma Knife surgery - Doctor doing stem cell therapy on a patient's knee

A clinic trial for a potential treatment for multiple sclerosis (MS) has shown promising results. The University of Cambridge reports that a team of scientists have shown that injecting stem cells directly into the brains of MS patients appears to have a protective effect. The treatment was shown to be safe and well-tolerated.

The study was led by researchers from University of Cambridge, University of Milan Bicocca and Hospital Casa Sollievo della Sofferenza (Italy). They found that delivering a special type of stem cell into the brain had the potential to reduce inflammation and protect nerves. The process has been tried with animals, but this is the first human study.

The neural stem cells from one donor were grown in a dish to ensure that they were identical and would give consistent and comparable results. The cells were delivered into the brains of 15 patients with secondary progressive MS. None of the participants had any serious side effects from the injection.

The patients were monitored with regular followup appointments for the next 12 months, and non experienced relapses or progression of their condition. This demonstrates that the stem cell treatment could be potentially used as an effective MS therapy.

Professor Stefano Pluchino from the University of Cambridge, who co-led the study, said: “We desperately need to develop new treatments for secondary progressive MS, and I am cautiously very excited about our findings, which are a step towards developing a cell therapy for treating MS.”

“We recognise that our study has limitations – it was only a small study and there may have been confounding effects from the immunosuppressant drugs, for example – but the fact that our treatment was safe and that its effects lasted over the 12 months of the trial means that we can proceed to the next stage of clinical trials.”

Caitlin Astbury, Research Communications Manager at the MS Society said: “This is a really exciting study which builds on previous research funded by us. These results show that special stem cells injected into the brain were safe and well-tolerated by people with secondary progressive MS.”

She added: “They also suggest this treatment approach might even stabilise disability progression. We’ve known for some time that this method has the potential to help protect the brain from progression in MS.”

“This was a very small, early-stage study and we need further clinical trials to find out if this treatment has a beneficial effect on the condition. But this is an encouraging step towards a new way of treating some people with MS.”

MS is a condition that causes the body’s own immune system to attack the nerve fibres around the brain and spinal cord. This causes chronic inflammation and problems with muscle coordination, vision, and cognition.

For more information on multiple sclerosis treatment and Gamma Knife surgery, please contact Mr Jonathan Hyam of Amethyst Radiotherapy.

Gamma Knife Treatment

We need to get more students and consultants interested in Stereotactic radiosurgery writes Ms Mary Murphy, MD Fellowship of the Royal Colleges of Surgeons and Clinical Director of Neurosurgery and Consultant Neurosurgeon.

Stereotactic radiosurgery (SRS) has an increasing role to play in the treatment of neurological diseases. Currently, SRS offers a non-invasive outpatient treatment option for complexly located brain tumours and neurovascular lesions. But SRS systems such as Gamma Knife are also increasingly recognised as an alternative treatment option for functional neurological conditions such as tremor, epilepsy, and some psychiatric disorders.

However, currently there is no formal or structured pathways for junior doctors to specialise in SRS, so it is not well known as a treatment modality among the wider medical community.

There are various indications for SRS, and these are expanding with developments in research on how this technology can be utilised. Expansion like this is vital as the global population is ageing at the fastest rate ever, according to the UN’s World Special Report 2023. And while brain tumours can occur at any age, the risk of developing most pathologies increases with age – the risk of brain tumours is greatest in those aged 85-89, an age group that tolerates surgery very poorly. This means that the demand for treatment systems like SRS is steadily growing.

Indications for Gamma Knife radiosurgery are also expected to extend to ‘nodular’ lepto-meningeal disease and other advanced forms previously reserved for palliative whole brain radiotherapy, which tends to impair and/or reduce cognitive brain function. Despite such expected developments though, there is a lack of time and resource among current consultants to proactively encourage and attract students – especially without any initial structured exposure.

Very few centres offer SRS treatment, especially with the equipment and installation of these systems driving a steep upfront investment cost. Not only does this mean that cases suitable for SRS are not being referred, and therefore receive treatment modalities that carry higher risk, unnecessarily; but it also means that there is a lack of awareness among junior doctors that this is an area in which they can specialise.

If there is not robust neurosurgical representation in this area, there is a risk of SRS becoming the domain of radiation oncologists. While both neurosurgeons and radiation oncologists are critical voices to sit on an MDT to determine the best course of treatment, the pathologies treated by SRS are traditionally neurosurgical pathologies. This means a neurosurgeon is best placed to give a balanced view of the most effective treatment, and they can best do that if SRS is in their armoury, or at very least, on their radar.

Currently, the main entry point for junior doctors to specialise in SRS is if they rotate through a centre or work under consultants with a direct interest in this area. This means that they usually ‘fall into’ it by accident. As neurosurgery is not covered in detail during medical school, it takes a remarkable person to seek out SRS as a speciality.

So, there is a potential problem with exposure to SRS expertise and the next generation of medical professionals.

Ideally, currently practicing neurosurgeons should take more control of how SRS expands – in terms of how junior surgeons are educated, and how to involve the existing medical community. Neurosurgery is a vast and very complex area, so it takes an exceptional individual to have the capacity to encompass that extra expertise.

For example, over the past 5-6 years, from approximately five vascular fellows I have trained, only one has managed to take the time to shoe-horn SRS training into an already busy day.

Where traditional neurosurgical education has been focussed on open surgery, medical developments (such as functional neurosurgery, high CPU and focused radiation) are moving away from open surgery in efforts to mitigate risk. Importantly, medical students in neurosurgery should see more than traditional operating practices, yet the neurosurgical representation in this area is not strong enough. More presence is needed in the way of developments, research and academia to attract more practitioners to this area.

One way to address this challenge is to educate consultants in more peripheral units in SRS. Many of them are typically removed from updates and developments in the area. As the indications for SRS are much greater than they were ten to fifteen years ago (and it has a lot to offer elderly, sick or frail patients, for whom open surgery is too risky), there should be a consideration for SRS with almost any patient presenting with neurosurgical pathologies.

In an effort to widen this knowledge base, I recently chaired a session on Radiotherapy for the Society of British Neurological Surgeons Conference Cork 2023 (SBNS).

The panel comprised national and international experts who gave an overview both on traditional SRS platforms like Gamma Knife as well as the whole of SRS. The purpose of the discussion was to provide education to all levels of interest from medical students to consultants to make SRS more accessible, more mainstream and relevant for neurosurgeons who otherwise would not be thinking about it. The hope is to get consultants involved with SRS and communicating more with those specialising in SRS, and specifically to get training grade neurosurgeons involved and understanding when to refer patients.

Ultimately, we must give future generations of neurosurgeons more structured learning around SRS. This puts them in the strongest position to deliver the best possible patient care.

 

Gamma Knife radiosurgery - donation

A woman who was diagnosed with an aggressive form of brain tumour has raised £8,000 for charity. The BBC reports that Catherine Heald from Northampton completed a marathon and a 274 mile bike ride despite undergoing treatment. 

Ms Heald, 39, began to suffer from persistent headaches that grew progressively more severe, and then she noticed that she could feel her heart throbbing in her left ear. She was diagnosed with an ear infection, but the headaches returned and eventually she was admitted to hospital for a CT scan in June 2020.

The CT revealed a large mass inside her brain, and she underwent neurosurgery to remove it. This procedure was followed up with radiotherapy and chemotherapy. Despite having a prognosis of just 12 months, Ms Heald has gone on to raise thousands of pounds for charity through a series of sporting challenges. 

She said: “I came up with ‘Cat’s Crazy Charity Challenge’ – both my husband and my parents thought I was absolutely insane. I wanted to cover 1,206.20 miles to coincide with the day I was diagnosed (12 June 2020) over 17 weeks, which coincides with my last treatment date.

I had to combine cycling, walking and trampolining.”

She added “The headquarters of Brain Tumour Research are a 10 minute walk from where I grew up, so they are my local charity.”

Brain Tumour Research said: “Brain tumours kill more children and adults under the age of 40 than any other cancer, yet just 1% of the national spend on cancer research has been allocated to this devastating disease.”

The charity reports that its petition to call for increased investment into research for brain cancer has reached a total of over 81,000 signatures. 

During October, various charity events were held to raise awareness and funds for brain tumour research, including a crew of pirates on the Isle of Wight. A group of ten friends dressed up as pirates of the high seas and toured the pubs and restaurants of the island to collect donations.

Captain Steve Usher explained that the fancy dress fundraiser was inspired by the experience of one of their friends, who has been fortunate enough to survive a brain tumour diagnosis. He has since had to wear an eye-patch, which made him feel self-conscious, so his friends decided to join in. 

Usher said: “We weren’t going to let him wallow for long and told him not to lose his sense of humour. To get him over it, we press-ganged him to the Isle of Wight for a fancy dress pirate weekend, seafarer’s logic leading us to believe he wouldn’t stand out if we were all wearing eyepatches.” 

So far, the gang have managed to raise over a thousand pounds for charity. 

For more information about Gamma Knife radiosurgery and glioblastoma, please contact Mr George Samandouras of Amethyst Radiotherapy.

headache - metastatic brain tumour

Getting a brain tumour diagnosis is something nobody wants to go through, which is why it is essential anyone who suspects something is wrong with them seeks medical advice as soon as possible. 

However, in order to know what symptoms are suspicious, you need to have a good idea about the first signs of a brain tumour. Here are a few you should be on the lookout for. 

 

Headaches

Anyone can suffer from headaches and it doesn’t mean you have a metastatic brain tumour, but if these become more frequent, worsen with activity, wake you up at night, make you feel sick, or start to feel severe, they should be checked out. 

 

Seizures

Seizures often affect your entire body, but can also just be twitching of the hands, so pay attention to any involuntary movement. They occur in 80 per cent of people with brain tumours, so if you begin to have them, see a doctor immediately. 

 

Personality changes

If you notice your behaviour has changed, or other people have mentioned that your personality is different, this can be difficult to digest. However, it is imperative you don’t ignore it, as it could be a sign of a brain tumour, especially together with confusion or memory loss. 

 

Problems with vision

Whether you have always had perfect vision or you wear glasses, you might suddenly find your vision deteriorating or you may experience periods of poor eyesight. Any signs of blurred or tunnel vision, or floating shapes, should be checked out.

 

Nausea or vomiting

There could be a lot of causes of nausea or vomiting, but if this is coupled with any of the other symptoms, it could be an indication of a tumour. 

 

Drowsiness, fatigue, or mobility problems

Some people feel drowsy, overwhelmed with fatigue, have a weakness in their body, or struggle with their memory and concentration. These are all early warning signs of a brain tumour, so if it concerns you, seek medical help as soon as possible.

gamma knife radiosurgery - Serious sad woman

Being diagnosed with a brain tumour can be a traumatic experience, and it can bring a rollercoaster of emotions. Everyone will have different ways of dealing with it, whether they prefer to reach out to family and friends or process events by themselves.

Even after a brain tumour has been treated with a method such as Gamma Knife radiosurgery, chemotherapy, or neurosurgery, you will need to have regular follow up appointments to check how you are feeling and possibly if there is any sign that the tumour is returning or growing. 

The regularity of your follow up appointments will depend on the type of brain tumour and what grade it is, and what treatment you have had. At the appointment, you will normally meet with a doctor or nurse to talk about how you are getting on, and if you are experiencing any side effects from the treatment.

You may also have blood tests and MRI scans to check if the tumour is regrowing or has come back. For many people, attending a follow-up appointment can understandably be an anxious or stressful time. Visiting the hospital may bring back unpleasant memories, and the person may have concerns about what the MRI results will show.

It’s important to remember that the point of the follow-up visit is to make sure that your health is keeping on track and that your recovery process is the best it can be. Attending the appointments promptly means that any concerns can be addressed and problems dealt with before they have a chance to escalate. 

It can help to prepare yourself mentally and emotionally for the appointment beforehand. It is useful to write down any questions or concerns you want to address in advance, because it can be easy to forget when you are feeling slightly overwhelmed or anxious. It’s important to be honest and accurate about any new symptoms or health worries you have.

If you are finding it hard to cope emotionally or psychologically, you should also discuss this with the nurse or doctor, because they may be able to help by referring you to a counsellor or psychologist. It can be very helpful to take someone with you for support, and to help remember to ask all the relevant questions and retain the information you are given.

If you do feel anxious or depressed about upcoming appointments, remember that you are coping with a difficult situation and it is perfectly normal to feel the way you do. Remember that your medical team will want to help you and bottling up your feelings can make things worse. 

A counsellor can help by sorting out complicated feelings and helping you to gain some perspective and insight into how you are really feeling. They can also help you to express your emotions, and to think about the best way to solve problems or accept a situation that cannot be changed.