Why Gamma Knife Radiosurgery Offers Unmatched Precision In Brain Tumour Treatment

One of the most common treatments for cancers, brain lesions and growths is radiotherapy, as it is often the most minimally invasive, minimally harmful and minimally inconvenient option for early-stage conditions.

Whilst conventional surgery can be invasive and typically requires rest and observation days, and chemotherapy uses drugs that can have quite strong side effects for certain people, someone can step into a radiotherapy centre, have a treatment that lasts a matter of hours and potentially walk out the same day.

Beyond the convenience aspect, radiotherapy needs to have some degree of precision in order to provide the greatest effect with the least amount of harm, and in that respect, radiotherapy treatments aimed at the brain are more precise than treatments designed for other parts of the body.

There are a few reasons for this, which centre around medical knowledge of the brain, the baseline requirements for treating brain conditions and the philosophy of medical treatment.

As the pioneer of the Gamma Knife radiosurgery treatment, Lars Leksell put it, there is no degree of refinement that is too precise for the human brain.

The Brain Moves More Predictably

One of the most interesting research fields as of late when it comes to radiotherapy is the potential for real-time diagnostics.

The reason why this matters is that many organs and parts of the body have a fairly wide range of motion, and where they are placed often depends on how someone is positioned or sitting.

This makes it quite difficult to plan treatments and often requires affected areas to be heavily secured to ensure that there is as little variation as possible between the position of the body when the scans were made and when the treatment is undertaken.

With the brain, there is far less variation in movement. The brain does move like any other organ, but these tiny motions are barely perceptible and fundamentally do not affect treatment.

As well as this, the brain is contained within the skull and the layer of cerebrospinal fluid that is vital to protect the brain in a wide variety of ways, both physically and in the regulation of substances within the brain.

This has the side effect of meaning that the brain largely stays where it is, and by extension, any growths or tumours that have not grown or metastasised will also remain in the same place they were found after a CT or MRI scan.

This allows for more precise treatment plans to be followed, with the minimum amount of radiation exposure necessary to destroy the growth or cancerous mass.

As well as this, the frames that are used to ensure that treatments are precise and unhampered by involuntary movement are more effective as they only need to stop external movement.

The Brain Has Been Accurately Mapped

The concept of stereotactic surgery predates its use in the Gamma Knife for many years and was initially used as a way to create an atlas of the human brain in an era when radiotherapy was not a fully established treatment and CT scans did not exist.

Victor Horsley and Robert Clarke created the Horsley-Clarke apparatus, which allowed them to create an accurate and detailed map of animal brains and similar systems were later applied to the treatment of humans as well.

Because there is less movement in the brain, the organ and its component parts can be mapped using a quadrant or coordinate system. Horsley-Clarke used a cartesian coordinates system, Lars Leksell used polar coordinates, and other systems such as Talirach and MNI are specifically used for brain treatments.

This means that the planning stages for a Gamma Knife treatment are particularly precise, which allows for accurate and effective results.

No Tool Too Refined

Lars Leksell has described his motivations for creating the Gamma Knife several times before his death in 1986, wanting to create a form of surgery that was less brutal and bloody than the treatments that he had learned at the Karolinska Institute.

He also noted that there is no such concept as too much precision when it comes to brain surgery, because of the complex interplay between the various different parts, and how any slight deviation from a treatment plan can have unexpected consequences.

The ideal for Mr Leksell was a form of surgery that required no incision at all, given that most stereotactic surgeries at the time involved the use of electrodes inserted to cauterise certain growths.

With the aid of an array of tiny beams of radiation focused on a fixed point, Mr Leksell no longer needed to make incisions for most common brain treatments.

Understanding Trigeminal Neuralgia and Multiple Sclerosis

Trigeminal neuralgia (TN) and multiple sclerosis (MS) are distinct neurological disorders. However, according to the MS Society, it is estimated that people with MS are 20 times more likely to experience TN than those without MS. Here’s a look at the causes, symptoms and treatments for trigeminal neuralgia occurring with MS.

What is Trigeminal neuralgia?

TN is caused by damage to the trigeminal nerve, which can trigger shooting pain in the face. The acute attacks of pain are described as sudden and severe, usually occurring in short stabbing bursts lasting up to two minutes, but sometimes just a few seconds. The pain is commonly felt on one side of the face, usually in the jaw, teeth or gums.

The pain can relapse and recur, with weeks or months in between attacks. However, over time the condition may get progressively worse and the pain becomes more frequent. Sometimes, TN can progress from acute to chronic pain, which is more likely to be an aching or burning sensation that is constantly present.

TN is thought to be a relatively rare condition that affects more women than men, and usually starts between the ages of 50 and 60. The attacks sometimes have an identifiable trigger, such as brushing the teeth, eating, washing, or moving the head. In some cases, there appears to be no reason for the onset of pain. 

What is multiple sclerosis?

Multiple sclerosis is a lifelong autoimmune condition that affects the central nervous system around the brain and spinal cord. The immune system mistakenly attacks the myelin sheath that covers the nerve fibres, resulting in difficulties of communication between the brain and spinal cord.

This can cause a wide range of problems that may get worse over time, or recur and relapse. Most MS patients eventually live with some degree of disability. 

Diagnosing TN

Anyone who is experiencing acute or chronic pain in their face should see a GP, who will carry out a review of the medical history, and may request some tests to try to identify the cause. In some cases there may be an alternative explanation, such as dental problems. The doctor may request an MRI scan to identify any abnormalities in the trigeminal nerve. 

What challenges do MS patients with trigeminal neuralgia face?

TN in itself can be a debilitating condition to live with, causing difficulty eating and sleeping, often resulting in weight loss. Patients may become depressed as a result of the severe pain, or become more socially isolated due to being physically unable to partake in usual activities such as exercise or going out for meals. 

MS patients face more severe challenges, because they may already be dealing with a wide range of other symptoms that are complex to manage. Therefore TN can seriously impact their quality of life and increase their current level of disability. 

The mental health of MS patients living with TN may suffer, particularly if it develops into chronic pain. Depression and anxiety are understandably common among MS patients, and it can be debilitating in itself. Combined with pain and all the other potential difficulties caused by MS, patients who also experience TN can be even more vulnerable. 

How can trigeminal neuralgia be treated?

The first line of treatment for TN is usually painkillers such as paracetamol or ibuprofen. However, these may not be effective for severe pain. In this case, doctors may prescribe anticonvulsants. If this is not successful or causes too many side effects, then the doctor may recommend a type of surgery.

In some cases, Gamma Knife radiosurgery has been found to be effective for treating TN. This is not traditional surgery involving an incision into the skull, so it carries much less risk for infections, bleeding and the other complications associated with open surgery. 

The radiosurgery involves applying a very high dose of gamma radiation that is precisely targeted at points along the trigeminal nerve. This causes deliberate damage to the nerve, resulting in a loss of feeling and relief from pain. 

If you are looking for further information on face pain and trigeminal neuralgia, please contact Mr Jonathan Hyam of Amethyst Radiotherapy..

Charities To Establish New Brain Tumour Research Centre

As we enter Glioblastoma Awareness Week (GMB Week) from 15-21 July this year, The Brain Tumour Charity has announced an important step forward for the field of brain tumour research as they team up with the Beatson Cancer Charity. They will establish a new research centre in Scotland in an attempt to find a cure.

During the collaboration, leading experts in the field of brain tumour research will work together and in partnership with Glasgow University and Edinburgh University. It will be the base for the biggest group of GMB researchers in the UK. 

What is GMB Week all about?

GMB is dedicated to raising awareness of GBM, which is the most commonly diagnosed high-grade (cancerous) brain tumour in adults. It is a devastating disease with a prognosis of just 12- 18 months. Approximately 3,200 adults are diagnosed with a GMB each year in the UK.

What are the treatment options for GMB?

Currently treatment options mainly include surgery, chemotherapy and radiosurgery. However, the method of treatment will vary depending on the size and location of the tumour, and the general health and preferences of the patient. 

The  first line of treatment is usually neurosurgery to remove the bulk of the tumour. However, because GMBs often have diffuse edges, it can be difficult to remove the tumour completely. This means that some of the tumour may remain and have the potential to grow. In this case, the GMB may be treated with a combination of chemotherapy and radiation.

An advanced method of radiation treatment that may be suitable for small remaining parts of the tumour is Gamma Knife Surgery. This is a type of stereotactic radiotherapy that is designed to deliver closely targeted beams of gamma rays that leave the surrounding healthy tissue intact. 

The higher dosage of radiation means that often the treatment is delivered in one session, which can last from about 15 minutes to several hours, depending on the size and nature of the area being treated. 

Funding is still required for the new research centre

The Brain Tumour Research chief executive, Dan Knowles, explained that they were still working to secure funding for the new research centre in Scotland. If successful, the team aims to run clinical trials for potential new GBM treatments. 

Knowles said: “New, improved treatments for GBM patients are desperately needed. At present, new discoveries and approaches are not progressing quickly enough into clinical testing in patients.”

“The Scottish Brain Tumour Research Centre of Excellence will help bridge this gap leading to pivotal preclinical proof-of-concept data to support clinical trial development for patients.

“The centre represents a significant investment in Scotland and would complement our other centres of excellence at the University of Plymouth, Imperial College London, Queen Mary University of London and the Institute of Cancer Research.”

Martin Cawley, Beatson chief executive, said: “This is such an exciting initiative and one which has the positive potential to make a significant impact into advancing research and ultimately new treatment options for brain tumours.

“Beatson Cancer Charity is delighted to be working in partnership with Brain Tumour Research to make this happen. I have no doubt this will result in a deeper understanding of the complexity of brain tumours and lead to a breakthrough in exciting new treatments in the years ahead.”

The only way to provide more advanced treatments and even a possible cure for aggressive brain tumours is through more research into the causes and drivers of the disease. This is only possible through adequate and well-administered funding levels that are available for research projects as well as drug development. 

Over the past few decades, developments have been extremely limited and progress has been frustratingly slow. However, charities such as the Brain Tumour Research Centres of Excellence continue to do vital research, and they work in partnership with a range of other organisations, from world leading university departments to other research charities. 

Despite the slow progress in new treatments, there are many excellent centres for the treatment of brain tumours in the UK, offering the most cutting edge techniques available, as well as robust post-treatment care plans.  

If you would like some more information about Gamma Knife surgery and brain cancer, please contact Mr Neil Kitchen of Amethyst Radiotherapy.

Alfie Boe Launches Rose For Father Lost To A Brain Tumour

The tenor and musical theatre star Alfie Boe has launched a rose in memory of his late father, who died from a brain tumour in 1997 when Alfie was 23 years old. The Alfred Boe Rose was launched at the RHS Hampton Court Flower Show on 6 July, and the proceeds will raise funds for the charity Brain Tumour Research. 

The Evening Standard reports that Mr Boe also expressed his frustration at the lack of progress in understanding and treating brain tumours, even 25 years after the death of his father.  

Brain tumours are the biggest killer of people under the age of 40 compared to any other type of cancer, but just one per cent of all cancer research funding has been spent on brain tumours since records began in 2002. 

Writing on Instagram, Mr Boe said: “A fun yet emotional morning down at RHS Hampton Court Palace Garden Festival 2024 launching the Alfred Robert Boe Rose with the fantastic @harknessroses1879 in memory of my late father. We are proud to donate £2.50 from the sale of each ‘Alfred Robert Boe’ rose to @braintumourrsch charity which I am a Patron for.”

In a further press statement he added: “My dad loved his roses, so it’s really special for me to do this in his memory while helping to raise money for Brain Tumour Research, a charity I am very proud to be a patron of and which is working to find a cure for this devastating disease.”

“It makes me angry that, in all this time, the situation for patients like Dad hasn’t really changed. I feel incredibly sad to think that families are still facing this awful diagnosis and, nearly 30 years later, there have been so few advances in treatment.”

“There is no doubt in my mind that research into brain tumours should be a priority and I am ashamed to think that charities are having to do so much in this area. The Government should be doing so much more.”

Dan Knowles, the chief executive of Brain Tumour Research, said he hopes the flower will raise funds and awareness to progress their “research into brain tumours and improve outcomes for patients like Alfred who are forced to fight this awful disease”.

Mr Boe, from Blackpool, has long been committed to raising awareness of brain tumours, and his latest Encore tour has raised over £16,000 for further research. He has spoken openly to his audiences about his distressing experience of losing his father to a brain tumour and participated in fundraising Shine A Light and Wear A Hat Day events.

At his show in Cardiff in June, Alfie met fan and volunteer Debra, who lost her only child Jenna to a brain tumour in January. Jenna was 15 years old and had been diagnosed with a diffuse hemispheric glioma 15 months previously.

Debra said: “Hearing Alfie speak during his show about his father was so moving and it’s clear he is so passionate about raising awareness for Brain Tumour Research. His fans were lovely, they were queuing up to donate and several of them shared their own experiences of how brain tumours had affected them.”

“Meeting Alfie was the icing on the cake. He stopped to chat and he ended up asking to have a photo taken with us, rather than the other way around!”

Despite continual research, scientists do not fully understand what causes brain tumours, and this limits the type of treatments that are available. There are over 120 different types of brain tumour, and around 16,000 people will be diagnosed with one each year in the UK. 

Brain tumours are divided into four classifications: grades one, two, three and four. Grades one and two are slow-growing non cancerous tumours, and grades three and four are cancerous tumours that can spread quickly and can result in a short prognosis. 

Low grade tumours may be actively monitored rather than treated, but high grade tumours require urgent attention. The most common types of treatment for brain tumours include surgery, radiotherapy, and chemotherapy. Sometimes a combination of two or more treatments will be used, depending on the size, location and type of tumour.

Smaller tumours may be treated with stereotactic radiotherapy, sometimes also called Gamma Knife surgery. This involves delivering very high doses of gamma rays to a precisely targeted area, to destroy the tumour cells and leave the surrounding healthy tissue untouched. 

For more information about Gamma Knife surgery, please contact Mr Neil Kitchen of Amethyst Radiotherapy.

How Can People With MS Manage Fatigue And Energy Levels?

Multiple sclerosis (MS) is an autoimmune condition that causes disruption to functioning of the central nervous system. This can lead to a wide range of symptoms that impact the quality of life of the patient. There is no cure for MS, but there are treatments that can potentially slow its progress or lessen the frequency or severity of relapses.

Many people find that by actively managing their symptoms and general health, they can improve their quality of life and make the condition easier to live with. Here’s a look at some daily living strategies that people with mild to moderate MS may find beneficial.

Fatigue is one of the most common symptoms of MS, and it can be seriously debilitating. It’s more than feeling tired most of the time; it’s feeling exhausted to a degree that is out of proportion to the activity undertaken. The fatigue can also be mental, causing brain fog and worse short term memory and concentration levels. 

Fatigue can be a difficult problem to manage, and it is not always easy to explain to other people the impact it has because there are no visible symptoms. It can come on suddenly and doesn’t necessarily go away with rest. 

Researchers are not completely sure why so many people with MS are affected by fatigue, but it is thought that it can be the result of the condition itself, or the consequences of living with the condition. The former type is simply thought to be because it takes up more energy for the damaged central nervous system to do its job.

The latter, known as secondary fatigue, is thought to be a result of symptoms such as pain, depression, weaker bladder control, disturbed sleep, or the side effects of medication. While it is not possible to prevent the feeling of fatigue occuring, it is possible to manage energy levels through lifestyle and strategic planning.

Boosting energy levels can be achieved through a combination of eating healthily, sticking to a good sleep routine, taking exercise, and managing stress levels. Planning and prioritising can help to ensure that the energy available is used in the most effective way.  

Eating small, frequent meals that contain a good balance of proteins, fibre and unsaturated fats can help to maintain a steady supply of energy and avoid sudden crashes. This not only improves energy levels, but also helps to maintain a healthy weight, keeps the skin and bones in good condition, and reduces the risk of developing other health problems such as high blood pressure, heart disease and some types of cancer. 

Sleep is obviously crucial to our ability to mentally and physically refresh our bodies and minds. To give yourself the best chance of a good night’s rest, go to bed and get up at the same time every day; limit intake of caffeine, alcohol and other stimulants; and develop a wind down routine that starts an hour or so before bed to help your mind prepare for rest. 

It is natural to reduce activity levels when you are feeling fatigued, but this can make the problem worse, because the more unfit you become, the more difficult and energy-intensive every day tasks of living will become. Staying active does not necessarily mean going to the gym; it can include household chores, carrying groceries, or going for a brisk walk. 

As well as boosting your energy levels, it’s important to make sure that you are making the best use of the energy that you have available. Keep a journal to record which activities you find most tiring, and plan to spread them out throughout the week rather than attempting too much in a short period of time. 

If you are currently struggling to carry out all of the activities you have planned, prioritise them in order of importance. However, remember that you should prioritise enjoyable activities as well as chores, otherwise your mental health may begin to suffer and this can in turn be a further drain on your energy and motivation levels. 

Make sure that you take regular breaks in between activities and break bigger jobs up into smaller more manageable steps if need be. If you have the opportunity to delegate tasks to family members or friends, this can help you to conserve energy levels. 

Be mindful of other people’s time pressures and responsibilities, and consider exploring the possibility of hiring paid assistants for jobs such as gardening, cleaning or laundry. 

If you would like some more information about multiple sclerosis and Gamma Knife surgery, please contact Mr Jonathan Hyam of Amethyst Radiotherapy.

Olympic Hopeful Reveals Inoperable Brain Tumour Diagnosis

The professional swimmer Archie Goodburn has revealed that he has been diagnosed with a rare form of inoperable brain tumour. BBC News reports that the 23 year old began to experience unusual symptoms during trials for the 2024 Olympic Games, and received the devastating tumour diagnosis six weeks ago.

Goodburn explained that he has been diagnosed with three oligodendrogliomas. Cancer Research UK explains that these are rare and slow growing brain tumours that develop from the glial cells called oligodendrocytes. The most common symptoms include seizures and headaches. 

Oligodendrogliomas mostly develop in the frontal lobes of the brain, but more rarely originate in the spinal cord, and very occasionally they can spread to other parts of the brain and spinal cord. The treatment for oligodendrogliomas depends on whether they are slow growing or fast growing. 

The main treatment options include active monitoring of slow growing tumours, surgery to remove as much of the tumour as possible; radiotherapy, which involves using precisely directed gamma rays to destroy the tumour cells; and chemotherapy. 

Surgery may not always be possible if there is no clear border between the tumour and the healthy brain tissue. In Goodburn’s case, he has explained that the nature of his tumours means that traditional surgery is not an option, and he will undergo a combination of radiotherapy and chemotherapy. 

He wrote on his Instagram: “Six weeks ago, my life experienced a profound change as I was diagnosed with three brain tumours. In December 2023, my training began to be interrupted by strange episodes. These episodes, initially thought to be hemiplegic migraines, would occur during hard training.”

“They would leave me with a loss of strength and a numb sensation on my left side, a deep feeling of fear, nausea and extreme deja vu. I now know that these were in fact seizures. With the trials behind me, I dug deeper into what was really causing these attacks. An MRI in May finally revealed what I’d begun to fear the most.”

“The silver lining to this diagnosis is that oligodendrogliomas generally respond better to radiotherapy and chemotherapy than many other serious brain tumour types. I am young, I am fit, I have the most phenomenal support network of friends, the best family I could ever hope for and a fantastic girlfriend by my side.”

He added: “I am determined to take this head-on, to remain positive and to keep being Archie.”

Despite suffering from headaches, nausea and a numb sensation down his left side, Goodburn only just missed out on qualifying for this year’s Olympic Games in Paris. He has previously won a bronze medal in the World Junior Swimming Championships and was part of the Scottish Commonwealth Games swimming team in 2022.

Radiotherapy is sometimes used as a second line of treatment after surgery to remove any remaining parts of the tumour. This process may involve Gamma Knife surgery, which is a form of stereotactic radiotherapy. This does not involve any surgical incisions, but is the delivery of multiple gamma rays that focus on the exact location of the tumour.

The high dose of radiation kills the tumour cells while avoiding the surrounding healthy tissue, minimising the risk of complications and side effects. The procedure takes between 15 minutes and several hours to perform, depending on the size  and location of the tumour. 

Stereotactic surgery is often used for more complex tumours or for patients who are not suitable candidates for conventional surgery. It is minimally invasive and usually the patient can go home from the hospital or clinic within the same day. After the procedure, the patient will be monitored with follow up scans and appointments. 

The cause of oligodendrogliomas is not fully understood, although research into brain tumours is continually ongoing to shed more light on why they develop, and how they can best be treated. The current understanding is that brain tumours are rarely preventable, but may be linked to a range of genetic and environmental causes.

There is some evidence that the risk of developing a small number of specific types of brain tumour may be increased by being overweight or obese. They are slightly more common in women than in men, and in both genders they are more common in people over the age of 75.

Understanding And Preparing For Gamma Knife Radiotherapy

Here at Amethyst Radiotherapy, we’ve been working closely with Radiotherapy UK to develop a new video series, which aims to help prepare brain tumour patients for Gamma Knife treatment, a type of radiotherapy.

This can be a daunting prospect at what is already a difficult time and the videos will take you through each step of the process to help demystify it and ease your natural apprehension.

The video shows a step-by-step guide to the Gamma Knife treatment and is supported by four additional videos from the medical team including the therapeutic radiographer, neurosurgeon, clinical oncologist and medical director.

Your diagnosis

A brain tumour diagnosis can cause major upheaval in the life of a patient and their loved ones. There is a lot of new information to take in, at a time when emotions can be running high and there are also practical issues to deal with, such as arranging time off work for treatment and dealing with paperwork and finances.

This can make the prospect of discussing and starting your treatment feel overwhelming. Every patient will have a dedicated medical team who will be able to guide them through their treatment options, based on the type and size of brain tumour they have and its location in the brain, and also their general state of health and personal wishes.

Patients with a certain type of brain tumour may be a suitable candidate for Gamma Knife radiotherapy. This is a highly focused form of radiotherapy that delivers tightly targeted high doses of radiation to the brain tumour. The radiation beams cause deliberate damage to the DNA of the tumour tissue, while leaving the surrounding healthy tissue largely untouched.

Brain tumours can affect people of all ages, and research is ongoing to understand more about what causes them. There are many different types of brain tumours, and they can cause different symptoms depending on the size and location in the brain. They are broadly categorised into two main groups: malignant and benign.

Malignant brain tumours are cancerous and fast growing, and benign brain tumours are usually slow growing and non-cancerous. However, the term benign can be misleading, because even non-cancerous tumours can cause serious symptoms and the tumour may need to be carefully monitored or removed if possible.

Some specific types of brain tumour are best suited to Gamma Knife radiotherapy, including metastases, acoustic neuroma, and meningioma, because they are well contained within one area of the brain. Other types of tumour such as gliomas may be less suitable for the treatment, because they tend to spread further through the brain.

Advice and guidance

Your medical team will provide you with expert advice and guidance on the treatment options open to you, based on the results of your biopsy and MRI scans. This will be a two-way process, and you will have the opportunity to ask questions and be given time to think over your decision.

In some cases, a combination of traditional surgery, chemotherapy, and Gamma Knife radiotherapy may be the agreed way forward. Gamma Knife does not involve any incisions despite its name; it is delivered externally from a special machine designed to accurately focus high doses of radiation at a precisely targeted area.

This eliminates the immediate risks of traditional surgery such as infections and bleeding, and recovery times are much quicker. Typically the treatment is delivered in one dose and can take between ten minutes and several hours, depending on the nature and extent of the tumour. Occasionally, a second or third dose may be required.

Gamma Knife treatment is generally tolerated well with few side effects, and usually results in the tumour being well-controlled. Sometimes, patients may experience a delayed reaction, which might include headaches or occasionally seizures. Your medical team will fully explain all the risks and potential side-effects before your treatment starts.

If you make the decision to go ahead with Gamma Knife treatment, it can be helpful to know what to expect on the day. In most cases, the treatment will be delivered as a day case and you will not need to stay overnight in the hospital. Your medical team will discuss in advance if you do need to stay overnight.

What to expect

Before the treatment begins, you will have an MRI scan that will be examined by the radiologist and consultant. This process can take up to an hour or two, so bring some entertainment with you. The medics will use the information from the scan to locate the exact position of the tumour in your brain.

On the day of the treatment, it’s important that you wear comfortable clothing with no metal attachments or jewellery. If you wear a headscarf, you will have to remove it while the frame is fitted, but it can then be placed back on.  You will be fitted with a lightweight frame (or in some cases a mask) to make sure that your head is kept still during the treatment process.

You can eat and drink as normal beforehand, and you will be invited to use the bathroom directly before the process starts to ensure your comfort. However, you can also have toilet or water breaks during the treatment.

During the treatment, you will lie on a couch and your head and chest will be positioned in a large horizontal bucket-shaped device. You will not feel anything, and can leave your eyes open and listen to music or podcasts if you wish. There will be no one in the room with you, but you will be able to communicate with your medical team via an intercom system.

You will be automatically repositioned during the procedure so that the gamma rays can target slightly different areas of the tumour each time. Each exposure will take several minutes, and the whole procedure may take several hours.

When the treatment is over, you will be taken to a preparation room where the frame will be removed from your head. You may feel slightly sore and sensitive in this area for a few days after the procedure. Your medical team will discuss all the potential side effects with you, such as nausea, headache, or dizziness.

The treatment is non-invasive and you will not be radioactive afterwards, so you can resume normal procedures as soon as you feel able to do so. After the procedure, you will have follow up appointments and may have further scans if necessary to monitor your progress.

If you have any issues or concerns after your treatment, contact a member of your medical team and they will be able to discuss these with you.

TV Star Russell Grant Shares Update On Brain Tumour Journey

The TV star Russell Grant, best known for his astrology slot on breakfast shows in the 1980s and 90s, has shared an update on his pituitary gland tumour treatment after being diagnosed in 2022. The Metro reports that Grant has undergone surgery to remove a growth from the base of his brain.

The 73-year old, who is best known to younger audiences for his turn on Strictly Come Dancing in 2011 with professional partner Flavia Cacace, first opened up about his diagnosis in 2022 after admitting that he was in denial about his health. He underwent a gruelling five-hour surgery to remove the tumour that was threatening his eyesight.

Since the surgery, Grant has stayed away from the public eye until now, when he shared concerns that his diabetes might have returned. 

Grant posted on social media site X: “Morning. The latest news on my post pituitary brain tumour operation is the possibility I have returned to being diabetic. I was once Type 2 but controlled it by diet. However, it’s possible taking so many steroids to keep me going they’ve increased my blood sugar. Tests today.”

Pituitary gland tumours are growths that start on the pituitary gland, which is a small organ that sits in the base of the brain, often compared to the size of a pea. The majority of these tumours begin as adenomas and can be malignant (cancerous) or benign (non-cancerous).

Both types of tumour can cause severe symptoms that impact on health and quality of life, and they may require treatment to shrink or remove them. Early diagnosis is key to ensure a good outcome, although the success of any treatment will be dependent on a range of factors such as the age and overall health of the patient. 

Pituitary tumours are broadly classified into two types: non secreting tumours and secreting tumours. Non-secreting tumours don’t make hormones and are usually larger than secreting tumours, which do produce hormones that can cause endocrine disorders. However, non-secreting tumours can press on the optic nerve and potentially damage eyesight.

The pituitary gland has a range of functions so the symptoms will vary greatly between patients. Often the symptoms are related to hormonal fluctuations, including disruption to the menstrual cycles or early menopause. Children and adolescents may experience delayed puberty or sudden growth spurts.

Other symptoms include unexplained weight changes, low blood pressure, lethargy and fatigue, easy bruising of the skin, personality changes, changes to the sense of smell, nausea and vomiting, headaches, and vision changes such as blurred vision, double vision, or loss of peripheral vision.

The exact causes of these tumours are unknown, although scientists believe that in a small number of cases there may be hereditary link. 

How are pituitary tumours treated?

The usual treatment options for pituitary tumours include surgery, chemotherapy, or a type of radiotherapy called stereotactic radiotherapy, sometimes also called Gamma Knife surgery. 

Stereotactic surgery is usually used for smaller tumours in an easily accessible part of the brain. It is not a traditional incision-based surgical procedure, but involves focusing very precisely targeted gamma rays on the tumour from multiple angles to deliberately damage the cells, leaving the surrounding healthy tissue intact. 

This type of surgery can shrink the tumour and prevent regrowth, and is sometimes used if not all of the tumour can be removed surgically, or if the tumour regrows after surgery. More rarely, cancerous tumours may be treated with chemotherapy drugs or a combination of the above. 

Smaller tumours that are not causing symptoms may be monitored closely for changes with MRI scans and checks on hormone levels, as part of a ‘watch and wait’ approach. If the tumour is causing hormone deficiencies, these may be addressed in some cases with hormone replacement therapy.

Living with a brain tumour can be challenging, as they can cause life changing symptoms that can disrupt careers, finances, and family life. Patients may be referred to support groups or counselling or talking therapy services for emotional support and practical advice about how to cope with their diagnosis.

After treatment, the patient may need to attend follow up appointments and rehabilitation sessions. 

For more information on pituitary tumours, please contact Ms Mary Murphy of Amethyst Radiotherapy.

New Initiatives Introduced For Brain Tumour Research Funding

A new package of research funding for brain tumours has been announced, and it is intended to boost new initiatives into developing better research and treatments. The National Institute for Health and Care Research (NIHR) reports that the suite of initiatives is the largest ever combined package of the kind.

The funding is part of the government’s £40m investment into developing new treatments for brain tumours and improving patient care. However, The Brain Tumour Charity points out that the funding was originally announced in 2018, following the untimely death of Dame Tessa Jowell from the condition.

The new funding announcement is jointly led by the NIHR and the Tessa Jowell Brain Cancer Mission (TJBCM), and comes after an inquiry and consultation sessions between the government, researchers, charities, and the wider brain tumour community. 

An investigation found that six years after the death of Dame Tessa Jowell, only £15m of the allocated £40m had been spent. This led to an all-party parliamentary inquiry into the allocation of the funds, and to assess the progress made so far. 

The inquiry found that there was too much focus on funding the later parts of the research process, when potential new treatments are developed.

NIHR told the inquiry that so little of the funding had been allocated for research because they received too few applications that met the quality threshold. However, because the whole field of brain tumours has traditionally been underfunded and under researched, there needs to be more focus on understanding how brain tumours grow and develop.  

The inquiry also found that there were significant barriers to running clinical trials, including patchy access around the country and a lack of time and resources within the NHS. The pharmaceutical industry was also represented at the inquiry, and raised concerns about the complex regulatory framework around running clinical trials. 

The subsequent report generated from the findings of the inquiry has led to the reformed funding packages, as announced by the NIHR for the allocation of the remaining portion of the £40m. Among the new measures announced is a national consortium to develop a network for the delivery of brain tumour trials. 

There will also be a greater focus on funding research into the quality of life of patients, including the standard of care, support, and rehabilitation that they receive. The Tessa Jowell Allied Health Professional (AHP) research fellowships are a new initiative to build an evidence base for the importance of rehabilitation for people with a brain tumour. 

Finally, the reforms will include measures to attract and retain more early career researchers who will focus on brain cancer, in order to boost the quantity and quality of the research that is being carried out in the field. 

The Brain Tumour Charity, who have campaigned consistently for the funding to be properly allocated, have welcomed the announcement of the new initiatives. However, they point out that there are remaining barriers to be overcome, particularly around the setting up and implementation of clinical trials. 

The charity currently believes that there are too many obstacles that prevent scientific breakthroughs in the field from being translated into medicines that can effectively be delivered to treat patients. This has led to the establishing of a new Translational Research Fund by the charity, backed by £2.2 funding.

Dr Michele Afif, Chief Executive, commented: “We are delighted to see a clear commitment to ensuring that the money promised in 2018 will be spent.”

“Our attendance at the roundtable is the first step in working alongside Government, the NIHR, the TJBCM and other key partners at a series of workshops that will ensure this money is spent where it will have the biggest possible impact, by bringing new treatments to patients through innovative clinical trial models and quality of life research.”

Professor Lucy Chappell, NIHR CEO, said: “This transformative brain tumour research funding we are announcing is a key moment in our search for novel therapies and better treatments to save lives and improve the quality of life for patients with this condition.”

She added: “We are pressing ahead in this innovative new step, made possible due to our strong and collaborative partnership with charities, patients, the life sciences industry and the brain tumour community.”

“As we continue this journey together, it shows the crucial value of world-leading research shaped and funded by the public, integrated across the health and care system.”

Nicky Huskens, CEO of TJBCM, said: “Today’s announcements represent a transformative investment in the brain tumour community. It is a testament to the hard work and tireless campaigning of charities, patients and family members that we are where we are today; with the real possibility of discovering new treatment and care options for patients.”

“It has been a pleasure to work with the Government and the NIHR to develop these new initiatives, and we are confident that what will be announced today really does reflect the urgent needs of the community.”

“Dame Tessa Jowell told us all not to just put brain cancer in the ‘too difficult’ box, so it is crucial that, almost six years to the day of her death, we double down on the progress we have made and give families and patients more hope for the future.”

The new funding call will be supported by workshops delivered by the TJBCM to provide ongoing support and guidance for the brain cancer research community. A national consortium will be launched to drive step change into brain tumour research, and it will prioritise recent developments such as precision medicine.

Currently, one of the most precise and effective methods for treating brain tumours is Gamma Knife surgery. 

This is a form of radiotherapy that doesn’t involve traditional incisions, but is a method of externally delivering highly focused radiation beams from multiple angles to target the cancer cells, whilst leaving the remaining healthy cells untouched.

For more information about brain tumour treatment, please contact Mr Neil Kitchen of Amethyst Radiotherapy.

Why Are Non-Invasive Treatments Such As Radiosurgery Vital?

When someone is diagnosed with a lesion, tumour or growth on the brain, they are given a wide variety of options, but if it is at all possible, they will be advised to have a treatment such as Gamma Knife at a radiotherapy centre.

Besides the fact that Lars Leksell’s pioneering stereotactic radiosurgery treatment is highly effective, fast and takes far less time to treat and recover from than conventional brain surgery would, it also has the key feature that it is non-invasive.

The concept of non-invasive and minimally invasive treatments in medical care is the core philosophy at the heart of modern medicine, and as long as a more minimally invasive treatment is effective, it is more likely to be recommended by a doctor.

Despite it being a more modern philosophical take, the balance between choosing effective treatments and the consequences of said treatments is a question that has been asked since the very start of medicine as we know it.

Primum Non Nocere

One of the core principles of medicine is the concept of doing no harm, even if the specific phrase does not appear in historic versions of the Hippocratic Oath.

The concept of “first do no harm”, which is at the core of modern questions about appropriate treatments comes from Hippocrates’ Epidemics Book I (Section II, Second Constitution, Section 5).

In it, he notes that the “physician” must have what he defines as “two special objects” in mind when it comes to the treatment of disease; either they must do good or do no harm to a patient. 

This principle is at the core of minimally invasive treatment; doctors should in all fields of medicine avoid overprescribing medication, recommending unnecessarily invasive treatments and doing anything more than is necessary to receive the ideal medical outcome.

In the field of brain surgery, where the margin of error is practically nonexistent, this is even more important, and in many cases outside of critical emergency treatments, the least invasive treatment is the correct option for a patient.

Mr Leksell himself came to this conclusion, albeit in a rather unusual way; he believed strongly in bloodless surgery for reasons that were as much aesthetic and based on an aversion to blood as they are based on fundamental principles or any empirical evidence available in the 1930s.

This led to a decades-long devotion to a form of surgery that required no incision, and this ultimately led to the development of the Gamma Knife and the entire field of stereotactic radiosurgery.

Practical Benefits Of Minimal Invasion

Besides philosophical and aesthetic reasons for wanting minimally invasive treatments, there is the notion of timescales and recovery to consider.

A Gamma Knife treatment takes between 30 minutes and four hours, depending on the complexity of the treatment, and whilst there is a small amount of aftercare, most people are able to go home after their radiotherapy treatment.

Contrast that with an equivalent brain surgery, which typically would require stitches or staples to be applied, and as a result of this and the need to monitor a patient’s condition, people can spend up to a week in the hospital, although this varies considerably depending on the complexity of the treatment.

This is a huge reason why surgery is avoided where possible, as the difference between half a day and a week of monitored recovery, followed by rehabilitation is massive, and the implications on a person from a personal, physical and financial perspective cannot be overlooked.

Mr Leksell was ahead of his time in this consideration, even if it took decades for others inspired by his pioneering work to develop the evidence base to change medicine.

An aspiring neurologist would pick up the mantle and ultimately change the practice of medicine in this direction, although the path he took was far from straightforward itself.

The Father Of Minimally Invasive Treatment

Whilst Hippocrates developed the basic principle and Gamma Knife was one of the first tools developed with this in mind, the man to both coin the term and fundamentally shift medicine in the direction of minimal invasion was John Wickham.

Born in Chichester in 1927, around the time Mr Leksell was starting to develop his philosophy and his skills as a neurologist, Mr Wickham wanted to follow in those footsteps and also become a neurologist, although he would ultimately switch to renal medicine.

Whilst he would be an exceptionally skilled urologist, his greatest achievement was in changing the philosophy of medicine and surgery and giving a phrase to a concept that had been on the minds of countless surgeons and radiologists regardless of speciality.

In 1984, Mr Wickham was the man to coin the term “minimally invasive treatment” in the context of surgery and wrote about it in a famous and influential article in the British Medical Journal in 1987.

From the very first line of the article, he noted that surgeons of the time favoured huge incisions compared to the then-novel practice of “keyhole surgery”, whilst patients wanted the “smallest wound possible”, which in the case of radiosurgery involves no incision whatsoever.

Whilst he invented the term, he noted that the concepts and technologies had been evolving since 1960, around the time that radiosurgery was starting to be adopted, and certain specialist fields had developed either non-invasive or minimally invasive alternative treatments for conditions.

He conceived of a world where, by the year 2017, most non-emergency surgery would be undertaken by radiologists and keyhole surgeons, with open surgeries limited to emergency treatments, and this is essentially how the field of medical development turned out.

Rather ironically, the next article was entitled “Retreat from openness”, and this is the exact world the Gamma Knife developed and a necessity to protect patients, improve recovery and give people more options for treatment without an expectation of a long recovery period.

There has always been and may always be room to develop and improve medical principles; diagnostic techniques are ever-improving and allowing for lesions on the brain to be spotted quicker and treated with similar rapidity, and the future of surgery may involve no incision at all.