1 00:00:06,962 --> 00:00:11,920 Every year, tens of thousands of people world-wide have brain surgery 2 00:00:11,920 --> 00:00:14,200 without a single incision: 3 00:00:14,200 --> 00:00:19,540 there’s no scalpel, no operating table, and the patient loses no blood. 4 00:00:19,540 --> 00:00:23,641 Instead, this procedure takes place in a shielded room 5 00:00:23,641 --> 00:00:28,173 with a large machine that emits invisible beams of light 6 00:00:28,173 --> 00:00:31,493 at a precise target inside the brain. 7 00:00:31,493 --> 00:00:35,493 This treatment is called stereotactic radiosurgery, 8 00:00:35,493 --> 00:00:39,323 and those light beams are beams of radiation: 9 00:00:39,323 --> 00:00:45,383 their task is to destroy tumors by gradually scrubbing away malignant cells. 10 00:00:45,383 --> 00:00:49,143 For patients, the process begins with a CT-scan, 11 00:00:49,143 --> 00:00:54,013 a series of x-rays that produce a three-dimensional map of the head. 12 00:00:54,013 --> 00:00:59,654 This reveals the precise location, size, and shape of the tumor within. 13 00:00:59,654 --> 00:01:05,048 The CT-scans also help to calculate something called "Hounsfield Units," 14 00:01:05,048 --> 00:01:08,318 which show the densities of different tissues. 15 00:01:08,318 --> 00:01:11,238 This offers information about how radiation 16 00:01:11,238 --> 00:01:15,403 will propagate through the brain, to better optimize its effects. 17 00:01:15,403 --> 00:01:20,331 Doctors might also use magnetic resonance imaging, or MRI’s, 18 00:01:20,331 --> 00:01:23,641 that produce finer images of soft tissue, 19 00:01:23,641 --> 00:01:28,248 to assist in better outlining a tumor’s shape and location. 20 00:01:28,248 --> 00:01:31,798 Mapping its precise position and size is crucial 21 00:01:31,798 --> 00:01:36,204 because of the high doses of radiation needed to treat tumors. 22 00:01:36,204 --> 00:01:40,306 Radiosurgery depends on the use of multiple beams. 23 00:01:40,306 --> 00:01:44,036 Individually, each delivers a low dose of radiation. 24 00:01:44,036 --> 00:01:48,357 But, like several stage lights converging on the same point 25 00:01:48,357 --> 00:01:53,015 to create a bright and inescapable spotlight, when combined, 26 00:01:53,015 --> 00:01:58,523 the rays of radiation collectively produce enough power to destroy tumors. 27 00:01:58,523 --> 00:02:02,343 In addition to enabling doctors to target tumors in the brain 28 00:02:02,343 --> 00:02:05,753 while leaving the surrounding healthy tissue relatively unharmed, 29 00:02:05,753 --> 00:02:09,856 the use of multiple beams also gives doctors flexibility. 30 00:02:09,856 --> 00:02:14,389 They can optimize the best angles and routes through brain tissue 31 00:02:14,389 --> 00:02:18,441 to reach the target and adjust the intensity within each beam 32 00:02:18,441 --> 00:02:19,941 as necessary. 33 00:02:19,941 --> 00:02:22,951 This helps spare critical structures within the brain. 34 00:02:22,951 --> 00:02:28,118 But what exactly does this ingenious approach do to the tumors in question? 35 00:02:28,118 --> 00:02:33,796 When several beams of radiation intersect to strike a mass of cancerous cells, 36 00:02:33,796 --> 00:02:38,203 their combined force essentially shears the cells’ DNA, 37 00:02:38,203 --> 00:02:41,343 causing a breakdown in the cells’ structure. 38 00:02:41,343 --> 00:02:46,198 Over time, this process cascades into destroying the whole tumor. 39 00:02:46,198 --> 00:02:51,670 Indirectly, the rays also damage the area immediately surrounding the DNA, 40 00:02:51,670 --> 00:02:55,819 creating unstable particles called free radicals. 41 00:02:55,819 --> 00:02:58,359 This generates a hazardous microenvironment 42 00:02:58,359 --> 00:03:00,439 that’s inhospitable to the tumor, 43 00:03:00,439 --> 00:03:03,839 as well as some healthy cells in the immediate vicinity. 44 00:03:03,839 --> 00:03:07,279 The risk of harming non-cancerous tissue is reduced 45 00:03:07,279 --> 00:03:09,699 by keeping the radiation beam coverage 46 00:03:09,699 --> 00:03:14,110 as close to the exact shape of the tumor as possible. 47 00:03:14,110 --> 00:03:18,000 Once radiosurgery treatment has destroyed the tumor’s cells, 48 00:03:18,000 --> 00:03:21,300 the body’s natural cleaning mechanism kicks in. 49 00:03:21,300 --> 00:03:25,300 The immune system rapidly sweeps up the husks of dead cells 50 00:03:25,300 --> 00:03:30,492 to flush them out of the body, while other cells transform into scar tissue. 51 00:03:30,492 --> 00:03:35,304 Despite its innovations, radiosurgery isn’t always the primary choice 52 00:03:35,304 --> 00:03:37,614 for all brain cancer treatments. 53 00:03:37,614 --> 00:03:41,744 For starters, it’s typically reserved for smaller tumors. 54 00:03:41,744 --> 00:03:44,454 Radiation also has a cumulative effect, 55 00:03:44,454 --> 00:03:49,010 meaning that earlier doses can overlap with those delivered later on. 56 00:03:49,010 --> 00:03:51,380 So patients with recurrent tumors 57 00:03:51,380 --> 00:03:55,604 may have limitations with future radiosurgery treatments. 58 00:03:55,604 --> 00:04:00,667 But these disadvantages weigh up against some much larger benefits. 59 00:04:00,667 --> 00:04:02,797 For several types of brain tumors, 60 00:04:02,797 --> 00:04:06,637 radiosurgery can be as successful as traditional brain surgery 61 00:04:06,637 --> 00:04:08,597 at destroying cancerous cells. 62 00:04:08,597 --> 00:04:13,829 In tumors called meningiomas, recurrence is found to be equal, or lower, 63 00:04:13,829 --> 00:04:16,679 when the patient undergoes radiosurgery. 64 00:04:16,679 --> 00:04:18,639 And compared to traditional surgery— 65 00:04:18,639 --> 00:04:21,979 often a painful experience with a long recovery period— 66 00:04:21,979 --> 00:04:24,739 radiosurgery is generally pain-free, 67 00:04:24,739 --> 00:04:28,479 and often requires little to no recovery time. 68 00:04:28,479 --> 00:04:32,049 Brain tumors aren’t the only target for this type of treatment: 69 00:04:32,049 --> 00:04:37,187 its concepts have been put to use on tumors of the lungs, liver, and pancreas. 70 00:04:37,187 --> 00:04:41,187 Meanwhile, doctors are experimenting with using it to treat conditions 71 00:04:41,187 --> 00:04:46,583 such as Parkinson’s disease, epilepsy, and obsessive compulsive disorder. 72 00:04:46,583 --> 00:04:49,693 The pain of a cancer diagnosis can be devastating, 73 00:04:49,693 --> 00:04:52,733 but advancements in these non-invasive procedures 74 00:04:52,733 --> 00:04:55,853 are paving a pathway for a more gentle cure.