Surgery without a scalpel?

The brain contains millions of delicate yet critical structures and connections. When an abnormality develops—such as a tumor growing or a neural circuit misfiring—treating the condition requires both precision and accuracy. The renowned neurosciences team at Swedish Medical Center works tirelessly to learn, refine, and provide innovative ways to treat these conditions, while causing as little disruption to healthy tissue as possible. Among other advanced treatments, the team has found success with a highly specialized treatment called stereotactic radiosurgery (SRS).

SRS often is referred to as knifeless brain surgery. That’s because the treatment can provide therapy deep inside the brain without need for an incision or opening the skull.

“SRS uses nearly two hundred precisely focused beams of radiation,” Matthew Mian, MD, a neurosurgeon at Swedish Medical Center explains. “Each individual beam has little effect on healthy brain tissue. But when the beams converge at the location we have targeted, they can have a powerful collective effect, destroying unhealthy or cancerous tissue or blocking errant nerve signals.”

Swedish Medical Center is using SRS to treat many neurological conditions including brain tumors, essential tremor, and facial pain disorders such as trigeminal neuralgia.

Destroying brain tumors with SRS

Tumors can grow nearly anywhere inside the head. Some tumors are malignant (cancerous), while others are slow-growing and benign. Tumors can arise from the brain itself or from other tissue inside the head, such as the skull, nerves, or meninges. Symptoms from a tumor can vary widely depending on the location, size, and rate of growth, but they can include headaches, nausea, cognitive or personality changes, vision changes, seizures, weakness, balance problems, and hearing loss, among others.

There are a variety of techniques for treating brain tumors. Large tumors may be appropriate for removal with surgery. Small, benign tumors can often be observed over time and may not need any treatment at all. For many tumors – particularly those that would be difficult or risky to remove with surgery – SRS is an excellent treatment option.

“SRS is an effective option for many brain tumors, including meningiomas and brain metastases. It helps us preserve the healthy tissue around a tumor and avoids many of the risks of open brain surgery. SRS is also accurate, allowing us to target tumors with sub-millimeter precision. Most importantly, SRS is safe, painless, and easier for patients to recover from than open surgery,” Dr. Mian highlights.

Relieving essential tremor with SRS

Essential tremor is a common neurologic disorder in which there is trembling or shaking in one or more parts of the body, often the hand. The tremor worsens with purposeful movements such as writing, eating, and drinking. In some cases, essential tremor can be debilitating, affecting basic activities of everyday life.   Essential tremor appears to be caused by dysfunction of a neural circuit that includes a deep part of the brain known as the ventral intermediate nucleus (VIM).  Fortunately, for patients with severe tremors despite medications, there are effective treatment options – including SRS. “Patients with essential tremor often have difficulty with basic activities such as drinking from a cup or writing legibly,” Dr. Mian explains. “SRS is an effective tool for suppressing tremor to help them get their lives back.”

In an SRS treatment for essential tremor, radiation beams are targeted at the VIM. When the beams converge, they damage the nerve cells, creating a lesion that interrupts the errant signals, relieving the tremor. The treatment is painless and lasts about an hour.

SRS to treat trigeminal neuralgia

Trigeminal neuralgia is a rare, debilitating pain disorder in which there are zaps of lightning-like pain in the face – often brought on by innocuous triggers such as chewing, brushing the teeth, applying makeup, touching the face, or even a light breeze. About half of patients with trigeminal neuralgia find lasting relief with medications. For those who continue to have severe pain despite medications, there are several effective procedures for relieving the pain – including SRS. 

Stereotactic radiosurgery is a safe, effective, and minimally invasive technique for treating trigeminal neuralgia. “When we treat trigeminal neuralgia with SRS, we target the root of the trigeminal nerve, where it emerges from the brainstem. We deliver a precise, concentrated dose of radiation to a tiny point on the nerve, creating a lesion that interrupts pain signals,” Dr. Mian explains. “SRS often yields dramatic pain relief, but the effects can take a few weeks to appear. Importantly, SRS can be repeated if the pain returns later in life.”

Benefits of SRS for neurologic conditions

SRS is usually performed as a single treatment, and patients are able to return home after the procedure. In the days or weeks before the procedure, most patients with have an MRI or CT that will be later used to create a treatment plan. On the day of the procedure, patients may receive  light sedation and then have a frame placed on the head or a mask on the face to help the patient hold still during treatment.  Next, the treatment team – which consists of a neurosurgeon, radiation oncologist, physicist and experienced support staff – finalize the treatment plan. Once the plan is complete, the patient is placed on a bed that slides into the SRS machine. The machine automatically focuses the radiation beams and administers the planned treatment. An SRS session may last anywhere from less than one hour to several hours, and patients may take a break, if needed.  At the conclusion of treatment, patients are allowed to return home. The treatment team continues to follow up with the patient during recovery to monitor progress.

“SRS provides an excellent alternative to traditional brain surgery. Many patients choose SRS because they are hoping to avoid the invasiveness, hospitalization, and recovery period needed for brain surgery.  And SRS allows us to treat patients who would not be good candidates for open brain surgery, for example those with significant health problems or those with conditions that don’t lend themselves to open surgery,” Dr. Mian clarifies. “SRS not only provides these patients another treatment option, but it also offers hope to those who are facing daunting diagnoses. It is a privilege offer this therapy and to help get them back to their lives.”

To learn why more patients are saying “Take me to Swedish” for their neurological and emergency needs, visit the Swedish emergency care page.

Matthew Mian, MD is a neurosurgeon at Swedish Medical Center in Englewood, Colorado, where he serves as the director of functional neurosurgery. He studied biomedical engineering and math at Duke University and then earned his medical degree with honors from a joint program between Harvard Medical School and Massachusetts Institute of Technology (MIT). While in Boston, Dr. Mian developed an interest in cognitive neuroscience, and his studies were published in prominent journals including Nature, The Journal of Neuroscience, and Cerebral Cortex. He completed his residency training in neurosurgery at Massachusetts General Hospital and then a fellowship in stereotactic and functional neurosurgery at Emory University. Dr. Mian is passionate about minimally invasive neurosurgical therapies for restoring neurologic function. He prioritizes clear and honest discussions with his patients. His practice focuses on bringing the latest advancements to the operating room, including technologies like robotic neurosurgery, laser interstitial thermal therapy, MRI-guided focused ultrasound, and clinical trials for patients with brain tumors and Parkinson's Disease.