Over the last generation, a veritable revolution has taken place in neurosurgery as a whole, resulting in much smaller and less invasive surgical procedures to treat a wide variety of conditions. To some extent these changes mirror progress in surgery as a whole, and have been driven not only by progressive neurosurgeons but by patients and families as well. Tolerance for surgical side effects, which in brain surgery can mean permanent new weakness, trouble walking or speaking, etc. has decreased dramatically (and for good reason, of course).

Radio surgery

Perhaps the best known and most widely accepted of these new treatments is stereotactic radiosurgery, or SRS. This technique was invented by the pioneering neurosurgeon Lars Leksell in Stockholm, Sweden in 1951, and came into widespread use abut 20 years ago.

Readers may know SRS from advertising campaigns that promote different devices such as Gamma Knife, Cyberknife, Novalis, and others. What unifies these different systems is the common goal of delivering a very high dose of radiation to a very small target, in an effort to overwhelm an abnormality with greater efficiency and fewer side effects than is possible with regular radiation therapy. That is why SRS typically is administered in a single treatment, or fraction, whereas radiation therapy is usually given over as many as six weeks.

Range of treatment

SRS has been a revolutionary and disruptive technology for patients with brain tumors. These include benign tumors, which are not cancerous but can cause devastating neurological problems by compression of the brain, but also malignant tumors as well.

"SRS and other minimally invasive approaches have greatly reduced treatment complications and provided an excellent and effective alternative for patients and families to choose."

To take one example, the benign tumors known as acoustic neuromas or vestibular schwannomas can be removed surgically using refined microsurgical methods. However, in so doing, the risks of new neurological problems, including disfiguring facial palsies, problems with coordination and walking, or even trouble swallowing can result. With SRS, these risks are reduced to near zero, while the likelihood of the tumor never growing again is close to 100 percent.

Against metastatic

A more common problem that neurosurgeons see is when patients develop cancers that spread to the brain, known as metastatic tumors. Until very recently, standard therapy in these cases involved whole brain radiation therapy (what it sounds like) with a high likelihood of permanent memory loss as a result, and definite loss of hair on the whole head.

The application of SRS to people with metastatic tumors has yielded very high rates of tumor disappearance with a much lower risk to one’s ability to remember or think. And all of these SRS treatments, whether for benign or cancerous tumors, are done on an outpatient basis. You arrive in your street clothes and leave a few hours later, unchanged. Compare that to a week in the hospital with an incision, risks of bleeding and infection and pain after surgery.

Regular surgery still has its place for people diagnosed with brain tumors, but SRS and other minimally invasive approaches have greatly reduced treatment complications and provided an excellent and effective alternative for patients and families to choose.