Winter 1998
Brain Surgery for the 21st Century
By Ann S. Boor

Brain surgery. These two words are certain to strike fear in even the bravest of patients. But new advances in brain surgery have eliminated some of the anxiety as well as much of the pain and recovery time. Alternatives to traditional "open brain" surgery are available in forms of stereotactic radiosurgery and stereotactic neurosurgery. And, a diagnosis of brain tumor or brain cancer will no longer seem as frightening.

Stereotactic Radiosurgery:
The Photon Knife

On Tuesday morning, a 10-year-old girl had what was considered to be an inoperable brain tumor. By Wednesday afternoon, the tumor was completely destroyed, the girl went home with her parents and she got to keep all of her pretty, long hair.

"Sound like a miracle? A medical miracle," says Robert Behar, M.D., of the Stereotactic Radiology Center at Spring Branch Medical Center. "Her tumor was eradicated by a revolutionary new method of non-invasive stereo radiosurgery -- otherwise known as the photon knife."

The photon knife is a new, minimally invasive type of brain surgery used to treat and wipe out brain tumors and other abnormalities.

"With this procedure, we do not need to shave the patient's hair or open the skull," says Dr. Behar. "The photon knife is a precise way to deposit a very intense dose of radiation in the brain to an area that's been localized, well defined and immobilized."

The advanced computer software of the photon knife allows it to deliver up to eight weeks of radiation therapy to an area as small as 4 millimeters in 20 minutes. One of the advantages of the photon knife is that it delivers the radiation to the part of the brain that needs treatment. Unlike external radiation, the photon knife restricts the radiation delivery to the affected part of the brain and basically ignores the healthy parts.

"Stereotactic radiosurgery has a number of applications," says Dr. Behar. "Malignant tumors is one such area. We have also had tremendous success in treating malformations."

"At Spring Branch, we have also pioneered the use of the photon knife in treating acoustic neuromas," continues Dr. Behar. "These are tumors that affect the part of the brain responsible for hearing and balance. Traditionally, they have been treated with a surgery with a significant chance of causing hearing loss and facial paralysis on the affected side. At Spring Branch, we have taken the lead in delivering the radiosurgery over three separate sessions separated by eight to 12 hours. This has resulted in a much lower chance of injuring our patients' hearing and facial functions."

Prior to the development of the photon knife, an open brain operation would have involved weeks of hospitalization. The recuperation period would be lengthy, and follow-up treatment may have included radiation.

On the other hand, stereotactic neurosurgery is performed under local anesthesia and often on an outpatient basis. There are little or no side effects. Patients resume their normal activities immediately and can usually return to work the next day. It may all sound so simple, but don't be fooled, advises Dr. Behar. "This is an extremely sophisticated procedure that calls for special training and state-of-the-art technology. Altogether, it is an excellent alternative to conventional surgery.