Prof. Adrian Merlo provides the entire range of neurosurgical procedures which can be reasonably performed in a private practice, such as the surgical treatment of cerebral tumours (e.g. meningeomata, gliomata, acoustic neurinomata, pituitary adenomata), as well as the surgical treatment of degenerative changes in the spinal column (discopathies of the cervical and lumbar spinal column, spinal stenosis, including instrument-based procedures).
For many years, Prof. Merlo has focused on the local radiation treatment of malignant cerebral tumours (WHO grade II – IV gliomata). In close collaboration with specialists in nuclear medicine and radiochemistry, he has developed a new treatment technique for malignant gliomata. This is a further development of brachytherapy (brachy = short), radiotherapy with a very short range.
What is new here is that instead of static radiation sources, a liquid radiation source is injected into the tumour, which diffuses not only into the main tumour mass, but also into the adjoining infiltration zones. The emitter, coupled to a small transport molecule (protein molecule), is injected directly into the tumour and disperses here, cloud-like, within minutes. The protein carrier molecule with the captive nuclide binds to surface receptors and is absorbed by the tumour cell.
Hence, the tumour cell is irradiated from the inside. Beta emitters were initially utilised as radionuclides; these have been gradually replaced by the more precise alpha emitters. Alpha particle therapy has been developed in close collaboration with the European Institute for Transuranium Elements in Karlsruhe since 2000. The actinium generators are also produced here. The high-energy alpha particle irradiation is broadly equivalent to single-cell radiotherapy.
Hence, it also succeeds in selecting and treating the tumour infiltration zones beyond the main tumour mass. Alpha particles invariably kill off the tumour cells completely; there are no so-called sub-lethal effects under which the incompletely affected tumour cells are able to recover again (resistance development). Until now, only a selected group of patients has been able to be treated with alpha emitters, due to the shortage in the production of nuclides. Initial experience shows that very long intervals without relapse can be achieved for WHO grade II gliomata.
For glioblastomata, the survival gain is approximately an additional 10 months in a case of relapse; with early intervention, based on index cases, the potential might be at least a three-fold extension of the average survival.
of selected experts in the specialist field Neurosurgery