Performing brain surgery without a scalpel - Hyunsoo Joshua No

Every year, tens of thousands of people
world-wide have brain surgery

without a single incision:

there’s no scalpel, no operating table,
and the patient loses no blood.

Instead, this procedure takes place in a
shielded room

with a large machine that emits invisible
beams of light

at a precise target inside the brain.

This treatment is called stereotactic
radiosurgery,

and those light beams are
beams of radiation:

their task is to destroy tumors by
gradually scrubbing away malignant cells.

For patients, the process begins with
a CT-scan,

a series of x-rays that produce a
three-dimensional map of the head.

This reveals the precise location, size,
and shape of the tumor within.

The CT-scans also help to calculate
something called ‘Hounsfield Units’,

which show the densities
of different tissues.

This offers information about how
radiation

will propagate through the brain,
to better optimize its effects.

Doctors might also use magnetic resonance
imaging, or “MRI’s,”

that produce finer images of soft tissue,

to assist in better outlining a
tumor’s shape and location.

Mapping its precise position and size is
crucial

because of the high doses of radiation
needed to treat tumors.

Radiosurgery depends on the use
of multiple beams.

Individually, each delivers a low dose
of radiation.

But, like several stage lights converging
on the same point

to create a bright and inescapable
spotlight, when combined,

the rays of radiation collectively
produce enough power to destroy tumors.

In addition to enabling doctors to target
tumors in the brain

while leaving the surrounding healthy
tissue relatively unharmed,

the use of multiple beams also
gives doctors flexibility.

They can optimize the best angles and
routes through brain tissue

to reach the target and adjust the
intensity within each beam as necessary.

This helps spare critical structures
within the brain.

But what exactly does this ingenious
approach do to the tumors in question?

When several beams of radiation intersect
to strike a mass of cancerous cells,

their combined force essentially
shears the cells’ DNA,

causing a breakdown
in the cells’ structure.

Over time, this process cascades into
destroying the whole tumor.

Indirectly, the rays also damage the area
immediately surrounding the DNA,

creating unstable particles
called free radicals.

This generates a hazardous
microenvironment

that’s inhospitable to the tumor,

as well as some healthy cells
in the immediate vicinity.

The risk of harming non-cancerous tissue
is reduced

by keeping the radiation beam coverage

as close to the exact shape
of the tumor as possible.

Once radiosurgery treatment has destroyed
the tumor’s cells,

the body’s natural cleaning
mechanism kicks in.

The immune system rapidly sweeps
up the husks of dead cells

to flush them out of the body, while
other cells transform into scar tissue.

Despite its innovations, radiosurgery
isn’t always the primary choice

for all brain cancer treatments.

For starters, it’s typically reserved for
smaller tumors.

Radiation also has a cumulative effect,

meaning that earlier doses can overlap
with those delivered later on.

So patients with recurrent tumors

may have limitations with future
radiosurgery treatments.

But these disadvantages weigh up
against some much larger benefits.

For several types of brain tumors,

radiosurgery can be as successful as
traditional brain surgery

at destroying cancerous cells.

In tumors called meningiomas,
recurrence is found to be equal, or lower,

when the patient undergoes radiosurgery.

And compared to traditional surgery––

often a painful experience with
a long recovery period––

radiosurgery is generally pain-free,

and often requires little
to no recovery time.

Brain tumors aren’t the only target for
this type of treatment:

its concepts have been put to use on
tumors of the lungs, liver, and pancreas.

Meanwhile, doctors are experimenting
with using it to treat conditions

such as Parkinson’s disease, epilepsy,
and obsessive compulsive disorder.

The pain of a cancer diagnosis can be
devastating,

but advancements in these non-invasive
procedures

are paving a pathway
for a more gentle cure.