Shaped beam radiosurgery Novalis / Radiotherapy Unit

Our medical staff is composed of a wide range of experts specializing in diseases of the central nervous systems (neurooncologists, neurosurgeons, radiooncologists and radiologists). Every doctor, assisted by a team of technicians and nurses, works with cutting-edge technology in order to optimize the treatment of brain tumours and vascular malformations to the utmost.

Radiosurgery consists of a sole high dose radiation to the tumour or arteriovenous malformation (AVM). Although the term surgery is used, there is no incision at all . It is an outpatient treatment, which eliminates the complications, hospitalization and recovery time associated with conventional cranial surgery.

Radiosurgery uses beams of light to remove, reduce or restrain the growth of a tumour by destroying tumour cells thereof or interefering with their growth. For AVM, the beams of radiation produce an enlargement of vascular walls, which acheives the obliteration of the abnormal vessels.

Radiosurgery permits more accurate radiation of the brain tumour or a AVM than conventional radiotherapy. This focused treatment is made possible thanks to the use of a minimally-invasive stereotactic frame that keeps the patient perfectly positioned.A localizing device is attached to the stereotactic frame, showing the reference points for the planning the treatment. Then treatment is performed. This procedure reduces radiation to healthy brain tissue and protects nearby organs.

Stereotactic radiotherapy permits the administration of the same amount of radiation (or higher) as conventional radiosurgery, but it is applied in smaller doses in a series of daily treatments (divided dose). The division of the dose favours the repair of the healthy tissue near the lesion, particularly in critical structures such as the optic canal or the brain trunk.

Novalis Shaped Beam Surgery™ is the cutting-edge system for stereotactic radiosurgery and radiotherapy available today. Novalis permits the most accurate adaptation of dynamic configuration of the radiation beam according to the size and shape of the tumour or AVM at any angle. This ensures that the tumour receives the full dose , while at the same time protects healthy brain tissue. The configuration of the radiation beam to the exact geometry of the tumour is the latest method available in performing stereotactic radiosurgery.

The procedure is painless and helps avoid long hospitalization periods or long rehabilitation. The patient remains awake during the entire treatment. Treatment can be given in the morning and normal routine can be resumed in the afternoon.

Depending on each particular case, Novalis Shaped Beam Surgery™may be the most suitable option for the following conditions:

• Arteriovenous malformations
• Brain metastases and gliomas
• Acoustic neuromas
• Cavernous angiomas
• Paediatric brain tumours
• Recurring brain tumours
• Pituitary adenomas
• Meningiomas in the base of the skull
• Cancers of the Head and Neck

Conventional surgery cannot be applied or recommended in some cases due to other diseases, the age of the patient or the localization of the abnormal tissue within the brain. The medical staff will decide the treatment that best fits your case.

Step 1

During the preparation before the treatment, the neurosurgeon or the radiologist-oncologist will place a stereotactic frame or a mask (depending on each case) over the head of the patient. The stereotactic frame is a metallic ring with tight bars forming a circle around your head. The stereotactic frame is an essential part of Shaped Beam Surgery™ as it is used to hold your head in a certain position to keep the referrance points in a fixed position during image-taking and treatment.

Step 2: Diagnostic Imaging

Ten, a localizing device ,is placed over the stereotactic frame. The localizer locates referrance points, which permit definition of the exact position of the lesion and the normal structures during the procedure. At this point, the team of doctors and physicists will accurately plan treatment for your tumour or AVM. The use of CT scan, MRI, SPECT or PET, obtains images that will be used to accurately define the size and the shape of the lesion and the connection thereof with other brain structures. This step takes approximately 15 to 20 minutes.

Step 3: Planning the treatment

After the diagnostic imaging, the localizing device is removed. The patient rests while the treatment is being planned. The images taken are transfered to a computer designed for planning, calculating the dose to be administered and obtaining coordinates for the treatment.

Step 4: Position and treatment

When everything is ready, the patient is brought to the treatment room and lies on an examining couch for the treatment with Novalis Shaped Beam Surgery™. The stereotactic frame has to be fastened to the examining couch, so that you will not be able to move during the treatment. The team of technicians, physicists and doctors will supervise the alignment between your head and the luminous projection of the beam of radiation. When the treatment is started, the head of the Novalis device will move around you in order to administer the desired dose of radiation, but you will feel no pain. The team of specialists will explain this procedure to you during the treatment, which takes about 30 minutes.

Step 5: Removal of the stereotactic frame and...

Once the treatment with Novalis Shaped Beam Surgery™ ends, the stereotactic frame is removed. The patient can go home and resume his/her normal routines again, including face and hair-washing.

1. The stereotactic mask system or stereotactic frame is safely placed over the patient's head.

2. A localizer is placed over the mask/frame and diagnostic images are taken (CT scan, MRI, SPECT or PET).

3. The images taken are transfered to the main computer, where the specialist and the physicist plan the treatment.

4. The patient is placed onto the table for Novalis treatment and the procedure starts.

5. The treatment is finished and the stereotactic frame is removed.

6. The patient goes home and resumes normal activity.