Dr. Sanjay Mongia
      
 
 

Gamma Knife Surgery

 

Gamma Knife® surgery is recognized worldwide as the preferred treatment for brain tumors, arteriovenous malformations and brain dysfunctions such as trigeminal neuralgia. It is supported by over 2,500 peer reviewed research articles that are primarily published in neurosurgery journals. The Gamma Knife® offers a non-invasive alternative for many patients for whom traditional brain surgery is not an option. Gamma Knife® surgery removes the physical trauma and the majority of risks associated with conventional surgery. This effective single session treatment may require an overnight hospital stay, but is often done in an outpatient surgical setting with periodic follow-up. It has been proven safe over the long term and is recognized and covered by insurance plans.

The same as neurosurgery, the Gamma Knife® allows noninvasive cerebral surgery to be performed in one session and with extreme precision, sparing tissues adjacent to the target. Based on preoperative radiological examinations, such as CT scans, MR scans and angiography, the unit provides highly accurate irradiation of deep-seated targets, using a multitude of collimated beams of ionizing radiation with scalpel-like precision.

Gamma Knife® surgery represents a major advance in brain surgery, and in the last decade has changed the landscape within the field of neurosurgery. Its development has enhanced neurosurgical treatments offered to patients with brain tumors and vascular malformations by providing a safe, accurate and reliable treatment option. Gamma Knife® enables patients to undergo a non-invasive form of brain surgery without surgical risks, a long hospital stay or subsequent rehabilitation.

Gamma Knife® surgery is unique in that no surgical incision is made to expose the inside of the brain, thereby reducing the risk of surgical complications and eliminating the side effects and dangers of general anesthesia. The "blades" of the Gamma Knife® are the beams of gamma radiation programmed to target the lesion at the point where they intersect. In a single treatment session, 201 beams of gamma radiation focus precisely on the lesion. Over time, most lesions slowly decrease in size and dissolve. The exposure is brief and only the tissue being treated receives a significant radiation dose, while the surrounding tissue remains unharmed.

With the Gamma Knife®, a surgical incision is not required; the attendant risks of open neurosurgical procedures (hemorrhage, infection, cerebrospinal fluid leakage, etc.) are therefore avoided.

Published reports indicate that the Gamma Knife® may be used as an alternative to standard neurosurgical operations or as an adjunctive therapy in the treatment of residual or recurrent lesions left unresected by conventional surgery. Radiosurgery can be especially useful for those patients who are not suitable for standard surgical techniques due to illness or advanced age. In many neurosurgical cases, the Gamma Knife® is the only feasible treatment.

Conditions for which the Gamma Knife® is considered most effective are:

1. Intracranial tumors such as acoustic neuromas, pituitary adenomas, pinealomas, craniopharyngiomas, meningiomas, chordomas, chondrosarcomas, metastases and glial tumors.

2. Vascular malformations including arteriovenous malformations.

3. Functional disorders such as trigeminal neuralgia and obsessive-compulsive disorder.


Evidence-based research has shown Gamma Knife® to be effective for trigeminal neuralgia. Research has not supported linear accelerator (linac) treatment of trigeminal neuralgia at this time. In addition to the above mentioned indications, functional disorders such as intractable pain, Parkinson's disease, essential tremors and epilepsy are often treated with Gamma Knife®.

ADVANTAGES OF GAMMA KNIFE®

•Gamma Knife® is a neurosurgical tool designed exclusively for the treatment of brain disorders.

•The lesion being treated receives a high dose of radiation with minimum risk to nearby tissue and structures.

•The cost of a Gamma Knife® procedure is often less than traditional neurosurgery.

•Patients experience little discomfort.

•The absence of an incision eliminates the risk of hemorrhage and infection.

•Hospitalization is short, typically an overnight stay or an outpatient surgical procedure. Patients can immediately resume their previous activities.

•Gamma Knife® technology allows treatment of inoperable lesions. The procedure offers hope to patients who were formerly considered untreatable or at very high risk during open skull surgery.

Leksell Gamma Knife® is a registered trademark of Elekta Instruments, Inc.

 
First of all, Leksell Gamma Knife® is not a knife at all. I make no incisions in your head. Instead, Leksell Gamma Knife directs up to 201 precisely focused beams of radiation at your brain tumor, lesion or other abnormality.

Head frame fixation prior to Gamma Knife(R) Surgery :: Courtesy of Bodo Lippitz, Priv.Doz. Dr. Med. H.M. Queen Sophia Hospital, Sweden

THE HEAD FRAME

One of the key components of Leksell Gamma Knife - the tool that allows your doctor to precisely pinpoint your tumor or problem - is the special stereotactic head frame.

 

This lightweight frame, which is attached to your head with four small screws, ensures that the radiation beams are precisely targeted.

 

The frame also prevents your head from moving during the treatment procedure, which ensures that only the target area in your brain receives radiation.

MRI scan

IMAGING

After your head frame is in place, a number of advanced imaging tests - such as an MRI or CT scan - will be required to precisely locate the size, shape and location of your tumor, lesion or abnormality.

 

If your physician is treating a blood vessel abnormality, an angiogram may also be required. As you may already know, an angiogram involves the injection of a dye into your bloodstream so that the imaging procedure clearly shows the blood vessels and arteries in the brain.

 

The coordinate markers on your head frame, which are part of the images taken, will help your physician develop an exact plan for your procedure.

Leksell Gamma Knife(R) treatment planning :: Courtesy of Bodo Lippitz, Priv.Doz. Dr. Med. H.M. Queen Sophia Hospital, Sweden

TREATMENT PLANNING

Once your images have been taken, you can sleep, rest or relax while your physician develops your specialized treatment plan. First, your brain images are computerized. Then, using Leksell Gamma Knife 3-D planning software, a treatment protocol is planned.

 

No two treatment plans are alike; every Leksell Gamma Knife patient’s plan is specifically designed to address his or her specific medical condition.

 

Because Leksell Gamma Knife includes a set of unique helmets that have 201 holes for the precise delivery of radiation to your brain, your plan will consist of one or more treatments using these helmets.

THE TREATMENT

Once your treatment plan is complete, you'll lay down on the treatment table and your head frame will be attached to the helmet for your first treatment. You'll be awake during the procedure and able to communicate with your Leksell Gamma Knife team through a video and audio connection.

When Gamma KnifeŽ Surgery begins, the treatment table, which is much like the one you were on for your MRI or CT scan, will move into the dome section of the unit.

The team will be monitoring your procedure at all times. There may be several treatments lasting anywhere from two to forty-five minutes during your Leksell Gamma Knife session.

BACK TO YOUR NORMAL ROUTINE

Once your treatment is complete, the head frame will be removed. If you had an angiogram, you might have to lie quietly for several more hours. Some patients experience a mild headache or minor swelling where the head frame was attached, but most report no problems. Your doctor will tell you whether or not he wants you to stay overnight for observation or if you can go home immediately. Either way, you should be able to return to work or your normal routine in another day or so.

The effects of your Leksell Gamma Knife treatment will occur over time. Radiation treatments are designed to stop the growth of tumors or lesions, which means they won’t disappear immediately but over a period of weeks or months. Your physician and Leksell Gamma Knife team will stay in contact with you to assess your progress, which will include follow-up MRI or CT images in the near future and periodic check-ups.

 
 

Dr. Sanjay Mongia

Neurosurgeon and Functional Neurosurgeon

A-791, Bandra Reclamation, Bandra (West), Mumbai - 400 050, India.

Tel :  (91-22) 2642 1111 ,2655 2222, 2645 5891   Extn : 2052 /2054

Fax : (91-22) 2640 7655

Mobile : +91 98704 96003

Email : radiosurgeon_9@yahoo.com

 
   
 
 
   
 
 
   
 
 
   
 
 
   
 
 
     
 
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