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B A U M E D I C A L S C H O O L
GAMMA KNIFE RADIO
SURGERY MANUAL

Gamma Knife
About Radio-Surgery Team
Gamma Knife Radio-Surgery was first performed by Prof. Türker Kılıç, M.D., in
Marmara University in Turkey on 1997. There are 367 Gamma Knife
Radio - Surgery Centers worldwide.
Eight hundred ninety thousand patients had globally been treated with
Gamma Knife Radio - Surgery since 1967. To date, approximately 10000
patients were treated by Prof. Türker Kılıç, M.D., and his team.
The principal underlying cause of this success arises out of the fact that both
neurosurgery and Gamma Knife is performed by the same team.

GAMMA KNIFE BY DIAGNOSES
GAMMA KNIFE UNIT OF MEDICAL PARK
GOZTEPE HOSPITAL COMPLEX,
GAMMA KNIFE BY FIGURES
24.11.2018
DIAGNOSES
FIGURES
AVM
1485
ACOUSTIC NEUROMA 902
GLIAL TUMOR 529
PITUITARY ADENOMA 1310
CAVERNOMA 559
MENINGIOMA 2129
METASTASIS 1765
OTHERS 922
TOTAL 9601
AVM
ACOUSTIC NEUROMA
GLIAL TUMOR
PITUITARY ADENOMA
CAVERNOMA
MENINGIOMA
METASTASIS
OTHERS

Gamma Knife
Is a Quick And Easy-to-Use
Treatment Method

What is
Gamma-Knife Radio-Surgery ?
Gamma Knife Radio-Surgery is a type of radio-surgery system that is used to treat
tumors and vascular diseases of brain and pituitary gland.
Gamma Knife Radio-Surgery focuses many (201) low-energy beams (which cause no harm
throughout the route of irradiation) to the diseased region inside the skull and biologic and
genetic changes in the diseased area secondary to the delivery of high energy is used for
treatment.
Gamma Knife Radio-Surgery is usually preferred for conditions where conventional
neurosurgery is not possible or poses high risk.

How is Gamma-Knife
Radio-Surgery Performed ?
First, patient's head is immobilized with a treatment frame to stabilize the head.
Immobilization of skull is of vital importance to perform surgery correctly and to deliver
beams accurately to the pre-planned location. Local anesthetic agent is instilled to locations,
where metallic helmet is fixed on the skull, and thus, patient feels no pain.
After the frame is fixed, the next step is imaging. MR images and angiography images,
if required, are acquired under the head frame. Neurosurgeon uses these images to make a
treatment plan for the diseased area using specialized software. After the final version of plan
is created, procedure continues with the treatment. The frame is positioned accurately
according to the coordinates that are determined at the planning phase. The patient is informed
about procedures. Next, the patient on the treatment table is slide into the machine and
radio-surgery is started. After each beam is delivered to the correct place for a pre-planned
time, and the patient is slide off the machine; and the frame is removed and patient
is discharged after relevant recommendations are made. Patient feels no pain and ache
during the treatment.

How to Apply
Gamma-Knife Radio-Surgery?
Gamma Knife Radio-Surgery may cure both benign cerebral tumors (meningiomas,
pituitary adenomas, acoustic neuroma, etc.) and malignant cerebral tumors
(cerebral metastases, glial tumors, etc.).
Moreover, Gamma Knife Radio-Surgery is used for vascular cerebral
diseases (arteriovenous malformations and cavernoma) and functional
cerebral diseases (trigeminal neuralgia, parkinsonism and epilepsy)
in addition to cerebral tumors.

Which type of diseases
can be treated with
Gamma Knife Radio-Surgery?
Gamma Knife Radio-Surgery is a non-invasive “surgical treatment” method. In other words,
accuracy of surgical treatment is ensured without drilling the skull.
Patient may resume ordinary social and work life one day after Gamma Knife Radio-Surgery.
General anesthesia is not required, and therefore, this treatment can be used for patients,
who are found ineligible for open surgery, and anesthesia-related risks are also eliminated.
Hospital stay is one day. Patient is discharged in same day.
This treatment is extremely cost effective, since hospital stay is short, the patient does not
need to stay at intensive care unit and the patient may resume work life in early
postoperative course.
Mortality rate is

What is difference between
Gamma Knife Radio-Surgery and
Radiotherapy ?
Following features distinguish Gamma Knife Radio-Surgery from radiotherapy;
Gamma Knife Radio-Surgery uses anatomic selectivity to access the target tissue.
In Gamma Knife Radio Surgery, gamma rays are absorbed only by the target diseased tissue.
Surrounding health tissues are not harmed. For Gamma Knife surgery, energy delivered to tumor
tissue is equal to sum of the energy delivered to the diseased tissue in 30 sessions of conventional
radiotherapy. Therefore, this therapy is not organized in sessions. It is delivered at once.
The error margin is 0.2 mm, thanks to the anatomic selectivity. This treatment is named
“Gamma Knife” due to this high anatomic selectivity. Therefore, this method is practiced by
neurosurgeons. It is not only one of neurosurgical procedures, but also a type of surgery.
Gamma Knife Radio Surgery is generally performed as a complementary treatment or an alternative
to another surgery. In conventional Radiotherapy, radiation is exposed to surrounding healthy
tissues along with the tumor and therefore, health tissue is also damaged.

What are Advantages of Undergoing
Gamma Knife Radio - Surgery And
Open Surgery by Same Surgeon?
Here, the most important fact is that Gamma Knife Radio-Surgery and microsurgery complement
each other. Gamma Knife radio-surgery and microsurgery are two separate methods which
complement each other and should be jointly used in certain diseases. Surgery is performed
following Gamma Knife radiosurgery in some cases, while Gamma Knife is preceded by surgery
in others.
It is extremely important for Gamma Knife Radio Surgery and microsurgery be performed
by same surgeon. However, Gamma Knife radio-surgery and microsurgery are not performed by
same surgeon in 95% of Gamma Knife Radio-Surgery Centers around the world. But, microsurgery
and Gamma Knife Radio-Surgery are complementary modalities rather than alternatives. Gamma
Knife radio-surgeon should also been well trained and educated in microsurgery.
A neurosurgeon can modify the course of surgery by taking the conditions requiring
Gamma Knife Radio-Surgery method into consideration. In Göztepe Medical Park Hospital,
Gamma Knife Radio Surgery and Microsurgery are performed by same surgeon.

FREQUENTLY ASKED QUESTIONS
What patients should do before undergoing Gamma Knife radio-surgery?
A patient should do followings before Gamma Knife Radio Surgery:
1. Inform your physician about drugs you take regularly. You will be informed about if you can take
or stop them before Gamma Knife Radio-Surgery.
2. Wash your head and hair at the night and in the morning before the surgery.
3. Wear comfortable clothes without metallic parts (such as zippers and buttons) when you visit our
hospital.
4. Do not wear any jewelry or watch.
5. Empty your pockets before the procedure.Do not carry your credit cards or electronic devices
such as cell phones during the procedure.

FREQUENTLY ASKED
QUESTIONS
Can this treatment be performed for elder patients and others with systemic diseases ?
Gamma Knife Radio-Surgery is recommended for patients with higher potential for surgery-related
complications due to age of patient. Moreover, Gamma Knife Radio-Surgery is also a good option
for patients with high anesthesia risks.
Do patients go into a deep sleep in Gamma Knife Radio Surgery ?
No, anesthesia is not administered or patients do not go into a deep sleep. However, sedative
agents can be considered for nervous patients. During Gamma Knife Radio-Surgery, the patient is
communicated by a microphone and patient is monitored throughout the procedure.
Is hair shaved for Gamma Knife Radio Surgery ?
No. Patient's hair is not shaved.
Does hair loss occur after Gamma Knife Radio-Surgery ?
No, it does not.
Does patient feel anything during Gamma Knife Radio Surgery ?
The patient may feel tightness or pressure in head while the frame (stereotactic frame) is secured,
but this feeling disappears in 3-5 minutes and patients feel like wearing a heavy hat. Patients
cannot see or feel radiation beams during the treatment.

FREQUENTLY ASKED QUESTIONS
How long do effects of Gamma Knife Radio Surgery sustain ?
Duration of effect varies in each case. Effects of Gamma Knife Radio-Surgery can sustain from
several months to several years. Following Gamma Knife Radio-Surgery, patients visit the surgeon
at instructed intervals.
Is Gamma Knife Radio-Surgery a safe method ?
To date, hundreds of scientific papers and articles are published on 1000000 patients, who had
undergone surgery worldwide since 1967, and safety of the procedure is proven. Mortality risk is
less than one per one hundred thousand cases for Gamma Knife Radio Surgery, while disability risk
is lower than 1-2%, if surgery is carried out by experienced surgeons.

FREQUENTLY ASKED
QUESTIONS
Is there any side effect of Gamma Knife Radio-Surgery ?
Transient swellings may be observed in tumor tissue or healthy tissue secondary to radiation,
after Gamma Knife Radio-Surgery is carried out.
Such swelling is managed with medical treatment, and they do not lead to any permanent
damage.
When can patient resume routine daily life ?
Patient may resume ordinary social and work life one day after Gamma Knife Radio-Surgery.
Hospital stay is one day and patients are discharged in same day.
Which type of brain tumors can be treated with Gamma Knife Radio-Surgery ?
Gamma Knife Radio-Surgery may cure both benign cerebral tumors (meningiomas, pitutary
adenomas, acoustic neuroma, etc.) and malignant cerebral tumors
(cerebral metastases, glial tumors, etc.). Moreover, Gamma Knife Radio-Surgery is used for
vascular cerebral diseases (arteriovenous malformations and cavernoma) and functional
cerebral diseases (trigeminal neuralgia, parkinsonism and epilepsy) in addition to
cerebral tumors.

FREQUENTLY ASKED QUESTIONS
How is Gamma Knife Radiosurgery used for management of acoustic neuromas?
Acoustic neuromas originate from the tissue that covers cranial nerve VIII and they are located
at the angle between the cerebellum and the pons. Gamma Knife Radiosurgery yielded outstanding
outcomes in treatment of progressive acoustic neuromas. Moreover, the technique has also been
successful in conserving functions of acoustic nerve, facial nerve and trigeminal nerves.
Gamma Knife Radiosurgery can be used in both unilateral and bilateral tumors, should maximum
diameter is 3 cm. Here, treatment aims to stop growth of tumor rather than complete destruction
thereof. In addition, hearing should also be conserved, if it has not already impaired.
The picture shows a patient with acoustic
neuroma before Gamma Knife Radiosurgery.
Tumor has near totally disappeared 2 years
after Gamma Knife Radiosurgery.
BEFORE
AFTER

FREQUENTLY ASKED
QUESTIONS
How is Gamma Knife Radiosurgery used for meningiomas?
Meningiomas are mostly benign tumors which originate from membranes covering
the brain, meninges and damage and compress the part of brain, where they are
located. They usually grow slowly and Gamma Knife Radiosurgery makes more
significant contribution, if it is performed immediately after the diagnosis.
Gamma Knife Radiosurgery is preferred for lesions that cannot be completely
removed with microsurgery due to location of tumor and for inoperable patients.
BEFORE TREATMENT
AFTER TREATMENT
Above picture shows a patient, who presented to our center with cavernous sinus meningioma,
before Gamma Knife Radiosurgery. Size of meningioma is reduced 2 years after Gamma Knife
Radiosurgery. Double-vision complaint of the patient secondary to movement disorder of eyes
disappeared after the treatment.

FREQUENTLY ASKED QUESTIONS
How is Gamma Knife Radiosurgery performed for pituitary adenomas?
This group of patients is very special. Pituitary gland is located immediately behind the root
of nose at the base of brain. There are three types of cells which can cause a tumor in
pituitary gland. Gamma Knife Radiosurgery is generally used to support surgery and to
destroy potential tumor residues following the operation.
BEFORE TREATMENT
AFTER TREATMENT
A patient whose pituitary adenoma can be seen in the picture above has been operated on
three times before presenting to our center, but the tumor relapsed. Tumor disappeared
2 years after this patient is undergone Gamma Knife Radiosurgery (at right side). Although
adenoma was secreting growth hormone, patient's hormonal balance can also be restored.

FREQUENTLY ASKED
QUESTIONS
How is Gamma Knife Radiosurgery used for management of brain metastases?
This is one of the areas in which Gamma Knife Radiosurgery is most commonly used.
Tumors that commonly spread to brain are lung cancer, breast cancer and kidney
cancer. Moreover, thyroid cancers and melanomas can metastasize to brain.
Gamma Knife Radiosurgery yields satsifactory results for metastases of those
and other tumors.
BEFORE TREATMENT
AFTER TREATMENT
The left picture shows a patient, who presented with history of seizure and was diagnosed
with brain metastasis, before Gamma Knife Radiosurgery. When the patient is re-assessed
3 months after Gamma Knife Radiosurgery, brain metastasis disappeared.

FREQUENTLY ASKED QUESTIONS
How is Gamma Knife Radiosurgery used for glioma?
Gliomas are malignant tumors that begin in supportive cells, called Glial cells.
Gamma Knife Radiosurgery can be used alone, after surgery or combined with conventional
fractional radiotherapy for treatment of those tumors. Size of tumor may hinder use of
Gamma Knife Radiosurgery. However; Gamma Knife Radiosurgery can be a practicable
alternative for small tumors.
What are other tumors that can be treated with Gamma Knife Radiosurgery?
Some of other tumors that can be treated with Gamma Knife Radiosurgery are as follows;
Glomus jugulare, craniopharyngioma, chordoma, hemangioblastoma, hemangioendothelioma,
hemangiopericytoma, pinealocytoma, uveal melanoma etc.
ARTERIOVENOUS MALFORMATIONS
As you can see in the picture below, AVM of the patient disappeared 2 years after
Gamma Knife Radiosurgery. AVM of the patient disappeared.
BEFORE TREATMENT
AFTER TREATMENT

Treatment Stages of
Gamma Knife Radiosurgery
1. Placement of Stereotactic Frame
A stereotactic frame is placed to patient's head at first stage of
treatment. This procedure is carried out under local anesthesia.
Patient does not feel pain or ache, while stereotactic frame is
placed. Patients will only feel a temporary tightness or pressure
in head. This feeling lasts for 3-5 minutes.
2. Neuroradiologic imaging
Necessary imaging studies are performed using a
specialized MRI scanner while stereotactic frame
is still on the patient's head.

Treatment Stages of
Gamma Knife Radiosurgery
3. Dose Planning
Images are transmitted to a special planning
software that is uniquely developed for the
treatment and the physician makes the
treatment plan.
4. Treatment Phase
After treatment is planned, resultant coordinates
are uploaded to treatment device. Next, patient
is placed in Gamma Knife Radiosurgery device.
Treatment is performed in concordance with the
coordinates. No pain or ache is felt during
the procedure.

Which Gamma Knife Radiosurgery Center Should You Prefer?
Prefer a team with a higher series of patients.
An experienced Gamma Knife Radiosurgery team can practice necessary treatment in a reliable way.
Prof. Türker Kılıç, M.D., is the founder of first Gamma Knife Radiosurgery Center in Turkey.
Prof. Türker Kılıç, M.D., and his team had treated approximately 10000 patients. A series of 10000
patients points to significant experience not only in our country but also around the world.
The principal underlying cause of this success arises out of the fact that both neurosurgery and
Gamma Knife is performed by the same team.
When you need to select a doctor, be careful that Gamma Knife Radiosurgery and open surgery
are carried out by same doctor.
Here, the most important fact is that Gamma Knife Radio-Surgery and microsurgery complement each
other. Gamma Knife radio-surgery and microsurgery are two separate methods which complement
each other and should be jointly used in certain diseases. Surgery is performed following Gamma Knife
radiosurgery in some cases, while Gamma Knife is preceded by surgery in others.
Prof. Türker Kılıç, M.D., has carried out
approximately 13.000 microsurgical
operations along with a Gamma Knife
experience of 10000 cases.
He is one of limited number of doctors who
can perform both Gamma Knife Radiosurgery
and microsurgery in our country and around
the wound.

Prefer a team with greater number of scientific publications and research in addition to
patient experiences.
It is very important to prefer a team with many researches and scientific publications on Gamma Knife
Radiosurgery. Having this treatment by a team with full command on recent advancements in field of
Gamma Knife Radiosurgery creates a huge advantage for the patient.
To date, Prof. Türker Kılıç, M.D. has organized or contributed to organization of many scientific meetings
and most recently, he hosted and chaired the international ASNO 2014 (Asia Neurology) Congress.
Prof. Türker Kılıç, M.D., had his medical education in Hacettepe University and residency education in
Neurosurgery in Marmara University. Carrying out research and investigations especially in field of brain
tumors at Dana – Farber Cancer Institute of Harvard University, Prof. Türker Kılıç, M.D., is a neurosurgeon
who has authored more than 80 articles in fields ofneurosurgery and Gamma Knife Radiosurgery and
has been rewarded with many local and international prizes.
BAU School of Medicine – Medical Park,
Neurosurgery Team

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