A new era in neurosurgery has begun in Georgia. On November 15, at the Biltmore Hotel, Aversi Clinic hosted a symposium dedicated not to traditional surgical strategies, but to the most advanced bloodless and painless technology, Gamma Knife Radiosurgery.
This is a modality that enables targeted treatment of brain tumors, complex neurological pathologies, and even rare malformations with exceptional precision and without damaging healthy tissue. Gamma Knife Radiosurgery utilizes gamma radiation: during the procedure, 192 beams converge at a single focal point, generating energy that is directed precisely at the pathological tissue and destroys it. Crucially, the surrounding healthy structures remain unharmed. The procedure lasts from thirty minutes to one hour, depending on the underlying intracranial pathology. During the session, patients may speak with the clinical team, fall asleep, or listen to music. No pharmacologic sedation is required, and unlike conventional surgery, the intervention is painless and free of perioperative complications. After completion, patients are discharged the same day and can typically resume normal activities as early as the following day.
It has now been a year since the latest-generation Gamma Knife Esprit system became available at Aversi Clinic. During this period, more than 300 patients have received effective and safe treatment. Georgia is the only country in the Caucasus offering this level of high-technology care to adult, pediatric, and even pregnant patients.
At the symposium, international experts reviewed the latest advances in radiosurgery, including the management of complex metastases, meningiomas, vestibular schwannomas, pediatric tumors, and various neurological disorders. The presented studies demonstrated remarkable outcomes, for example, a 70–80% increase in survival by five or more years in cases of medulloblastoma, and a 54.4% reduction in tumor burden in patients with large brain metastases.
Tbilisi hosted leading neurosurgeons from Turkey, France, Croatia, and Russia. Representative of Georgian medicine speaker was Lasha Bakradze, Head of the Neurosurgical Department at Aversi Clinic. He is a specialist who utilizes the capabilities of the Gamma Knife on a daily basis to improve patients’ quality of life.
Why did you decide to introduce Gamma Knife radiosurgery in Georgia for the first time, and with what innovations in neurosurgery is it associated?
My first professional encounter with radiosurgical technology, specifically the Gamma Knife, occurred in 2007, when it became necessary to use it for the treatment of a close relative. For this reason, I had to become closely acquainted with the technology abroad. Although the device used at that time was an earlier-generation model, the unique significance of the Gamma Knife as a highly effective alternative to invasive surgery became clearly evident. Gamma Knife is used for the treatment of brain pathologies, including tumors, vascular malformations, and other neurological conditions. The technology provides a therapeutic effect equivalent to surgical intervention, but through a completely non-invasive method—without incisions, contact with blood, or the complications that often accompany traditional neurosurgical procedures. The device introduced in Georgia represents a latest-generation model manufactured by a Swedish company. In modern medical practice, Gamma Knife is recognized as the “gold standard” of radiosurgery, distinguished by its precision and safety. Its use is permissible across all age groups, including children and pregnant women. In practical terms, there is virtually no area of the brain that cannot be managed radiosurgically using this method.
Gamma Knife radiosurgery is a highly complex and expensive technology. What is the significance of increasing access to this procedure for the entire Caucasus region?
It is noteworthy that the Gamma Knife represents one of the highest-cost medical technologies in modern medicine. Its introduction in Georgia marks the first time that full-scale radiosurgical services are being provided in the country, placing Georgia among the rare states where such a high-level technological resource is available. Within a radius of approximately 1,400 kilometers, there is no alternative to the Gamma Knife. For this reason, foreign patients come to Georgia from Armenia, the North Caucasus, Azerbaijan, Russia, as well as Belarus, Moldova, and countries in Central Asia. Most importantly, whereas in the past Georgians had to travel abroad for treatment, incurring significant financial costs, today such patients can receive care in their own country.
How has stereotactic radiosurgery fundamentally changed the patient treatment process?
The Gamma Knife is a state-of-the-art technological device developed for neurosurgery that today significantly aids neurosurgeons. Its existence gives us greater confidence in the planning and execution of treatment. In the past, in some cases, we had to make high-risk decisions for the patient’s life in order to remove as much of the pathology as possible from structures such as the carotid artery, optic nerve, and other critical areas. Today, thanks to the Gamma Knife, it is possible to choose a much safer approach. We provide the patient with complete information in advance, explaining that during surgery only the portion that can be safely removed with minimal risk to life will be resected, while maximizing tumor volume reduction. The remaining portion is then targeted for destruction using Gamma Knife treatment postoperatively. This approach protects the patient from disability and from complications that may accompany traditional neurosurgical interventions.
Why is treatment with the Gamma Knife preferable to other types of surgical interventions, and specifically, for which diseases is it used?
The Gamma Knife is effectively used for the treatment of benign brain tumors such as meningiomas, vestibular schwannomas, pituitary adenomas, hemangioblastomas, and other pathologies. Neurosurgical intervention always carries certain risks: the average mortality rate is approximately 0.5%, and complications can reach up to 22%. The introduction of the Gamma Knife has significantly reduced the need for high-risk surgical procedures; however, not every case is suitable, and the decision is made individually based on the patient’s condition. There has also been significant progress in the radiosurgical treatment of brain metastases. Whereas metastases were previously considered a terminal condition, today the Gamma Knife allows many patients with metastases to achieve a longer, high-quality life.
How long does it take for Gamma Knife radiosurgery to show results after a single session, and is there a difference in the dose between successive sessions?
The outcome of the procedure and the radiation dose vary depending on the specific disease. The primary goal in benign tumors is to halt tumor growth. This differs from the case of metastases, where the main objective is rapid treatment, tumor size reduction, and disease control. In cases of trigeminal neuralgia, where the patient experiences pain, it is not possible to wait for a long period, and the procedure is scheduled immediately. Typically, it takes about one and a half to two months to observe the results.
Are there any limitations or situations in which radiosurgery is not used?
Currently, according to the literature, the highest number of metastases treated with the Gamma Knife is 140, with patient survival extended up to four years. Typically, in about 80% of cases, survival is maximally prolonged, and in such instances, the cause of death is usually due to other systemic problems, such as abdominal issues, including the liver, rather than the brain. The Gamma Knife can be repeated as many times as necessary and deemed appropriate. It has no contraindications or limitations, which is its unique advantage and what distinguishes it from other devices.
Based on what criteria is a patient evaluated in the clinic to determine whether they should undergo Gamma Knife radiosurgery directly or first have a surgical intervention?
The main reason we decline a patient for Gamma Knife treatment in the case of a benign tumor is brain swelling caused by tumor pressure and the presence of established neurological deficits, which require urgent medical or surgical intervention.
