Gamma Knife Esprit

What are Target Organs for Gamma Knife?

Gamma Knife has been designed and developed for intracranial diseases. Diseases of brain can be treated with Gamma Knife along with the diseases that involve bones, vessels, nerves, eyes, skin and other tissues around the brain.

Different technologies are used to treat diseases that involve other body parts. Gamma Knife has been installed at more than three hundred facilities and used to treat more than one million patients around the world. It is a standard treatment modality for intracranial diseases.

Gamma Knife has been installed at more than three hundred facilities and used to treat more than one million patients around the world. It is a standard treatment modality for intracranial diseases. 7000 patients have been treated at Acıbadem Gamma Knife Unit since 2005.

Gamma Knife technology has been ever increasingly used since 1968 when it was introduced to routine clinical use. Statistics show that more than one million patients have been globally treated with Gamma Knife for various brain diseases.

• Cerebrovascular Diseases
• Arteriovenous malformation (AVM - Abnormal arteriovenous plexus in brain)
• Cavernomas
• Benign Brain Tumors
• Vestibular schwannoma (Acoustic neuroma)
• Hemangioblastoma
• Meningioma
• Chordoma
• Pituitary tumor
• Trigeminal schwannoma
• Tumors of pineal gland
• Craniopharyngioma
• Glomus jugulare tumor
• Malignant Brain Tumors
• Metastases
• Uveal melanoma
• Some glial tumors
• Hemangiopericytoma
• Nasopharyngeal carcinoma
• Patients with Movement Disorders
• Tremor secondary to Parkinson's disease
• Essential tremor
• Patients with Functional Disorder
• Trigeminal neuralgia
• Patients with tumors at hardly accessible and deep locations of brain
• Patient who cannot tolerate surgical procedures due to certain reasons like age, medical condition, general health status
• Patients who refuse open surgery.

Furthermore, Gamma Knife Icon is used for treatment of following diseases.

Brain tumor

Brain tumor is the uncontrolled growth that begins in brain and peripheral tissues at a certain focus. The tissue that grows uncontrollably not only functions improperly, but also causes problems by occupying space in the skull, which is a closed volume.

Treatment of Brain Tumor

The most important step in treatment of brain tumors is to determine the type. Because different types of brain tumors are treated with different treatment techniques or a combination of these methods. The treatment options of all brain tumors are surgery, radiotherapy, chemotherapy or Gamma Knife.

Acromegaly

Acromegaly is caused by benign tumors of pituitary gland that secrete growth hormone, but treatment of the condition is challenging.

For acromegaly, Gamma Knife is an effective treatment to hinder growth of tumor, shrink the tumor and restore hormone values to normal ranges in case of residual tumor after surgery or relapse.

Cerebrovascular Diseases

Cerebrovascular diseases involve the vascular system directly that supplies blood to the brain. Mostly, they are manifested by cerebral crises, called stroke that develops suddenly. They can also cause clinical pictures in the form of a slowly-progressing chronic disease.

Clear determination of the underlying vascular disorder is the first step in treatment of these diseases. Treatment choices vary for different vascular disorders: medication treatment, surgery, endovascular approach or Gamma Knife.

Arteriovenous Malformation

Arteriovenous malformations (abbreviation: AVM) are conditions that are secondary to anomalies, which begin at developmental stage of blood vessels in brain. The disease is characterized by abnormal tangles of blood vessels in various parts of the brain secondary to hypervascularization.

These vascular disorders cause bleeding, epileptic seizures and regional cerebral dysfunctions. They should absolutely be assessed for treatment since they can be life-threatening. Gamma Knife is one of the current effective treatment modalities for AVMs.

Astrocytomas

Astrocytomas are one of the most common tumors that begin in native tissue of brain. There are two types: Pilocytic astrocytoma is a classical example that grows without peripheral invasion. Treatment options for pilocytic astrocytoma are surgery, Gamma Knife, Radiotherapy or Chemotherapy, depending on the patient’s age and location of tumor. However, the group called diffuse astrocytoma grows by invading the normally functioning cerebral tissue and therefore, the only option is a combination treatment.

Intracranial Hemorrhage

Cerebral hemorrhages are manifested by cerebral crises, called stroke that develops suddenly. Although the most common cause of hemorrhages is systemic diseases, such as hypertension, the hemorrhages can be caused by aneurysms that affect the vascular walls or other diseases such as arteriovenous malformations that implies an anomalous vascular structure.

Clear determination of the underlying vascular disorder is the first step in treatment of these diseases. Treatment choices vary for different vascular disorders: medication treatment, surgery, endovascular approach or Gamma Knife.

Brain cancer

Brain tumors are addressed under two titles. Cerebral metastasis is the most common form that implies spread of cancers of other body tissues to brain. On the other hand, a brain tumor begins in and originates from brain tissue and other support tissues (vessels, meninx, etc.). Most common one in adults is glioblastoma that is a rare condition with poor prognosis.

Treatment of Brain Cancer

Treatment of brain cancers is complex and challenging as the disease progresses by invading normally functioning brain tissue and it requires a combination treatment.

Brain Stem Tumor

There are many types of brain stem tumors and they vary greatly depending on patient’s age, their anatomic locations and growth patterns. Surgery, Gamma Knife, Radiotherapy and combination thereof are used for treating these different tumors.

Brain tumor

Brain tumor is the uncontrolled growth that begins in brain and peripheral tissues at a certain focus. The tissue that grows uncontrollably not only functions improperly, but also causes problems by occupying space in the skull, which is a closed volume.

Symptoms of Brain Tumors

Brain tumors manifest in three ways. The most common symptoms are headaches, nausea, vomiting and altered mental status due to increased intracranial pressure. Brain tumors can also cause epileptic episodes.

The third most common symptom is dysfunction in a part of brain that is directly involved by tumor (strength losses, speech disorders, visual impairment, personality changes, etc.).

Types of Brain Tumors

Brain tumors are rare when compared to tumors that begin in other parts of the body. Majority of these tumors are benign. On the other hand, malignant tumors have the worst prognosis among all cancers of human body.

The most common brain tumors are; metastases from cancers that begin in other parts of body, meningeal tumors (meningioma), glial tumors that originate from the native brain tissue, benign tumors of pituitary gland (adenomas) and vestibular schwannomas that begin in vestibular nerve.

Treatment of Brain Tumor

The most important step in treatment of brain tumors is to determine the type. Because different types of brain tumors are treated with different treatment techniques or a combination of these methods.

The treatment options of all brain tumors are surgery, radiotherapy, chemotherapy or Gamma Knife.

Gamma Knife for Treatment of Brain Tumors

Gamma Knife is a medical technology developed to perform low-risk surgical treatment of various diseases of the brain. Tumors are among the most important intended uses of this technology.

Gamma Knife is most commonly used for metastatic brain tumors and benign brain tumors, namely vestibular schwannomas and meningiomas, all around the world.

Radiotherapy in Brain Tumors

Radiotherapy may be used if brain tumors are dispersed in properly functioning brain tissue. Aim of this treatment is to kill tumor cells at the target location, while preserving healthy brain tissue.

While this treatment can be applied to the whole brain, GammaKnife or Stereotactic radiosurgery can also be used, which are significantly focused forms of radiotherapy.

Arteriovenous Malformations in Brain

Arteriovenous malformations (abbreviation: AVM) are conditions that are secondary to anomalies, which begin at developmental stage of blood vessels in brain. The disease is characterized by abnormal tangles of blood vessels in various parts of the brain secondary to hypervascularization.

These vascular disorders of brain cause bleeding, epileptic seizures and regional cerebral dysfunctions. They should absolutely be assessed for treatment since they can be life-threatening. Gamma Knife is one of the current effective treatment modalities for AVMs.

Brain Cancer

Brain tumors are addressed under two titles. Cerebral metastasis is the most common form that implies spread of cancers of other body tissues to brain. On the other hand, a brain tumor begins in and originates from brain tissue and other support tissues (vessels, meninx, etc.).

Most common one in adults is glioblastoma (GBM) that is a rare condition with poor prognosis.

Chondrosarcoma

Chordoma and Chondrosarcoma originate from cartilage tissue and precursors thereof; they grow slowly, but invade the bone.

Treatment of intracranial chordoma and chondrosarcoma is very complex and difficult, as they are located in the cranium and surrounded by very important blood vessels and nerves at the central zone of the skull. Gamma Knife, radiotherapy and particle irradiation (proton beam, carbon ion) are treatment options.

Chordoma

Chordoma and Chondrosarcoma originate from cartilage tissue and precursors thereof; they grow slowly, but invade the bone.

Treatment of intracranial chordoma and chondrosarcoma is very complex and difficult, as they are located in the cranium and surrounded by very important blood vessels and nerves at the central zone of the skull. Gamma Knife, radiotherapy and particle irradiation (proton beam, carbon ion) are treatment options.

Cushing Disease

Cushing disease is caused by cortisone-secreting benign tumors of the pituitary gland. The disease is difficult to treat.

For Cushing Disease, Gamma Knife acts by hindering growth of tumor, shrinking the tumor and restoring hormone values to normal ranges in case of residual tumor after surgery or relapse.

Arteriovenous Malformation

Arteriovenous malformations (abbreviation: AVM) are conditions that are secondary to anomalies, which begin at developmental stage of blood vessels in brain. The disease is characterized by abnormal tangles of blood vessels in various parts of the brain secondary to hypervascularization.

These vascular disorders of brain cause bleeding, epileptic seizures and regional cerebral dysfunctions. They should absolutely be assessed for treatment since they can be life-threatening. Gamma Knife is one of the effective treatment modalities for AVMs.

Balance Nerve Tumor

It is used for vestibular schwannoma, which is a benign tumor that develops on the balance nerve (previously called acoustic neurinoma or Acoustic schwannoma). Growth of tumor can be controlled with Gamma Knife in patients who do not require surgery.

Low Grade Glial Tumor

Low-grade glial tumor is one of the most common tumors that begin in native tissue of brain. There are two types: Pilocytic astrocytoma is a classical example that grows without peripheral invasion. Treatment options for pilocytic astrocytoma are surgery, Gamma Knife, Radiotherapy or Chemotherapy, depending on the patient’s age and location of tumor.

However, the group called diffuse gliomas (astrocytoma or oligodendroglioma) grows by invading the normally functioning cerebral tissue and therefore, the only option is a combination treatment.

Movement disorders

Parkinson’s disease, multiple sclerosis (MS) and traumatic or essential (due to unknown causes, in the elderly) tremors are health conditions with adverse effects on quality of life.

Gamma Knife thalamotomy can be considered in addition to medications for treatment of aforementioned diseases.

Pituitary adenomas (Pituitary Tumor)

Benign tumors originating from pituitary gland, called pituitary adenomas, show clinical symptoms by secreting hormones or compressing the important tissues such as optic nerves. Gamma Knife is a therapeutic option for both hormone-secreting and compressive pituitary adenomas.

Patients followed up at endocrinology department are assessed to determine if they are good candidates for Gamma Knife radiosurgery. Gamma Knife radiosurgery can be used alone or in combination with medical treatment and surgery.

Growth of pituitary tumors can be controlled by 95 to 98 percent with Gamma Knife radiosurgery.

Hearing Nerve Tumor

Nowadays, Gamma Knife is used for vestibular schwannoma, which is a benign tumor that develops on the balance nerve (previously called acoustic neurinoma or Acoustic schwannoma).

Growth of tumor can be controlled with Gamma Knife in patients who do not require surgery.

Benign Brain Tumor

Benign tumors grow slowly over the years. Gamma Knife therapy aims to stop growth in such tumors.

Chondrosarcoma

Chordoma and Chondrosarcoma originate from cartilage tissue and precursors thereof; they grow slowly, but invade the bone.

Treatment of intracranial chordoma and chondrosarcoma is very complex and difficult, as they are located in the cranium and surrounded by very important blood vessels and nerves at the central zone of the skull. Gamma Knife, radiotherapy and particle irradiation (proton beam, carbon ion) are treatment options.

Chordoma

Chordoma and Chondrosarcoma originate from cartilage tissue and precursors thereof; they grow slowly, but invade the bone.

Treatment of intracranial chordoma and chondrosarcoma is very complex and difficult, as they are located in the cranium and surrounded by very important blood vessels and nerves at the central zone of the skull. Gamma Knife, radiotherapy and particle irradiation (proton beam, carbon ion) are treatment options.

Malignant Tumors

Malign tumors have the capability to grow very quickly. Effect of Gamma Knife treatment on these tumors emerges very quickly and can be observed within months. In malignant tumors, Gamma Knife usually destroys the tumor completely.

Arteriovenous Malformations (AVM) also reduce and disappear in a similar way after Gamma Knife therapy, but this effect is slower in AVMs and it appears in a few years.

Meningiomas

Meningiomas are slowly growing tumors that begin in membranes, which surround the brain and the spinal cord, and are mostly benign in nature. Signs and symptoms are secondary to the mass effect.

Treatment of Meningioma

First treatment option is a surgical procedure. However, it may not be possible to remove some meningiomas completely. In some cases, the risk of planned surgery may be high. Gamma Knife radiosurgery becomes a useful option for these cases.

Moreover, this modality can be used for patients with postoperative residue and recurrence. Gamma Knife aims to stop growth of tumor in meningiomas.

In fact, growth of the tumor is stopped in most patients. Gamma Knife radiosurgery stops growth of tumor and reduce the mass lesion in time by 95% in meningiomas.

Oligodendroglioma

Low-grade glial tumor is one of the most common tumors that begin in native tissue of brain. There are two types: Pilocytic astrocytoma is a classical example that grows without peripheral invasion.

Treatment options for pilocytic astrocytoma are surgery, Gamma Knife, Radiotherapy or Chemotherapy, depending on the patient’s age and location of tumor.

However, the group called diffuse gliomas (astrocytoma or oligodendroglioma) grows by invading the normally functioning cerebral tissue and therefore, the only option is a combination treatment.

Pilocytic Astrocytoma

Low-grade glial tumor is one of the most common tumors that begin in native tissue of brain. There are two types: Pilocytic astrocytoma is a classical example that grows without peripheral invasion.

Treatment options for pilocytic astrocytoma are surgery, Gamma Knife, Radiotherapy or Chemotherapy, depending on the patient’s age and location of tumor.

However, the group called diffuse gliomas (astrocytoma or oligodendroglioma) grows by invading the normally functioning cerebral tissue and therefore, the only option is a combination treatment.

Trigeminal Schwannoma

Trigeminal Schwannoma is a benign tumor which begins in trigeminal nerve that is responsible for sensorial innervation of the face.

Trigeminal neuralgia

Trigeminal neuralgia is usually diagnosed after patient complains of pain that is similar to electric shock only in either half of the face. This pain is generally felt in nose, corners of mouth and jaw. Diagnosis is commonly based on patient’s complaints in a physical examination.

Treatment of Trigeminal Neuralgia

Medications are the first-line treatment option. Various surgical interventions may be considered, if symptoms cannot be alleviated. Gamma Knife treatment is also included in surgical options. While the success rate of pain relief is similar with other percutaneous methods, it provides an alternative, especially for elderly patients.

Vestibular Schwannoma (Tumor of the Hearing and Balance Nerve)

Vestibular schwannomas are benign tumors which originate from sheath of vestibulocochlear nerve. It is the fifth most common brain tumor. They are more prevalent in middle- and advanced-age people, but it can be diagnosed in all age ranges.

Patients most commonly present to a clinic with hearing loss and tinnitus. The hearing loss leads to problems such as loss of balance, facial paralysis, and sensorial deficit in face and threatens life of patient by compressing the brain stem.

Treatment of Vestibular Schwannoma

Nowadays, Gamma Knife is used for vestibular schwannoma, which is a benign tumor that develops on the balance nerve (previously called acoustic neurinoma or Acoustic schwannoma).

Growth of tumor can be controlled with Gamma Knife in patients who do not require surgery.

Stereotactic Frame

Mask

Neuroradiology Imaging

After the frame is affixed, an imaging method is selected that best fits the pathology of the patient. Nowadays, MRI is scanned for all patients. In cases of AVM, angiography is performed, while stereotactic frame is affixed. Computerized tomography is also used to plan the treatment in skull base tumors and for the patients with contraindications for an MRI scan.

Dose Planning

Irradiation

After the treatment is planned in a computer, radiation beams are delivered in another part of the device, namely treatment unit. It takes 15 minutes to 1 or 2 hours. Duration of treatment is dictated by volume of tumor and planned dose of radiation.

Gamma Knife Tomography

This tomography modality shows even the smallest movements of the head before and during the treatment. Thus, the target can be irradiated delicately and safely. Moreover, this tomography technique enables use of mask in the treatment.

Patient Monitoring During Treatment

Gamma Knife Icon monitors the application of treatment with tomography and infrared movement sensor. Tomography device locates the skull very precisely in treatments, where a mask or a frame is used, and thus, the intracranial target is identified very clearly. Tomography scan can be repeated during the procedure, if necessary. Moreover, movements of the patient, such as breathing, are continuously tracked by infrared motion sensor.

End of treatment

Gamma Knife is performed in a single session for most patients. Treatment starts in early morning, generally ends in a couple of hours and the patient can be discharged to home. Patients are fit to travel between cities either by plane or highway right after the treatment. Patients continue their daily lives after the treatment.