Gamma Clinic Center for High-Precision Radiology

Treatment of brain tumors and vascular pathologies in 1 day using the Gamma Knife device.

The center was officially opened on February 1, 2018. Famous European specialists took part in the operations of the Clinic at the commencement stage - the beginning of work with patients. Among them are professor R. Lischak and medical physicist J. Novotny from one of the oldest radiosurgical centers in Eastern Europe - the hospital on Homolka in Prague.

Currently, the geography of Gamma clinic patients in the literal sense of the word extends from Kaliningrad to Petropavlovsk-Kamchatsky, and even wider in the near abroad: in Kazakhstan, Latvia, Estonia, Ukraine, Azerbaijan, Armenia, and other CIS countries.

Stereotactic radiosurgery using the Gamma knife technology is no novelty in our country. Sergey Rustamovich Ilyalov, the Head of the Center, stood at the origins of its development in Russia. This doctor has three specialties: a neurosurgeon, a radiotherapist, and an organization man in healthcare, and possesses extensive experience in using the Gamma knife in the surgical treatment of various types of intracranial pathologies primarily in neuro-oncology and vascular neurosurgery. Since the introduction and first implementation of the Gamma knife at the Research Institute of Neurosurgery named after Burdenko in 2005, during 12 years past, Sergey Rustamovich has not only thoroughly mastered this technique but has also defended the first dissertation dedicated to the Gamma knife using in Russia. He also constantly shared his experience with colleagues from Moscow (NIISP named after N. In. Sklifosovsky), from St. Petersburg (Medical Institute named after Sergey Berezin and FSI Russian Scientific Center of Radiology and Surgical Technologies), from Khanty-Mansiysk (District oncological dispensary), from Minsk and Astana who were taking training courses at the Research Institute of Neurosurgery.

The Gamma clinic center is small but very cozy and comfortable for patients who stay there. The unique atmosphere, in which patients can relax as much as possible and entrust the doctors with the most valuable thing - their health, has been created and is constantly maintained in the Gamma clinic center. Moreover, the Gamma clinic is ready to help everyone who needs it - with advice and guidance by leveraging professionalism and competence, human involvement, and a sense of humor.

What is a Gamma Knife?

Gamma knife is the world's first device designed for stereotactic radiosurgery - highly targeted remote irradiation of pathological targets located inside the skull. The Gamma knife allows delivering an irradiation dose of tens of Gray to the irradiated area (1 Gy = 100 rad) in one session. At the same time, the maximum of this dose is located inside the target. At the border of the irradiated focus with healthy tissues, a sharp drop (gradient) of the dose occurs, as a result of which a minuscule, safe dose of radiation falls on the adjacent tissues. The radiobiological effect of radiosurgery is to damage the genetic apparatus of tumor cells. As a result, they lose their ability to divide and further increase the tumor mass. In radiosurgery of malignant tumors, higher doses of radiation are usually implemented (15-25 Gy along the edge of the lesion with a maximum of up to 30-50 Gy). This leads not only to suppression of the mitotic activity of cells but also to their rapid death. However, the higher the dose at the edge of the tumor and the more extensive the tumor, the higher the radiation load on the adjacent healthy tissues, which in 10-15% of cases leads to local (in the irradiation zone) post-radiation reactions. Owing to the immediate effect, malignant tumors not only stop growing or shrinking but also wholly disappear.

We must also mention that the Gamma Knife, despite its unrivaled accuracy and high efficiency, the relatively low complication rate (in comparison with traditional neurosurgical interventions or standard radiation therapy) is not a panacea for brain tumors. Just as surgery, radiation therapy, or other treatments is not a panacea. Each method has its strengths, weaknesses, advantages, and disadvantages. And only a specialist can determine which treatment method in this special case, for a particular patient, is optimal. The Gamma Knife is a very reliable but not the only tool in the available arsenal of treatments for a wide range of severe neurosurgical pathologies.

At present, the most technically advanced model of the Gamma Knife is the Leksell Gamma Knife Perfexion model (LGK Perfexion), which significantly expands the capabilities of existing techniques, facilitates, and accelerates treatment planning, and creates more complex radiation fields with increased safety for surrounding structures. With the help of LGK Perfexion, precise (with an error of only 0.15-0.3 mm) local irradiation of various hard-to-reach brain tumors, including those previously considered incurable, arteriovenous malformations, and cavernous angiomas, some brain structures in functional diseases (trigeminal neuralgia, parkinsonism). LGK Perfexion, due to its unprecedented precision, is the "gold standard" in stereotactic radiosurgery of brain pathology and practically has no restrictions on the number and localization of pathological formations, including in the area of the upper cervical spine and spinal cord. Furthermore, thanks to the innovative system with the automatic change in the diameter of the collimators, the treatment time is significantly reduced in comparison with the previous models of the Gamma Knife, which creates exceptional comfort during radiosurgery.

On the basis of LGK Perfexion, the LGK Icon device was created and passed clinical testing. Its difference lies in the additional connection of a compact X-ray tomograph to the Gamma knife and other devices that allow for "non-rigid" fixation of the patient with a thermoplastic mask. This type of fixation is indicated only for patients with large tumors that require so-called hypofractionated (2-5 sessions) radiotherapy. CT, in this case, is necessary to verify the correct head posture during each treatment session. Single-fraction (radiosurgical) irradiation on Icon is also performed using a stereotactic frame and does not differ in any way from Perfexion. Both devices have an identical source arrangement scheme, a robotic system for changing the diameter of collimators, and identical irradiation accuracy when using a stereotactic frame.

Stereotactic radiosurgery using the LGK Perfexion device is a highly effective and rather safe method of treating patients with various types of intracranial pathology, which allows achieving excellent and lasting results while maintaining a high level of quality of life of patients with a low probability of complications.