“Bloodless Surgery” for brain tumours or Stereotactic Radiosurgery (SRS) is used for the treatment of certain small non-cancerous (benign) lesions and other cancerous (malignant) tumours of the brain. The ability to precisely reach a point within the brain and perform a requisite procedure is a branch of Neurosurgery called Stereotactic Surgery, which uses mathematical principles to accurately localize any point in the brain with reference to external markers. This type of surgery has been used since the last 60 years. Radiation is a standard form of treatment that is used for various types of tumours of the brain and other tissues. Conventional radiation treatment exposes the tissues to fairly large amounts of radiation which is given in multiple doses over a number of days or weeks using a high energy X-ray beam from a Medical Linear Accelerator. 

‘Stereotactic Radiosurgery’ (SRS) refers to a special treatment involving the combination of radiotherapy and stereotactic neurosurgical procedures. In SRS, the Linear Accelerator is fitted with specialized attachments called micro multi leaf (mMLC) collimators or small cones, which very precisely control the size and shape of the radiation beam. This collimated radiation is directed to a specific point in the body using the principles of stereotactic Neurosurgery, allowing a very high dose of radiation to be given to the target area, while minimizing exposure to surrounding normal structures. The use of the word ‘surgery’ is a misnomer since this technique does not involve an open surgical procedure; but the precision and effect of this high dose of focused radiation is similar to that achieved by surgery. The radiation selectively destroys tumour cells with very minimal effects on the surrounding areas. SRS is useful in the treatment of both benign and some types of cancerous (malignant) tumours, as well as some blood vessel malformations in the brain.

Patients referred for SRS are jointly evaluated by a team of doctors from radiation oncology and neurosurgery who decide on the suitability of this treatment. A team comprising of Neurosurgeons, Radiologists, Radiation Oncologists, Radiation Physicists, and Radiotherapy Technologists administers the treatment. 

The treatment procedure is very patient friendly and safe. It begins with fixing an external reference frame to the patient’s head, after which CT and MRI scans are done, along with other specific imaging studies as may be required. The images are then transferred to a dedicated treatment planning computer system (TPS), where the target tumour and other critical structures in the vicinity are localized. The radiation dose and delivery are then planned. The specialized software has the ability to develop a plan with  optimum beam size, shape, directions and doses; it also  calculates very rapidly and accurately, the actual radiation doses that would be received by the tumour and surrounding areas. Once this is done, the patient is positioned inside the linear accelerator room with the guidance of high precision lsaer beams, and the radiation is administered as planned by the treatment planning system.

Stereotactic radiosurgery is a major addition to the armamentarium against tumours and other complex blood vessel abnormalities of the brain. It helps improve outcomes for the patient while maintaining a high degree of safety. No anesthesia is required. Patients are generally discharged from the hospital the day after treatment, and can resume their normal activities almost immediately. No additional period of rest is required. SRS is especially useful for tumours that recur after previous surgery, for cases in which the lesion is close to critical structures in the brain, and for patients who are considered high risk for anesthesia or open surgery.

This special treatment has recently been made available at the Amrita Institute of Medical Sciences (AIMS), Cochin, jointly offered by the Departments of Neurosurgery and Radiation Oncology. This is the first of its kind in the state of Kerala. Apart from SRS, AIMS, Kochi is the first hospital in Kerala to offer other special radiation treatments like Intensity Modulated Radiotherapy (IMRT) and Total Skin Electron beam treatments (TSET). These Special treatments are offered at a very affordable cost and are currently available in only a few centers throughout the country.

Participants:

1. Dr. Dilip Panicker, MCh, Head, Dept. of Neurosurgery, AIMS
2. Dr. T.K. Padmanabhan, MD, Head, Dept. of Radiation Oncology, AIMS
3. Dr. K. Bhaskaran Pillai, PhD, Head, Dept. of Medical Physics, AIMS
4. Mr. Satheesh Prasad, MSc, Dip R.P., Assoc. Professor, Medical Physics, AIMS