When I was a child, the closest I ever came to a brain surgeon was Dr. Zorba on the old television show, “Ben Casey.” Played by Sam Jaffe, Dr. Zorba had the look of what you would expect from either a brain surgeon or a gifted concert violinist: wiry hair, somewhat wild eyes, yet a cool demeanor, the calm in the storm. The show needed him to offset the tempestuous Dr. Casey, the cocksure young surgeon and star of the show. Back in those days, the idea of gamma knife or cyber knife surgery was as far out as a Buck Rogers serial.

When I was an actual neurosurgical candidate, I found that many of the young neurosurgical residents weren’t too far off from Dr. Ben Casey. Overly confident, somewhat brash, little demi-gods-in-training, they had the swagger down before they actually had the full credentials. Thank goodness the doctor in charge of my case (Dr. Curtis Dickman) was nothing like that.

My surgery took place 13 years ago this last February. The tumor I had, called a meningioma, was benign, but it was located deep within my brain, so it took a lot of doing to resect (or remove it). See my earlier blog (“Brain Surgery Ain’t No Salad”).

About a week ago, I was approached by a friend to contact a friend of his who has recently been diagnosed with the same type of tumor and will be a patient at the same facility: Barrow Neurological Institute in Phoenix, AZ. Not only does she have the benefit of 13 years of advancement in neurosurgery, but she will also have access to Barrow’s beautiful new state-of-the-art neuroscience wing.

In exchanging a few e-mails, she has indicated that they may be able to resect her tumor without cutting her open. Isn’t that amazing? To remove a tumor from the brain without ever cutting open the skull? I think even in his wildest dreams, Harvey Cushing (the father of neurosurgery) would never have imagined such a feat! Yet it is done today around the world through something called “stereotactic radiosurgery.”

“Stereotactic” refers to the precise positioning in a three-dimensional space. When a patient’s head is positioned into a stereotactic 3-D frame, it is totally immobilized so that the head can be referenced and provide exact coordinates for delivering radiation.

“Radiosurgery” is the delivery of a single, large dose of radiation to a specific target in the brain with surgical precision. It will react on a molecular level with cancer cells, arresting their development, thereby killing the cancer.

The two most current robotic radiosurgery modalities in use are the Gamma Knife and the CyberKnife.

The Gamma Knife radiosurgery has been used in over 500,000 patients worldwide for various brain tumors and brain disorders. The Gamma Knife is a Swedish invention, which, over the years has been refined and improved as advances in engineering radiation physics, robotic controls and computerized treatment planning have taken place.

The Gamma Knife is used for brain only and requires a frame attached temporarily to the head. Gamma Knife surgery is sometimes used as a complement to open surgery and is normally performed by a neurosurgeon, a radiation oncologist and a medical physicist. There are lower complications than open surgery and oftentimes it is done on an outpatient basis.

The Cyber Knife is also a non-invasive radiosurgery but can be used to treat a broad range of tumors all over the body. Although its name conjures up cutting, like the Gamma Knife, it involves no cutting on the body. Although it is a newer technology, it is less precise than the Gamma Knife. The Cyber Knife does not involve attaching the head to a frame, the patient is merely positioned on the treatment table and the Cyber Knife’s computer-controlled robot slowly moves around the patient to the various locations to which it will deliver the radiation.

So although there are various treatment options available and more on the horizon, newer is not always better. The best course of action is the one discussed thoroughly with one’s team of doctors. This is best accomplished from a patient standpoint if the patient has the time beforehand and feels comfortable doing so, by researching the subject. Ideally, the patient would have the information reviewed and a list of questions available and ready to ask the doctor so the visit is maximized for both the doctor and the patient.

And a special thanks to Dr. Dickman for his expertise in helping me with some facts!