John Buatti, MD, Professor, Division of Radiation Oncology
University of Iowa Hospitals and Clinics

First Published: May 2001
Last Revised: May 2001
Peer Review Status: Internally Peer Reviewed

What is bloodless brain surgery?

Bloodless brain surgery is another term for radiosurgery that involves very precisely targeting hundreds of beams of radiation at a specifically defined target. It therefore can replace conventional surgery.

Why is it beneficial?

Radiosurgery can effectively cure a number of abnormalities, arteriovenous malformation, acoustic tumors, or meningiomas. It can effectively cure those tumors and lesions. It can contribute to significant improvements in quantity and quality of life for patients with a number of malignant tumors. It can also be used for some functional applications like the treatment of trigeminal neuralgia.

Does this type of surgery make for better recovery?

Yes, this is an outpatient procedure and does not require admission to the hospital like a conventional surgery. The recovery is such that many patients return to work the next day.

Are you using lasers?

No.

Why does it have to be a malignant tumor?

It does not have to be a malignant tumor. In fact, many of the tumors are benign or not really tumors at all.

Is this similar to a gamma knife machine?

Gamma knife is one method of delivering radiosurgery and there are other effective methods as well.

Are there limits to what you can use this technique for?

There are limits to the use of radiosurgery. Specifically tumors that are too large or are too close to special neurologic locations may not be ideally treated with radiosurgery. Other alternatives, including fractional stereotactic radiotherapy, may be preferred in such instances. In addition, some types of tumors may be served better by a combination of surgery and radiotherapy, or one of these treatments alone.

How new is this method of surgery?

The initial stereotactic radiotherapy is attributed to Lars Leksell in Sweden in 1951. However the common application of radiosurgery and stereotactic surgery in the United States has been from the mid1980s through the current time.

Can you combine this type of surgery with other forms, or does this replace traditional methods?

Yes, you can combine this treatment with traditional methods and in fact this is commonly done. It also can replace traditional methods of both radiotherapy and surgery in other instances. The selection for a combination vs. one method alone is best made by an experienced team of physicians who have used all of the methods including traditional end radiosurgical techniques.

Is there much pain or discomfort involved?

The application of a stereotactic head frame creates some pain. This is generally treated with local anesthetics, and sometimes pain medication. In addition, there are some new optic-guided methods that may allow the avoidance of a headring, and hence avoid any significant pain.

Can this technique be used for Parkinson's disease?

Yes, this technique can be used for Parkinson's disease. There are, however, some more standard surgical techniques that may have advantages. In particular, the surgical technique allows the neurosurgeon to test the site for producing the lesion and test whether it is correct. The radiosurgical treatment requires a high dose, that if misdirected can produce complications. Therefore there may be some advantage for neurosurgical approach as opposed to radiosurgical, although good effect can be obtained.

Is this an outpatient treatment?

Yes.

Can you explain how a typical procedure is performed?

In a typical procedure, a detailed MRI scan is obtained a day prior to the treatment. We usually have the patients arrive at 6:30 in the morning and give them a pill for relaxation. At about 7:00 a.m., the patient has two spots in the front of the head and two spots in the back of the head numbed-up with both a long-acting and a short-acting Novocain (it's like going to the dentist). We then attach four pins at the areas that are numb. These pins go through the skin and rest against the outside of the skull. Immediately following this, the patient is transported in a wheelchair to radiation oncology, where a very detailed CT scan is obtained. The patient is then returned to a waiting area and is able to have breakfast. The doctors including a neurosurgeon, radiation oncologist, and physicist, take both the MRI and the CT scan and put them into a computer where they are merged to each other. The images are then used to create a treatment plan, using 100s of beams of radiation towards the site of interest. The patient is then called back to radiation oncology where the treatment plan is delivered on the treatment machine. The treatment may last from 20 minutes to about 2 hours depending on the complexity of the shape of the lesion and plan. Following the treatment, the patient sits up and has the ring removed from the head, and is discharged about 5 minutes later.

Do you have to undergo any special training to do this?

The radiation oncologist and neurosurgeon should have special training in this procedure.

Is this procedure the norm in brain surgery, or are there other more traditional means that are more commonly used?

This is one of the standard methods to treat some types of tumors and lesions, although conventional brain surgery is also used commonly for many of these same lesions as well.

What kind of follow up does a patient need afterward?

The follow-up of the patient depends on the specific type of tumor or lesion that is treated. For example, arteriovenous malformation or benign brain tumor might have follow-up appointments with neuroimaging on a yearly basis, whereas a patient with a malignant tumor may be followed every 2 - 3 months with imaging and appointments.

Who is a candidate for this procedure?

Many patients are a candidate for this procedure and evaluation by an experienced team that uses this technology frequently will best dictate who is a good candidate. In general many benign and malignant tumors can benefit. Although it is important that selection by an experienced group of physicians is made.

Can this technology be used in other applications?

Yes, this technology is used in image-guided surgery and biopsy and the technique is applied to improve daily delivery of radiation therapy. The accuracy of radiation delivery can be improved by applying these techniques to standard treatments.

How is the tumor destroyed?

The radiation is known to damage the tumors DNA and prevent further reproduction of the cells. After a cell does not grow any longer, it is essentially dormant and unable to grow and cause problems. I think that there are some mechanisms that may be involved that are poorly defined biologically beyond a conceptual framework.