Treatable illnesses
The outcome of radiosurgical treatments is different for each type of abnormality
The result of radiosurgery treatment may vary depending on the effect of the ionizing gamma rays directed by the device at the focal point on the tissue. The results are usually not immediate. The radiation passing through the tissue may cause changes in cell function, leading to cell death or cell division. These processes do not usually produce immediate changes but can take weeks, months, or even years to reach the desired effect, depending on the intensity of the irradiation.
The desired effect can be the stopping of tumor growth, the shrinking or even disappearance of the tumor, or in optimal cases, the thickening of blood vessel walls, thus blocking blood vessels. The desired effects can be checked and monitored by imaging studies and by clinical examinations during subsequent medical reviews. If the desired outcome cannot be achieved with single irradiation further repeated or supplementary treatments may be necessary.
Diseases treated with gamma radiosurgery
Based on our experience and that of the international radiosurgery community over the past decades, the following diseases can be most effectively treated by radiosurgery:
Malignant tumors
Malignant tumors
Metastases to the brain
Benign tumors of the auditory nerve
Benign tumors originating in the cerebral cortex meningiomas
Other rare types of tumors (glomus tumor, rare tumors of the brain nerves, etc.)
Brain vascular lesions (AVM, cavernoma)
Facial nerve entrapment
In addition to the type of tumor, several other conditions must be met before certain lesions can be treated. Treatment is influenced by the size of the lesion, or its overall size if there are multiple lesions, its location, its relationship to vital organs (e.g., the optical nerve), and possibly pre-existing histological findings. Each patient, therefore, requires an individual assessment. After examining the patient and their case documentation, a specialist in radiosurgery (neurosurgeon, radiotherapist, oncologist) can give an opinion on whether the patient can be offered treatment. This physician will also be able to advise on the possible outcome of the treatment, the risks, and possible complications of the procedure, and what other procedures may be available in the case.
Benign tumor of the auditory nerve (also known as acoustic neurinoma or vestibular schwannoma)
An acoustic neurinoma is a tumor originating in the vestibular part of the VIII (vestibulocochlear) nerve. It is caused by the abnormal proliferation of Schwann cells, which form the myelin sheath of the brain nerve. With few exceptions, it is a benign tumor and grows very slowly.
The tumor usually starts in the internal auditory canal and then grows out of it and is located in the pontocerebellar angle of the cerebellar bridge.
It is a rare type of tumor. According to literature data, there are 100-200 newly diagnosed cases of auditory nerve tumors in Hungary every year; but the number is increasing year-by-year.
The number of patients with auditory nerve tumors might be higher, as some cases are not even detected, given that the disease often causes no symptoms. It is most often detected around the age of 40-60 but can occur at virtually any age, and it is slightly more common in women. In some inherited diseases, such as various forms of neurofibromatosis, tumors can develop on one or both sides, along with many other types of tumors.
The most common symptoms of auditory nerve tumors are due to pressure on the VIII, VII, and V cranial nerves. Such symptoms may include slow or sudden loss of hearing, ringing of the ear (tinnitus), loss of balance, facial paralysis, disturbance of tear and saliva secretion (dry eyes, mouth), disturbance of taste, facial sensation, etc.
In severe cases, when the tumor is large, other brain nerves and the brain stem may get damaged. Even brain fluid buildup (hydrocephalus) or loss, and in the worst cases, even death may occur.
If the tumor is a few millimeters small, regular monitoring of the patient may be sufficient. If, the tumor is growing or is already large when detected, treatment may be necessary. These tumors can be treated by open cranial surgery, radiosurgery, or a combination of both.
The surgical removal of an auditory nerve tumor is one of the high-risk neurosurgical procedures, despite the large number of patients worldwide who undergo this operation.
Due to the location and the size of the tumor, several complications are possible, some of which can lead to a marked deterioration in the quality of life.
The risk of developing temporary or permanent facial nerve paralysis is particularly high (up to 30- 40%).
Statistics and our own experience suggest that with radiosurgery this risk can be significantly reduced to less than 5%. For this reason, conventional surgery, nowadays used mainly for complications and large tumors. Radiosurgery can reduce the size of tumors and-or even remove them completely.
Thus, eliminating the pressure on the surrounding area. Small and medium-sized tumors of the auditory nerve do not usually cause enough pressure on the surrounding area to warrant surgery. They mainly cause hearing loss or movement disorders, which is why they are detected.
For these tumors, which are usually less than 3 cm in diameter, radiosurgery is a good alternative to surgery, which in most cases can ensure that the tumor stops growing (i.e., tumor control). In many cases, after some years, tumor shrinkage can be observed.
Brain metastases
Many aggressive tumors occur in the body (lung, breast, intestine, kidney, skin).
The cells of these tumors can travel via the bloodstream to distant organs, including the brain, where they can form metastases.
Depending on the size and number of tumors, their impact on the brain these tumors can be treated with neurosurgery, radiosurgery, radiotherapy, or a combination of these.
In patients, who are in good general condition and have a limited number of smaller tumors (max 4-5 tumors), targeted radiosurgical treatment may be effective.
The aim of the treatment is to deliver ionizing radiation only to the tumor areas, while protecting the healthy brain areas from harmful effects.
If the number and total volume of tumors is large, stereotactic fractionated brain irradiation (SBRT) or conventional whole brain irradiation (WBRT) is recommended in regional radiotherapy facilities.
The latter procedure is
also necessary in the case of tumor spread
causing leptomeningeal infiltration of the brain
membrane (meninges).
Brain vascular malformations - angiomas (AVM), cavernomas
Many non-tumor vascular disorders of the brain that, if detected (typically in the case of a headache or stroke problem), require treatment.
This treatment can be by surgical
blockage of the blood vessels, catheterization
using a metal coil or special adhesive (vascular
embolization), surgical removal of the
abnormality, or radiosurgery.
Radiosurgery is
used for small angiomas, difficult-to-reach
hemorrhagic cavernomas, or the smaller
remnants of embolized angiomas treated in a
multistage procedure.
Radiosurgery induces the proliferation of the inner cells of the abnormal vessels of the vascular bundle, which, over a long period (up to several years), leads to the thickening of the vessel wall, a gradual occlusion of the vessels, and the reduction of the possibility of bleeding. The risk of bleeding persists from the time of treatment until complete occlusion, but generally, it is reduced gradually after treatment.
Trigeminal neuralgia - tic doloureux
Trigeminal neuralgia is an intense pain in the area supplied by the sensory part of the V nerve of the facial skin, the mucous membranes of the mouth, the teeth, the orbits of the eyes.
This occurs in the second and third nerve branches.
The cause of the disease is mostly unknown (idiopathic), but in some cases it may be due to dental disease, mechanical damage to the nerve fiber (e.g., pulsating vascular lesions, plaque), inflammatory lesions, herpes virus infection, tumors, etc.
In addition to the neurological examination, CT and MRI or MRA imaging play a role in the diagnosis.
Treatment is basically with medication, but if the facial nerve does not respond to therapy, other treatment modalities, such as surgery and radiosurgery are considered.
In cases that do not improve with medication, and the where vascular compression on the nerve fiber is not visible, or the patient is too old or internally unstable, or the patient refuses open cranial surgery, destruction of the nerve fiber by radiosurgery can relieve symptoms and, or even eliminate them.
In these cases, it is worth visiting a neurosurgery specialist for the treatment of trigeminal neuralgia.
After a proper examination, a decision can be made, considering the patient's opinion, as to which intervention may lead to a successful outcome.
If radiosurgery is recommended, in Hungary, it can only be performed at the Radiosurgery Center in Debrecen.
In this case, please contact our neurosurgical colleagues for further information.