Radiotherapy treatments need to have a degree of precision, but stereotactic radiosurgery such as the Gamma Knife treatment is more precise than some others.
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.
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 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.
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.
Centres of Excellence for Stereotactic Radiosurgery treatment of complex Brain Tumours
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