Brain tumor treatment in Turkey

The neurosurgery centers of two of Turkey’s largest clinics, Acibadem and Medical Park, employ unique, world-class specialists. At Acibadem Altunizade, children with brain tumors are operated on by Professor Memet Özek, a leading pediatric neurosurgeon and head of the Pediatric Neurosurgery Department with 30 years of experience. Neurosurgical operations are performed by a whole team of doctors that includes a pediatric neuroanesthesiologist.

All of the mid-level staff, the operating room nurses and technicians who run the equipment during surgery, have extensive experience working with young patients. The medical history and treatment plan of every child are discussed at a weekly multidisciplinary tumor board that includes pediatric neurosurgeons, neuroradiologists and neuro-oncologists.

At both Acibadem and Medical Park, tumor cells from brain tissue samples obtained by biopsy are examined in a high-tech laboratory by highly qualified pathologists who specialize in oncology. This helps improve diagnostic accuracy.

Both the adult and pediatric neurosurgeons at these clinics operate in an innovative hybrid operating room and use modern neurosurgical technologies such as neuromonitoring and neuronavigation. This helps make tumor removal more precise and safer. Early postoperative neurological rehabilitation helps patients recover quickly and return to normal life.

Brain tumor treatment in Turkey meets world standards and follows the guidelines of international medical societies (oncology and neurosurgery). As with other types of cancer, the treatment protocol usually includes the following:

• surgical removal of the tumor (still the main treatment in most cases);

• radiation therapy / radiosurgery (Gamma Knife, CyberKnife);
• chemotherapy ;
• targeted therapy ;
• various surgical procedures (for example, implantation of high-tech ventricular shunt systems to reduce high intracranial pressure and relieve the patient’s condition).

Each patient’s treatment plan is developed by several doctors, a neurosurgeon, a neuroradiologist and a neuro-oncologist, who take many factors into account, including the patient’s individual characteristics and the molecular genetic features of the tumor.

Turkish medical centers have extensive experience in treating brain tumors without surgery in the following cases:

• the tumor cannot be removed surgically because it lies deep in the brain tissue or close to vital centers;
• the tumor could not be removed completely;
• the patient has contraindications to brain surgery;
• the patient has firmly refused surgery for personal reasons;
• the tumor is benign and small;
• there are multiple brain metastases;
• the tumor has recurred after surgical treatment.

To treat brain tumors without surgery, Turkish medical centers widely use both radiosurgery, a single-session irradiation of the tumor with Gamma Knife and CyberKnife technologies, and fractionated radiation therapy (irradiation in small doses over 1-2 months).

Gamma Knife radiosurgery is used for specific indications; the method is not suitable for all brain tumors. Acibadem performs 790 of these radiosurgical procedures every year.

At Medical Park, radiosurgery for brain tumors is performed with the Gamma Knife Icon system (the latest Gamma Knife model), so the clinic accepts patients who have been turned down by medical centers that use a standard Gamma Knife. Gamma Knife radiosurgery has been performed here since 1997, and the clinic ranks among the top five for the number and results of non-surgical brain tumor treatments. These procedures are also performed by Professor Türker Kılıç, the first neurosurgeon in Turkey to master this method in Europe, who is considered a world-class specialist.

In many cases, radiation therapy and radiosurgery on the latest-generation systems, followed by chemotherapy and targeted therapy, allow doctors to stop further growth of a malignant brain tumor and achieve remission for several years, even without surgery.

Tumors are removed at Turkish medical centers in a high-tech hybrid (multifunctional) operating room. This operating room is equipped with medical imaging systems: MRI and CT scanners, surgical X-ray and ultrasound systems, video navigation systems, as well as microscopes with powerful optics and endoscopic equipment.

This equipment allows surgeons to perform both open and minimally invasive “keyhole” procedures at a whole new level, working through a small opening 2 cm in diameter in the nasal cavity, above the eyebrow, behind the ear or on the head.

During surgery, the neurosurgeon uses various types of neuronavigation. For example, a digital 3D model of the lesion, built from MRI and CT scans, is overlaid on the view of the surgical field in the neurosurgical microscope in real time. This ensures precise movements during tumor removal.

Intraoperative Neurophysiologic Monitoring (IONM) is also used during surgery. Using electroencephalography, MRI and electrical stimulation in real time, the surgeon identifies important areas of brain tissue that could be damaged while the tumor is removed, maps these areas and relies on this map while working on the tumor.

During open brain surgery, awake surgery is used for the same purpose. The patient is kept awake for a short period during the operation, and talking with the patient allows the surgeon to identify, accurately and in time, areas such as the speech and hearing areas and the motor and visual centers, and so preserve them during tumor resection.

These technologies make it possible to remove the tumor more completely, as safely and gently for the patient as possible. The recovery period after such operations is much shorter than after conventional surgery.

As at all major European medical centers, treatment at Turkish clinics follows the latest international protocols. For most malignant tumors, after surgery and/or radiosurgery/radiation therapy, these protocols include additional (adjuvant) chemotherapy, for example, several cycles of temozolomide. A targeted drug may also be prescribed, which acts more precisely on cancer cells; the type and frequency of side effects depend on the specific drug. As with other types of cancer, chemotherapy and targeted therapy are given to control the disease and reduce the risk of recurrence when indicated for the specific type of tumor.

At Turkish medical centers, the patient’s neurological rehabilitation begins immediately after surgery. A multidisciplinary team of physical therapists, nurses and neuropsychologists uses modern equipment and techniques to restore neurological functions that were lost or impaired as a result of tumor removal. Early rehabilitation aims to help the patient recover and return to normal life as quickly as possible. The length of rehabilitation (from 2 weeks to 2 months) depends on the extent of the surgery and the degree of functional impairment. If needed, physical therapy continues during radiation therapy and chemotherapy.