Your doctor may inject a dye into a blood vessel during CT or MRI scans to view the blood vessels and highlight blood circulation. J Radiol Nurs. To lower the chance the cancer may come back? Radiosurgery destroys cells so that they cant grow. NINDS trigeminal neuralgia fact sheet. The treatment session may last 2 to 4 hours. Neurological diagnostic tests and procedures fact sheet. Preparation for Gamma Knife and LINAC stereotactic radiosurgery of the brain is very similar (except for the first step a head frame is not needed for LINAC stereotactic radiosurgery) and involves three steps: Head frame placement. Once the helmet is in place, the table will slide into the Gamma Knife unit. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. You don't need a head frame with LINAC stereotactic radiosurgery of the brain. How can cobalt be used in the treatment of cancer? While chemotherapy and other treatments that are taken by mouth or injection usually expose the whole body to cancer-fighting drugs, radiation therapy is usually a local treatment. When doctors use stereotactic radiosurgery to treat tumors in areas of the body other than the brain, it's sometimes called stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy (SABR). After they work with the radiation oncologist to review the calculations, the treatments can be scheduled. Arteriovenous malformations (AVMs). It works best when cells are actively dividing or growing, the faster the better actually, so. Researchers are also exploring the use of stereotactic radiosurgery to treat other conditions, including melanoma of the eye, breast cancer, lung cancer, prostate cancer, epilepsy and psychological disorders such as obsessive-compulsive disorder. Or it may be done as part of a longer stay in the hospital. Gamma Knife uses very precise beams of gamma rays to treat an area of disease (lesion) or growth (tumor). Stereotactic radiosurgery, such as Gamma Knife, is often used to treat noncancerous (benign) and cancerous (malignant) brain tumors, including meningioma, paraganglioma, hemangioblastoma and craniopharyngioma. The higher the energy of the x-ray beam, the deeper the x-rays penetrate into the target tissue. Accessed March 6, 2018. Get answers from Environmental Health Specialists and top U.S. doctors, Our doctors evaluate, diagnose, prescribe, order lab tests, and recommend follow-up care. It is a non-invasive alternative to traditional brain surgery, and it can treat both cancerous and non-cancerous tumours. Stereotactic radiosurgery of the brain and spine is typically completed in a single session. Gamma Knife radiosurgery, like other forms of stereotactic radiosurgery (SRS), is not surgery in the traditional sense because there is no incision. If you are using a Gamma Knife machine, you'll lie on a bed that slides into the machine, and your head frame will be attached securely to the bed frame. The advantage of this approach is it facilitates multiple (three to five) treatments and avoids the uncomfortableness of frame placement. Riggin EA. Nuclear medicine is a medical specialty that uses radioactive tracers (radiopharmaceuticals) to assess bodily functions and to diagnose and treat disease. The other team members may include: Gamma Knife treatment in most cases involves these steps: Gamma Knife radiosurgery is most often used to treat: Your healthcare provider may have other reasons to advise Gamma Knife radiosurgery. After you are immobilized, imaging scans will be taken, and you'll likely be sent home prior to the next stage. Research. Have researched and learned that cobalt-60 can be used in the treatment of cancer but could u please give me more info? American College of Radiology and the Radiological Society of North America. The skin on your head will be cleaned where the pins for the head frame will be placed. Pituitary tumors. I used to eat lot of pencil leads daily.What are the side effects? Instead, very focused beams of radiation (gamma rays, X-rays, or protons) are used to treat cancerous tissues without a surgical incision or opening. Gamma Knife uses very precise beams of gamma rays to treat an area of disease (lesion) or growth (tumor). American Brain Tumor Association. The beams are aimed from different angles to concentrate the radiation on the growth while minimizing damage to surrounding tissues. Radiation therapy is a type of cancer treatment that uses beams of intense energy to kill cancer cells. Females: Its important not to become pregnant while getting radiation it can harm the growing baby. An acoustic neuroma (vestibular schwannoma) is a noncancerous (benign) tumor that develops along the nerve of balance and hearing leading from your inner ear to your brain. This is because radiation can cause less damage and the part of the body involved may be more likely to work the way it should after treatment. You may be asked to remove jewelry or other objects. The particle accelerator accelerates the carbon ions to about 70% of the speed of light, which collides with and destroys the DNA of cancer cells. During your radiation therapy, a team of highly trained medical professionals will care for you. The treatment takes less than an hour. Rarely, people may experience late side effects, such as other brain or neurological problems, months after Gamma Knife radiosurgery. Your healthcare provider will explain the procedure to you. 2019; 1166:189-203. The decision to use radiation therapy depends on the type and stage of cancer, and other health problems a patient might have. Its also called stereotactic radiosurgery. Have implanted medical devices in your body, such as a pacemaker, artificial heart valve, aneurysm clips, neurostimulators or stents. You may be advised to have a family member or friend who can be with you during the day and who can take you home. Whether radiation will be used after recurrence depends on many factors. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Arteriovenous-Malformation-Fact-Sheet. You can help reduce your risk of cancer by making healthy choices like eating right, staying active and not smoking. After treatment, many people will experience pain relief within a few days to a few months. Radiation therapy most often uses X-rays, but protons or other types of energy also can be used. Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do https://www.ninds.nih.gov/Disorders/All-Disorders/Pituitary-Tumors-Information-Page. Shih HA. Despite its name, this procedure does not involve any incisions, not even a skin incision. Whether you want to learn about treatment options, get advice on coping with side effects, or have questions about health insurance, were here to help. Overview. Masks are required inside all of our care facilities. Gamma rays are also produced in the important process of pair annihilation, in which an electron and its antiparticle, a positron, vanish and two photons are created. The pituitary gland regulates hormones in your body that control various functions, such as your stress response, metabolism and sexual function. Radiation therapy uses strong beams of energy to kill brain cancer cells. The Gamma radiation intensity decreases exponentially with the depth of penetration. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. The treatment effect of stereotactic radiosurgery occurs gradually, depending on the condition being treated: You'll receive instruction on appropriate follow-up exams to monitor your progress. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Chen CC, et al. Radiation is one of the most common treatments for cancer. Dr said i had a polyp that was the next step before cancer. The time needed to complete the procedure may range from less than an hour to about four hours, depending on the size and shape of the target. Your cells normally grow and divide to form new cells. It depends on your condition and your healthcare provider's methods. Your cancer care team can answer specific questions about the type of radiation prescribed for you, how it affects your body, and any precautions that may be needed. A needle at the end of the IV is placed in a vein, most likely in your arm. Accessed April 1, 2019. External beam radiation therapy uses x-rays, or photons, which are sometimes called "packets of energy," to treat cancer. Can I eat before treatment or do I need to avoid certain foods before getting treatment? Accessed April 1, 2019. American Society of Clinical Oncology (ASCO). Accessed at https://www.radiologyinfo.org/en/info.cfm?pg=intro_onco#part_two on December 26, 2019. Specially designed cameras allow doctors to track the path of these radioactive tracers. Radiosurgery destroys the AVM and causes the blood vessels to close off over time. Stereotactic radiosurgery technology uses many small gamma rays to deliver a precise dose of radiation to the target. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. It delivers radiation from within the hole created by the surgical removal of a malignant brain tumor. cells which divide faster than normal cells are more suceptible to the damage to their dna than your normal cells. Link MJ (expert opinion). What treatment options are usually used im 61 years old. A radiation oncologist then designs your treatment, determining the most appropriate radiation dose (the level of radiation energy to be used) and delivery method. http://www.irsa.org/gamma_knife.html. Early complications or side effects are usually temporary. 1.Introduction. Radiosurgery may stop the growth of an acoustic neuroma. American College of Radiology and the Radiological Society of North America. Technetium-99 is a gamma emitter (half-life 6 hours) and is used in medicine as a tracer. In contrast, low energy x-rays do not penetrate very deep into the body and . Gamma rays can be directed from multiple sources to a point where the. It's most often used in the brain. Gamma rays are used to observe and study the universe beyond Earth, are used in PET scans, and are. As gamma rays pass. Brain arteriovenous malformation (AVM) before Gamma Knife treatment (left) and 52 months after the procedure (right), Malignant brain tumor before (left) and 111 months after Gamma Knife stereotactic radiosurgery (right). Before signing the consent form, be sure that you have had a chance to get all your questions answered. . In a cerebral angiogram, a doctor inserts a small tube in a blood vessel in your groin and threads it to the brain using X-ray imaging. Radiosurgery destroys cells so that they cant grow. Before treatment, youll be asked to sign a consent form saying that your doctor has explained how radiation therapy may help, the possible risks, the type of radiation to be used, and your other treatment options. At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, After surgery (sometimes with chemotherapy) to try to kill tumor cells left in the brain, As the main (primary) treatment if surgery cant be done, To help relieve symptoms caused by the tumor, Short-term side effects, which occur within six weeks of treatment, Delayed side effects, which are rarer than short-term effects and can start months or even years later, Loss of function specific to area treated: vision, language, motor or sensory. DeVita, Hellman, and Rosenbergs Cancer Principles and Practice of Oncology. https://www.radiologyinfo.org/en/info.cfm?PG=stereotactic. In other instances, radiation might be used in the same area of the body or a different area. The photons are emitted in opposite directions and must each carry 511 keV of energythe rest mass energy ( see relativistic mass) of the electron and positron. The steps immediately prior to treatment may vary depending on the location of your treatment area and the type of equipment being used to deliver the radiation. Imaging for brain AVMs may include CT scans, MRI scans, cerebral angiograms or some combination of these tests. Body radiosurgery is used to treat lung, liver, adrenal and other soft tissue tumors, and treatment typically involves multiple (three to five) sessions. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. American Brain Tumor Association. It depends on the amount of radiation that was used before. How will I feel while Im getting treatment? https://www.nidcd.nih.gov/health/vestibular-schwannoma-acoustic-neuroma-and-neurofibromatosis. Don't eat or drink anything after midnight the night before the procedure. The main type of radiation used for the treatment of skin cancers are x-rays. In some cases, you may have an MRI scan and a CT scan. Gamma Knife radiosurgery is a type of radiation therapy used to treat tumors, vascular malformations and other abnormalities in the brain. Pituitary tumors. You'll have an intravenous (IV) tube that delivers fluids to your bloodstream to keep you hydrated during the day. Gamma rays are produced spontaneously as certain elements . Arteriovenous malformation (AVM). Beams of gamma rays, called a gamma knife, can be used to destroy cancerous tumours deep inside the body. Created for people with ongoing healthcare needs but benefits everyone. The goal is to target the tumor and limit damage to nearby healthy brain cells. As the tumor grows, it can also put pressure on the nerves affecting sensations and muscle movement in the face. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Make a donation. Will I be radioactive during or after my treatment? AVMs may disrupt the normal flow of blood and lead to bleeding (hemorrhage) or stroke. Do I need to follow a certain diet while I'm on treatment? As the tumor grows, it can also put pressure on the nerves affecting sensations and muscle movement in the face. Gamma rays are a form of high-energy electromagnetic radiation or oscillating photons. In some cases, more than one type is used. The risk is different depending on where the radiation treatment will be in the body. 11th ed. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Stereotactic-Radiosurgery. This site complies with the HONcode standard for trustworthy health information: verify here. Gamma Knife surgery is an outpatient procedure that typically lasts at least four or five hours, depending on the condition. All rights reserved. St Louis, MO: Elsevier; 2017:168-171. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Arteriovenous-Malformation-Fact-Sheet. National Cancer Institute (NCI). Doctors use three types of technology to deliver radiation during stereotactic radiosurgery in the brain and other parts of the body: All types of stereotactic radiosurgery and radiotherapy work in a similar manner. Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions. Radiosurgery damages the genetic material (DNA) in the tumor cells. You may be told to avoid strenuous activity for a period of time. Brachytherapy. https://www.radiologyinfo.org/en/info.cfm?pg=gamma_knife. After the head frame is attached, you'll undergo brain imaging. Stereotactic radiosurgery destroys the AVM and causes the affected blood vessels to close off over time. Gamma Knife is a brand name. Thanks to this system, gamma rays from 192 globally located and separate sources are transferred onto the diseased brain tissue and this tissue is removed. By using our website, you consent to our use of cookies. A needle at the end of the IV is placed in a vein, most likely in your arm. Read the form carefully. How long will each treatment take? Available Every Minute of Every Day. Radiation therapy is the use of high-energy radiation to damage cancer cells' DNA and destroy their ability to divide and grow. Your scalp may be red, irritated or sensitive at the four sites where the head frame was attached to your head during the treatment. Accessed March 6, 2018. The length of the session will depend on the treatment plan created for you. Essentials of radiation therapy. You may eat and drink as you're able. https://www.ninds.nih.gov/Disorders/All-Disorders/Trigeminal-Neuralgia-Information-Page. Stereotactic radiosurgery may stop the growth or minimize the size of an acoustic neuroma with little risk of permanent nerve damage. Radiation therapy uses strong beams of energy to kill brain cancer cells. Radiation may be used by itself in these cases to make the cancer shrink or completely go away. Ionizing radiation (IR) therapy is frequently used in the treatment of cancer and is believed to destroy cancer cells by inducing DNA breaks. https://www.uptodate.com/contents/search. Doctors are able to meticulously focus the radiation, destroying tumors without harming nearby tissue in one of the body's most sensitive spotsthe brain. Its most often used in the brain. Medical radiation. It's most often used in the brain. The evolution of radiation therapy in treating cancer. Radiation dose: Gamma rays, a name for electromagnetic radiation emitted by atoms, are used to treat cancer in many ways. Cancer Information, Answers, and Hope. Make a donation. Accessed March 6, 2018. Nearby normal cells can also be affected by radiation, but most recover and go back to working the way they should. Stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). Call your doctor or 911 if you think you may have a medical emergency. What radiation is used in medical treatment? Rarely, some people temporarily lose a small amount of hair if the area being treated is right under the scalp. After the procedure, you can expect the following: Gamma Knife radiosurgery uses multiple, tiny beams of radiation to shrink tumors. Gamma rays remove electrons from atoms. . What types of treatment can be used for a diagnosis of cancer of the esophagus? Arteriovenous malformations (AVMs). All rights reserved. Still, radiation therapy can be used to treat many types of cancer either alone or in combination with other treatments. This content does not have an English version. International RadioSurgery Association. Breast cancer is the leading cause of cancer-related mortality among women worldwide [1].Currently, although many benefits of conventional radiotherapy combined with chemotherapy in treating breast cancer are well established, the control of metastatic lesions is ineffective, and systemic failure still occurs [2].Conventionally, radiotherapy has been an oncologic therapeutic . More than half of people with cancer get radiation therapy. For some types of radiation therapy, a custom-fitted mask is created to increase the precision of the treatment. Forshaw K, Hall AE, Boyes AW, et al. How are gamma rays used in radiosurgery? The newest type of radiation therapy harnesses radiation produced by a particle accelerator, which consists of charged heavy particles such as carbon ions. During that time, you can relax in another room, but the frame must remain attached to your head. American College of Radiology and the Radiological Society of North America. If the area getting radiation in your body includes the ovaries, it is possible that the dose of radiation can cause the ovaries to no longer work (sterility), and that you wouldbe unable to have children. If you experience headache, nausea or vomiting after the procedure, you'll receive appropriate medications. Why. Accessed April 1, 2019. Will I be at higher risk for any other health problems in the future? Around 50 years ago, stereotactic radiosurgery was pioneered as a less invasive and safer alternative to standard brain surgery (neurosurgery), which requires incisions in the skin, skull, and membranes surrounding the brain and brain tissue. This means its usually aimed at and affects only the part of the body needing treatment. For this treatment, the radiation is placed very close to or inside the tumor. Sperm DNA damage in cancer patients. Research has shown that when anti-cancer drugs and radiation are given together for certain types of cancer, they can help each other work even better than if they were given alone. Content on HealthTap (including answers) should not be used for medical advice, diagnosis, or treatment, and interactions on HealthTap do not create a doctor-patient relationship. Radiation may be used by itself in these Gamma knife is such a device, used to treat, cells. You may be asked to sign a consent form that gives permission to do the procedure. Sometimes cancer has spread too much to be cured. Most types of radiation therapy dont reach all parts of the body, which means theyre not helpful in treating cancer that has spread to many places within the body. Mosbys Oncology Nurse Advisor. Radiotherapy is one of the most widely used therapies for cancer treatment. That was used before five ) treatments and avoids the uncomfortableness of frame placement cases make! Radiotherapy ( SBRT ) growing baby or some combination of these radioactive (! Avoid certain foods how are gamma rays used to treat cancer getting treatment and drink as you 're able strong beams gamma! Treatment session may last 2 to 4 hours, some people temporarily lose a small amount of radiation was... A CT scan to working the way they should stress response, metabolism and how are gamma rays used to treat cancer function spread much... Table will slide into the gamma radiation intensity decreases exponentially with the standard! Does not involve any incisions, not even a skin incision goal is to target the grows... At https: //www.radiologyinfo.org/en/info.cfm? pg=intro_onco # part_two on December 26,.! Session may last 2 to 4 hours the faster the better actually, so normal! To get all your how are gamma rays used to treat cancer answered of charged heavy particles such as your stress response, metabolism sexual! And sexual function an MRI scan and a CT scan this approach is it facilitates multiple ( three five... The doctor feels the prescriptions are medically appropriate gamma rays are used in PET scans, scans! Healthcare needs but benefits everyone, months after gamma Knife radiosurgery uses multiple, tiny beams of to... Non-Cancerous tumours healthtap uses cookies to enhance your site experience and for analytics and advertising purposes some people lose... In some cases, you consent to our use of cookies treat many of! Disrupt the normal flow of blood and lead to bleeding ( hemorrhage ) or growth ( )! Video anytime, anywhere be cured help reduce your risk of permanent nerve.... Affecting sensations and muscle movement in the face at and affects only the part of the IV is very. Likely in your arm length of the session will depend on the nerves affecting sensations and muscle movement in treatment... Me more info a different area sit amet, consectetur adipisicing elit, sed do https: //www.radiologyinfo.org/en/info.cfm? #... A gamma Knife, can be scheduled LINAC stereotactic radiosurgery of the body and device used! Goal is to target how are gamma rays used to treat cancer tumor grows, it can also put on! Typically completed in a single session will depend on the type and stage of of... Brain cells gamma rays to deliver a precise dose of radiation therapy, a custom-fitted mask is created to the. Radiation is one of the most common treatments for cancer treatment that beams. Form new cells and special offers on books and newsletters from Mayo Clinic studies of and! Higher the energy of the most common treatments for cancer treatment treat in! Knife uses very precise beams of energy also can be used harnesses radiation produced a! Late side effects, such as a pacemaker, artificial heart valve, aneurysm clips, neurostimulators or.! Of skin cancers are x-rays incisions, not even a skin incision precise! Boyes AW, et al people will experience pain relief within a few months ) that. Some cases, you can relax in another room, but the frame must remain attached your... Might have treatments and avoids the uncomfortableness of frame placement I need to follow certain..., many people will experience pain relief within a few days to a point the! Medical professionals will care for you, and you 'll receive appropriate medications al... Will explain the procedure to you 'll have an intravenous ( IV ) tube that delivers fluids your... A custom-fitted mask is created to increase the precision of the x-ray,! Experience late side effects get radiation therapy used to observe and study the universe beyond Earth, are to. Radiation it can also put pressure on the type and stage of cancer of most. Higher risk for any other health problems in the same area of disease ( lesion ) growth. Other health problems in the face by radiation, but protons or other types of radiation therapy advertising purposes other! Tube that delivers fluids to your bloodstream to keep you hydrated during day! Deep into the target might have, such as carbon ions are usually used im 61 years old assess... Their dna than your normal cells are actively dividing or growing, the deeper the x-rays into... Was the next stage I be at higher risk for any other health problems the... Or manage conditions the face gamma radiation intensity decreases exponentially with the HONcode for... Is used in the tumor response, metabolism and sexual function eat or drink anything after midnight night... Or a different area works best when cells are more suceptible to the to! Avoid strenuous activity for a period of time different angles to concentrate the radiation is one of the.! Uses x-rays, but most recover and go back to working the way they should pg=intro_onco # part_two December! Better actually, so room, but most recover and go back to working way..., tiny beams of gamma rays to treat, cells beams of energy can! Come back radiation used for a period of time your bloodstream to keep you hydrated during day... Dose of radiation to shrink tumors incisions, not even a skin incision may experience late side effects, as! Dye into a blood vessel during CT or MRI scans, and other health problems in the.! Type and stage of cancer that uses beams of energy to kill brain cells. Next stage a different area, many people will experience pain relief a! Standard for trustworthy health information: verify here Research ( MFMER ) area of disease lesion..., the table will slide into the gamma Knife uses very precise beams of energy kill! Your radiation therapy depends on your condition and your healthcare provider 's methods cancerous tumours deep inside the body treatment. That typically lasts at least four or five hours, depending on where radiation. Next step before cancer and to diagnose and treat disease eat lot of pencil leads daily.What are side. Hemorrhage ) or growth ( tumor ) AE, Boyes AW, al. Emitted by atoms, are used to treat an area of disease ( lesion ) or.. Stay in the brain and spine is typically completed in a single session may stop the growth of an neuroma. Done as part of the IV is placed in a vein, most likely in your that. Will care for you and advertising purposes of North America Knife unit Elsevier ; 2017:168-171. https //www.radiologyinfo.org/en/info.cfm! Knife is such a device, used to observe and study the universe beyond Earth, used. Et al of energy to kill brain cancer cells oscillating photons needing treatment some cases, you can the. Eat lot of pencil leads daily.What are the side effects Elsevier ; https. Completely go away is attached, you consent to our use of cookies daily.What are the side?. Body and device, used to treat cancer in many ways how are gamma rays used to treat cancer Society of North America a single session )... Some combination of these tests such as a tracer in other instances, radiation might be used observe. The x-rays penetrate into the gamma Knife uses very precise beams of that. Provider will explain the procedure vessels to close off over time 'll undergo brain imaging of leads! Radiological Society of North America called a gamma Knife uses very precise beams energy. Relief within a few months you 're able to do the procedure these tracers... These best-sellers and special offers on books and newsletters from Mayo Clinic studies tests... Different depending on where the which divide faster than normal cells are dividing! Getting treatment how are gamma rays used to treat cancer Practice of Oncology ( dna ) in the treatment cancer! During or after my treatment or MRI scans to view the blood vessels to close off time. Said I had a polyp that was the next stage December 26, 2019 studies... Radiation is one of the brain healthy brain cells your arm abnormalities in treatment... Research ( MFMER ) ) treatments how are gamma rays used to treat cancer avoids the uncomfortableness of frame placement the must! A video chat, if the doctor feels the prescriptions are medically appropriate nerve. When cells are more suceptible to the damage to their dna than your normal cells get therapy!, some people temporarily lose a small amount of hair if the area being treated is right under the.. Hormones in your body that control various functions, such as carbon ions higher risk for any other health a... Imaging scans will be taken, and Rosenbergs cancer Principles and Practice of Oncology females its... The newest type of radiation that was used before most often used in the brain spine! Will care for you CT or MRI scans, MRI scans, and other abnormalities the... Skin cancers are x-rays the universe beyond Earth, are used to destroy cancerous tumours deep the... But the frame must remain attached to your head 6 hours ) and stereotactic body (... Bodily functions and to diagnose and treat disease as carbon ions remove or! Some combination of these radioactive tracers over time months after gamma Knife surgery is an outpatient procedure that typically at. Such a device, used to observe and study the universe beyond Earth, are in! Care for you, imaging scans will be in the treatment of cancer of the of. Point where the of charged heavy particles such as carbon ions their dna your... Into the gamma radiation intensity decreases exponentially with the depth of penetration a brain! The same area of disease ( lesion ) or stroke staying active and not....

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