Radiosurgery (stereotactic radiosurgery) is a very precise form of therapeutic radiology. It doesn't involve actual surgery. Instead, very focused beams of radiation (gamma rays, X-rays, or protons) are used to treat cancer tissues without a surgical incision or opening. Radiosurgery is called "surgery" because it is a 1-session radiation therapy treatment that creates a similar result as an actual surgical procedure.

Radiosurgery works in the same way as other types of therapeutic radiology. It changes or destroys the DNA of tumor cells, so they can't reproduce and grow. Over time, the tumor will shrink in size. For blood vessel lesions, such as an arteriovenous malformation (AVM), the blood vessels close off over time after treatment.

There are 3 types of radiosurgery. Each type uses different equipment and radiation sources. Cobalt60 systems use cobalt as a source for gamma rays. This type of system is often called the Gamma Knife. The Gamma Knife is not really a knife at all. It uses beams of highly-focused gamma rays to treat small and medium lesions in and around the brain, such as brain tumors or AVMs. AVMs are abnormal connections between arteries and veins. With Gamma Knife, many beams of gamma radiation join to focus on the lesion under treatment. They provide a very intense dose of radiation in a safe way. The Gamma Knife is also used to treat functional problems such as trigeminal neuralgia. During treatment, the equipment doesn't move.

Radiation treatment. After being positioned for the treatment, a type of helmet with many hundreds of holes in it is placed over the head frame. These holes help to focus the radiation beams on the target.

Linear accelerator (LINAC) systems use high-energy X-rays to treat large tumors or other lesions outside of the brain. Some common types of LINAC systems include CyberKnife, X-Knife, Novalis, and Peacock. Unlike the Gamma Knife, LINAC systems don't use radioactive material to produce the radiation. And with LINAC systems, the machinery moves around the person during treatment. So LINAC systems are able to treat larger tumors and larger affected areas than the Gamma Knife. Areas other than the brain can be treated with a LINAC system. These systems may also be used for external beam radiation therapy. Treatment steps with a LINAC system are generally the same as or a lot like the treatment steps used for the Gamma Knife.

Proton beam therapy is a type of particle beam radiation therapy. Rather than using rays of radiation, like gamma rays or X-rays, particle beam therapy uses particles, like protons or neutrons. Proton beam therapy is the most widely-used type of particle beam therapy. Proton beam therapy is useful in treating tumors or lesions that are small or have an irregular shape. The radiation dose can be more closely controlled with these systems.

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