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Surgical Removal of the Tumor for Glioblastoma (brain Cancer) in Germany ⭐Hospital Prices, Ranking, Reviews ⭐Bookinghealth

Surgical Removal of the Tumor for Glioblastoma (brain Cancer) in Germany

Surgical removal of glioblastoma in Germany ⭐Direct prices from the best hospitals in Germany ⭐We will help you save money on brain cancer treatment in Germany ⭐Patient support 24/7

Treatment prices are regulated by national law of the corresponding countries, but can also include additional hospital coefficients. In order to receive the individual cost calculation, please send us the request and medical records.

Charite University Hospital Berlin
Choice of patients
Germany, Berlin
Charite University Hospital Berlin
Overall rating 9 / 10

Department of Adult and Pediatric Neurosurgery

The Department of Adult and Pediatric Neurosurgery offers the full range of accurate diagnostics and surgical treatment of diseases of the central and peripheral nervous system. The department's surgeons annually perform over 5,000 surgical interventions, which indicates their high professionalism and tremendous experience. The key attention is paid to the treatment of cerebrovascular diseases, diseases of the spine and spinal cord, brain and skull base tumors, peripheral nerve lesions, cerebrospinal fluid circulation disorders, as well as pain therapy (functional neurosurgery). The treatment of neurosurgical diseases in children and adolescents is carried out by a specially trained team of experts.

Peter Vajkoczy
Prof. Dr. med.Peter Vajkoczy
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Price from: 46538.97
Beta Clinic Bonn
Specialized hospital
Germany, Bonn
Beta Clinic Bonn
Overall rating 9.7 / 10

Department of Neurosurgery and Spinal Surgery

The Department of Neurosurgery and Spinal Surgery offers the full range of modern surgical procedures for patients with diseases of the brain, spinal cord, spine, and peripheral nervous system. The department has state-of-the-art equipment, including navigation systems, monitoring devices, surgical microscopes, intraoperative X-ray diagnostic systems, angiography systems, and laser equipment. In addition, a system for minimally invasive stereotactic interventions has been installed in the department's operating room. The department's neurosurgeons use the latest microsurgical and endoscopic techniques in their work. The medical facility is one of only three in Europe to successfully use the VISUALASE™ device for MRI-guided laser ablation to treat epilepsy. This minimally invasive procedure is highly effective and represents a real breakthrough in epilepsy surgery. The department's neurosurgeons always strive to provide the patient with optimal medical care. They talk in detail about each stage of treatment and are happy to answer the patient's questions. Neurologists and specialists in the field of neuroradiology are often involved in the therapeutic process, which guarantees a comprehensive approach to treatment.

Thomas Gasser
Prof. Dr. med.Thomas Gasser
Price from: 36746.25
University Hospital Freiburg
Specialized hospital
Germany, Freibung
University Hospital Freiburg
Overall rating 9.7 / 10

Department of Adult and Pediatric Neurosurgery

The Department of Adult and Pediatric Neurosurgery offers the full range of surgical treatment of diseases of the brain, spine, spinal cord and nerves in adults and children. The department keeps pace with new trends in medicine, as well as contributes significantly to their development. Therefore, the most modern diagnostic and therapeutic methods are available here. An individual approach to each clinical case is crucial to ensure optimal treatment results with the preservation of all neurological functions.

Jürgen Beck
Prof. Dr. med.Jürgen Beck
Price from: 36982.19
University Hospital Frankfurt am Main
Specialized hospital
Germany, Frankfurt am Main
University Hospital Frankfurt am Main
Overall rating 10 / 10

Department of Adult and Pediatric Neurosurgery

According to the Focus magazine, the Department of Adult and Pediatric Neurosurgery ranks among the top German medical facilities specializing in the surgical treatment of brain tumors! The department offers the full range of diagnostics and surgical treatment of diseases of the central and peripheral nervous system. A specially trained team of pediatric neurosurgeons provides treatment for various neurosurgical pathologies in children. During the treatment, the doctors use state-of-the-art equipment, in particular, imaging-guided neuronavigation, functional imaging (fMRI), intraoperative mapping, intraoperative videoangiography, etc.

Volker Seifert
Prof. Dr. med.Volker Seifert
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Price from: 33989.04
University Hospital Würzburg
Specialized hospital
Germany, Würzburg
University Hospital Würzburg
Overall rating 9.2 / 10

Department of Adult and Pediatric Neurosurgery

The Department of Adult and Pediatric Neurosurgery offers the diagnostics and treatment of the entire spectrum of neurosurgical diseases. The department specializes in the treatment of brain tumors, vascular diseases and intracerebral hemorrhages, spinal diseases, deep brain stimulation, etc. Special competence lies in the field of pediatric neurosurgery. The department offers the very latest highly accurate and minimally invasive treatment methods.

Ralf-Ingo Ernestus
Prof. Dr. med.Ralf-Ingo Ernestus
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Price from: 33689.42
University Hospital Carl Gustav Carus Dresden
Specialized hospital
Germany, Dresden
University Hospital Carl Gustav Carus Dresden
Overall rating 9.1 / 10

Department of Adult and Pediatric Neurosurgery, Epilepsy Surgery, Spinal Surgery

The Department of Adult and Pediatric Neurosurgery, Epilepsy Surgery, Spinal Surgery offers the full range of diagnostics and surgical treatment of diseases of the brain, spinal cord and peripheral nerves at the highest international level of modern medicine. The department has four high-tech operating rooms, in which more than 2,400 surgical interventions are performed annually. Surgery to treat tumors of the nervous system in childhood and adulthood is of particular interest to the department's specialists. In addition, the department's medical team has unique clinical experience in the surgical treatment of epilepsy, spinal pathologies and deformities, as well as neurovascular pathologies. The department's doctors have a perfect command of advanced surgical techniques, for example, navigational surgery, intraoperative neuromonitoring, hybrid surgical techniques, which are the basis of successful clinical practice. State-of-the-art computer-assisted systems allow neurosurgeons to plan each stage of surgical intervention as accurately as possible, thereby guaranteeing its high efficiency and safety.

Gabriele Schackert
Prof. Dr. med.Gabriele Schackert
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Price from: 41808.6
University Hospital Bonn
Specialized hospital
Germany, Bonn
University Hospital Bonn
Overall rating 9.2 / 10

Department of Neurosurgery

The Department of Neurosurgery offers the full range of surgical treatment of diseases of the nervous system and belongs to the largest medical facilities of this kind at the national level. The department has 4 state-of-art operating rooms where more than 2,700 interventions are performed annually. It has the progressive surgical equipment, for example, intraoperative monitoring, neuronavigation, tools for performing minimally invasive operations, which provide the most effective and reliable therapy. The department has earned the reputation of the Center of Competence in the field of tumor surgery of the nervous system and spine.

Hartmut Vatter
Prof. Dr. med.Hartmut Vatter
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Price from: 37209.78
University Hospital Erlangen
Specialized hospital
Germany, Erlangen
University Hospital Erlangen
Overall rating 9.1 / 10

Department of Adult and Pediatric Neurosurgery, Spinal Surgery

The Department of Adult and Pediatric Neurosurgery, Spinal Surgery offers modern diagnostics and effective treatment of the full range of diseases, injuries, inflammatory processes, tumors and malformations of the brain, spinal cord and their meninges, as well as spinal diseases. Spinal surgery is performed in collaboration with doctors from the Department of Adult and Pediatric Traumatology, Orthopedic Surgery. The department admits adults and children with malformations of the nervous system, brain and spinal cord tumors, drug-resistant epilepsy and other diseases. As one of the largest medical facilities of this kind in Germany, the department's doctors annually perform more than 2,500 surgical interventions on the brain and spinal cord, peripheral nerve endings. The department's specialists also perform over 400 spinal surgical procedures annually. To achieve high success rates of the surgical treatment, doctors use the very latest equipment, including neuronavigation systems. Thanks to this, surgeons not only successfully eliminate the pathology, but also guarantee the patient maximum safety. The department has 78 beds, including 14 beds in the Intensive Care Unit. The priority goal of the department's medical team is to provide high-quality treatment focused on the patient's needs.

Michael Buchfelder
Prof. Dr. med.Michael Buchfelder
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Price from: 35502.84
University Hospital Hamburg-Eppendorf
Specialized hospital
Germany, Hamburg
University Hospital Hamburg-Eppendorf
Overall rating 9.2 / 10

Department of Adult and Pediatric Neurosurgery, Spinal Surgery

The Department of Adult and Pediatric Neurosurgery, Spinal Surgery provides a full range of services in its areas of expertise. The department's doctors operate on patients with brain and spinal cord tumors, central nervous system malformations, epilepsy, traumatic brain injuries, degenerative disc diseases, spinal stenosis, spinal cord injuries, and peripheral nervous system pathologies. Neurosurgeons specialize in treating patients of all ages, including children and adolescents. Pediatricians, pediatric oncologists, radiologists, and neuroradiologists are involved in the treatment of young patients. Surgical procedures to treat pathologies of the nervous system are performed by highly qualified surgeons with extensive clinical experience. The physicians use state-of-the-art equipment in their work: intraoperative imaging systems, neuronavigation devices, and fluorescence imaging. Advanced technologies are key to effective and safe treatment, as damage to vital anatomical structures of the brain or spinal cord may cause severe neurological deficits. More than 2,000 operations are performed annually in the department's state-of-the-art operating rooms, the majority of which are for brain tumors. The department treats more than 11,000 patients each year. For many years, it has been one of the leading neurosurgical centers in Germany that treats patients from many European countries.

Lasse Dührsen
PD Dr. med.Lasse Dührsen
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Price from: 41736.57
University Hospital Ulm
Specialized hospital
Germany, Ulm
University Hospital Ulm
Overall rating 8.7 / 10

Department of Neurosurgery and Spinal Surgery

The Department of Neurosurgery and Spinal Surgery provides top-class medical care for patients with diseases of the central and peripheral nervous systems. The medical facility performs surgery of any complexity on the brain, spinal cord, spine, and peripheral nerves. The department is the largest healthcare facility of this kind in Germany and has a team of highly professional neurosurgeons with long clinical experience. The department's specialists focus on patients with brain tumors (gliomas, meningiomas, and brain metastases), neurovascular diseases (aneurysms, arteriovenous malformations, and dural arteriovenous fistulas), and traumatic brain injuries. Spinal surgeons operate on patients with herniated discs, spinal canal stenosis, spondylolisthesis, spondylodiscitis, spinal fractures, and spinal tumors. The department extensively uses minimally invasive surgical techniques that allow for good therapeutic results with high safety in surgical manipulations. The medical facility has two hybrid operating rooms with state-of-the-art equipment, including the Zeego® intraoperative robotic angiography system and the intraoperative Brainsuite® MRI.

Christian Rainer Wirtz
Prof. Dr. med.Christian Rainer Wirtz
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Price from: 35397.4
University Hospital Heidelberg
Specialized hospital
Germany, Heidelberg
University Hospital Heidelberg
Overall rating 9.8 / 10

Department of Adult and Pediatric Neurosurgery

The Department of Adult and Pediatric Neurosurgery offers the full range of diagnostics and treatment of diseases of the central and peripheral nervous system. The medical institution occupies a leading position in this sector in Europe. The neurosurgeons of the department have at their disposal four high-tech operating rooms, in which more than 3,500 interventions are performed annually. Active clinical and experimental research activities, as well as close cooperation with national and international reputable research centers, promote the introduction of innovative treatment techniques that are available only in a few clinics in the world.

Andreas Unterberg
Prof. Dr. med.Andreas Unterberg
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Price from: 0
University Hospital Essen
Specialized hospital
Germany, Essen
University Hospital Essen
Overall rating 9.6 / 10

Department of Adult and Pediatric Neurosurgery

The Department of Adult and Pediatric Neurosurgery offers the widest range of surgical interventions for the treatment of diseases of the central and peripheral nervous system, including stereotactic surgery and endoscopy. With more than 2,400 operations every year, the department has a unique experience, which allows it to provide the high-quality medical care even in extremely complex clinical cases. The key focus of the department is pediatric neurosurgery. In addition to the high professionalism of doctors, the treatment success is facilitated by exclusively advanced medical equipment, for example, neuronavigation systems and intraoperative fluorescence navigation.

Ulrich Sure
Prof. Dr. med.Ulrich Sure
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Price from: 33573.53
University Hospital Jena
Specialized hospital
Germany, Jena
University Hospital Jena
Overall rating 8.9 / 10

Department of Adult and Pediatric Neurosurgery

The Department of Adult and Pediatric Neurosurgery offers the full range of modern services in this medical field. The high level of technical equipment in the department allows for the performance of all highly specialized surgical interventions to treat pathologies of the central and peripheral nervous system. The clinical practice mainly focuses on the diagnostics and surgical treatment of diseases, injuries of the brain, spine, spinal cord, intervertebral discs, nerve plexuses, functional neurosurgery and the treatment of neurosurgical pathologies in children.

Rolf Kalff
Prof. Dr. med.Rolf Kalff
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Price from: 37332.98
University Hospital Marburg UKGM
Specialized hospital
Germany, Marburg
University Hospital Marburg UKGM
Overall rating 8.6 / 10

Department of Adult and Pediatric Neurosurgery

The Department of Adult and Pediatric Neurosurgery offers all modern surgical interventions for the treatment of pathologies of the nervous system. The clinical focuses include the treatment of oncological diseases of the nervous system (neuro-oncology), skull base surgery, vascular neurosurgery, spinal surgery and functional neurosurgery, including the surgical treatment of epilepsy. As a state-of-the-art medical facility, the department has the advanced systems for deep brain stimulation, multimodal neuronavigation devices, intraoperative neuronavigation using CT, ultrasound systems, fluorescence imaging devices and endoscopy equipment. Thus, the department has all the possibilities to ensure effective treatment according to the international standards.

Christopher Nimsky
Prof. Dr. med.Christopher Nimsky
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Price from: 32027.37
University Hospital Halle (Saale)
Specialized hospital
Germany, Halle
University Hospital Halle (Saale)
Overall rating 9.6 / 10

Department of Adult and Pediatric Neurosurgery, Spinal Surgery

The Department of Adult and Pediatric Neurosurgery, Spinal Surgery specializes in performing surgical procedures of any complexity on the brain, spinal cord, spine, and peripheral nervous system in patients of all ages. The department's operating rooms are equipped with the latest technology to ensure the most effective and safe treatment of neurosurgical pathologies. During surgery, the department's specialists use innovative intraoperative neuromonitoring systems, neuronavigation devices, and continuous electrophysiologic monitoring systems. The department employs skilled neurosurgeons with extensive clinical experience and in-depth expertise, who prioritize effective treatment according to each patient's individual needs. The physicians strictly follow current clinical protocols and recommendations of the German Society of Neurosurgery (DGNC). It should be noted that the department is part of the Center for Neuro-Oncology certified by the German Cancer Society (DKG), has the status of a Center for Spine Surgery certified by the German Spine Society (DWG), and a Center for Skull Base Surgery certified by the German Society for Skull Base Surgery (GSB).

Christian Strauss
Prof. Dr. med.Christian Strauss
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Price from: 33945.2
University Hospital of Ludwig Maximilian University of Munich
Specialized hospital
Germany, Munich
University Hospital of Ludwig Maximilian University of Munich
Overall rating 10 / 10

Department of Adult and Pediatric Neurosurgery, Spinal Surgery

The Department of Adult and Pediatric Neurosurgery, Spinal Surgery offers the full range of diagnostic examinations and surgical treatment of diseases of the central and peripheral nervous systems. The team of the department's neurosurgeons successfully performs operations for pathologies of the brain and spinal cord, spine, neurovascular pathologies, pituitary diseases, and epilepsy. The doctors specialize in surgery for malignant brain tumors. The department is part of the Gliome Competence Center Network and the German Cancer Aid. The department uses the latest minimally invasive microsurgical techniques, navigation systems, intraoperative systems, and other advanced technical resources that allow for an optimal therapy result. The department has 84 beds for its patients, 10 of which are intended for intensive care. Medical care is based on an individual approach with due consideration of the patient's specific clinical data and needs. The specialists working at the medical facility always devote enough time to personal communication with their patients and do everything possible so that they receive effective treatment and maintain a decent quality of life.

Christian Schichor
Prof. Dr. med.Christian Schichor
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Price from: 37311.05

The brain is the most complex structure of the human body. Any type of brain dysfunction can pose a threat to overall health, and its consequences and complications can lead to disability. Brain pathologies are difficult to treat. One of the most dangerous diseases of this kind is a brain tumor process called glioblastoma.

What is glioblastoma?

Glioblastoma is one of the most aggressive and common forms of brain tumors in the central nervous system. It develops inside the cranium. Statistically, for unknown reasons, men are more likely to suffer from glioblastoma.

The causes of such a brain tumor formation are associated with a hereditary predisposition, various genetic defects, the contact with carcinogenic substances, as well as with radiation exposure.

The process of the disease development is characterized by pathological degeneration of cells, which makes them divide randomly, forming a tumor mass. Since brain tumor cells develop from astrocytes, glioblastoma is also called grade 4 astrocytoma.

As it develops and grows, the malignant neoplasm compresses the structures of the brain and invades the surrounding tissues, constantly expanding the area of ​​the lesion. As a result, many neurological deficits develop and intracranial pressure increases, which put the major risk at patients’ lives.

According to statistics, children and adolescents are most susceptible to this type of cancer. It is extremely difficult to establish the cause of the onset of the tumor process in patients.

Oncologists specify such the most common provoking factors:

  • Craniocerebral trauma
  • Genetic predisposition
  • Inflammatory pathologies of the brain (meningitis, encephalitis)
  • Chronic viral infections (cytomegalovirus)
  • Exposure to chemical carcinogenic substances

Types of brain tumors

Brain tumors are pathological neoplasms in which the growth and differentiation of cells are impaired due to changes in their genetic structure.

Primary tumors originate in the cells of the organ. For example, primary brain tumors occur in brain cells. Besides, there are secondary tumors that originate in other parts of the body but spread (metastasize) to the brain or spinal cord.

Therefore, depending on the origin, glioblastomas can be:

  • Primary. Primary glioblastoma develops directly from healthy astrocytes and is much more common. It can develop over several weeks and mainly affects people between the ages of sixty and seventy.
  • Secondary. Secondary glioblastoma develops from a lower grade astrocytoma, that is, from an already existing brain tumor consisting of astrocytes. In this case, glioblastoma is the advanced stage of cancer.

Symptoms of glioblastoma

At the early stages of glioblastoma, patients usually do not notice any symptoms. That is why this form of the tumor process is often diagnosed at the advanced stages. In the clinical picture, only nonspecific symptoms appear which are attributed to malaise, lack of sleep, and fatigue. In Germany, doctors pay attention to even minor patients’ complaints, which increases the likelihood of diagnosing a brain tumor at the early stages.

The most pronounced and common symptoms of glioblastoma include:

  • Frequent headaches
  • Systematic dizziness
  • Sudden impairment of sight and hearing
  • Sudden onset of speech disorders
  • Impairment of memory and cognitive functions
  • Various forms of paralysis
  • Constant feeling of fatigue
  • Regular low body temperature

Diagnostics

The main examinations to verify clinical diagnosis are biopsy, magnetic resonance imaging or computed tomography, positron emission tomography, and a neurological examination.

Brain tumors are often found on occasional examinations when patients are concerned about a different area of the body. When planning a surgery, angiography of the vessels of the brain is performed. In addition to analyses of clinical signs, as well as studying the anamnesis, the diagnosis of the tumor process includes several informative studies, among which the most relevant are:

  • Complete blood count and biochemical blood tests
  • General urine test
  • Coagulogram
  • Echocardiography
  • Magnetic resonance imaging of the brain
  • Positron emission tomography
  • Biopsy of the brain tumor with further histological examination (if possible)

The prognosis for patients with glioblastoma depends largely on the timely diagnosis, therefore, the specialists of German clinics pay special attention to the early determination of an accurate diagnosis, as well as to laboratory studies and their interpretation.

Treatment of glioblastoma in Germany

Malignant tumors, including glioblastoma, are more difficult to remove. Most of them require additional treatments beyond surgery, such as radiation therapy, chemotherapy, or participation in clinical trials.

The scheme of glioblastoma treatment is determined by German doctors based on the size of the neoplasm, its localization, presence or absence of metastases, and some other factors. Taking into account the peculiarities of the oncological process, treatment implies the use of the most modern techniques, while verification of the oncological process is carried out using the cutting-edge diagnostic equipment.

The following methods are used in the treatment of glioblastoma:

  • Surgery.

The most common types of surgery are craniotomy and skull resection.

During the surgery, the doctor first makes an incision in the scalp. After the incision is made, the surgeon invades the skin and the muscles covering the bones of the skull. The surgeon then uses special instruments to access the brain tumor.

After removing the bone graft, the surgeon opens the dura mater (the tissue that covers the brain) and removes the tumor. The surgeon uses guidance of a computer system for controlling the removal. After removing the brain tumor, the surgeon closes the dura mater. The bone graft may or may not be replaced. In craniotomy, the bone graft is replaced, in resection it is not.

Сraniotomy and resection help reduce the pressure in the skull caused by the tumor and can relieve symptoms and side effects. Those types of surgery also allow the doctor to take a sample of tumor tissue for biopsy.

Whether the surgery can be carried out or not, depends on brain tumor type, which is mostly described by the fact of its spreading.

  • Radiation therapy.

Before conducting radiation therapy, complex diagnostics is carried out to confirm the fact of the presence of a tumor of the central nervous system. When deciding to conduct a course of radiation therapy, a further treatment plan is prepared.

The standard treatment for glioblastoma begins with surgery followed by radiation therapy or chemotherapy. Surgery is the first step in the treatment of glioblastoma and it determines the effectiveness of additional therapy. The overall survival of patients with glioblastoma depends directly on the degree of its resection.

The development of new, more effective radiation therapy techniques is performed by studying the possibilities of various irradiation modes based on remote radiation therapy. These are dose escalation, as well as increasing the radiation therapy dose using intraoperative radiation, brachytherapy, stereotaxic radiosurgery, and stereotaxic radiation therapy, that can be presented in the clinical trials.

Clinical trials in particular are an option for the treatment of all types of brain tumors. Therefore, it is important to look for the information about clinical trials as soon as possible, after the diagnosis is confirmed. Sometimes, clinical trials are the most effective option of the treatment of extraordinary glioblastoma cases.

  • Chemotherapy.

Chemotherapy involves the use of innovative anticancer drugs, carried out both as part of preoperative and postoperative treatment. If preoperative, chemotherapy is administered to shrink the neoplasm. If postoperative, chemotherapy serves to prevent a relapse.

Glioblastoma, as the most aggressive and malignant type of brain tumors and other neoplasms of the central nervous system, requires high-quality diagnosis and the most effective treatment by competent clinicians. The use of progressive methods and the most modern technology is highly encouraged. Therefore, doctors often suggest the patients participate in clinical trials, if any are available.

You can undergo all of the above, including randomized clinical trials, in Germany. German hospitals use only the latest technologies, up-to-date medical developments while prioritizing patients’ comfort during treatment.

Rehabilitation period

The rehabilitation process after the treatment of glioblastoma is individual in each case. A unique rehabilitation program is elaborated for patients, aimed at alleviating specific symptoms with the most comprehensive techniques to support the restoration of patients’ health.

Cost of treatment in Germany

The cost of treatment in Germany in hospitals listed on the Booking Health website is relatively low. As a rule, you can save up to 30-40% of the initial prices by booking the medical program here.

With Booking Health, you can undergo the treatment of glioblastoma at an affordable price. The cost of treatment in Germany varies, as the prices depend on the hospital, the diagnosis, and the complexity of treatment. The cost of treatment in Germany is in the price range from 21,298 EUR to 37,282 EUR.

Where can I undergo the treatment of glioblastoma in Germany?

Among German hospitals, the best success rates in the treatment of glioblastoma are demonstrated by:

  1. University Hospital Bergmannsheil Bochum
  2. Charite University Hospital Berlin
  3. Beta Klinik Bonn
  4. University Hospital Freiburg
  5. University Hospital Frankfurt am Main

How can I undergo glioblastoma treatment in Germany?

Arranging the treatment of brain astrocytoma abroad by oneself can be challenging. It is safer, easier, and less stressful to shift some responsibility onto a medical tourism agency that will support you throughout your journey.

Booking Health will facilitate the organization of treatment in Germany by solving the following issues:

  • Translation of the documents and medical reports
  • Communication with the hospital
  • Assistance in obtaining a visa to Germany
  • Booking tickets and transfer
  • Accommodation booking in Germany for the period of treatment, or anything related to a comfortable stay in the country

We will also help to find the right medical institution for you. It’s practically not possible to do this on your own, as it requires specific knowledge and experience in medical treatment abroad. It is in our power to do everything to make the treatment in Germany as comfortable as possible.

If you want to get more information on the right hospital for your diagnosis or the cost of treatment in Germany, please leave a request on the Booking Health website. We will contact you as soon as possible, and answer all your questions.