Gamma Knife Radiosurgery

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Dr. Pravina Ushakant Shah

  • MD,Neurologist
  • 40 years experience

Dr. Virender Kumar Khosla

  • MBBS, MS (General Surgery), M.ch (Neurosurgery), FICS, MNAMS
  • 38 years experience

Dr. Pratibha Dutta Singhi

  • MD (Ped.), All India Institute of Medical Sciences, New Delhi (1978), M.B.B.S., JLN Medical College, University of Rajathan, Jaipur, 1973
  • 38 years experience

Dr. Sudesh Kumar Prabhakar

  • DM Neurology-1978
  • 37 years experience

Dr. S.S.K Ayyar

  • FAAN (USA), MD, DM (Neurology)
  • 35 years experience

Dr. Madhuri Behari

  • DM (Neurology) from AIIMS, MD (Medicine) from Lady Hardinge Medical College, Delhi University, MBBS
  • 34 years experience

Dr. Arun Garg

  • D.M. (Neurology), Swai Man Singh Medical College, Jaipur - 2002, M.D. (General Medicine), Swai Man Singh Medical College, Jaipur - 1989, M.B.B.S., Swai Man Singh Medical College, Jaipur - 1986
  • 32 years experience

Dr. Ashis Pathak

  • M.Ch-1987
  • 30 years experience

Dr. Lt(Gen) Ajit Singh Narula

  • DM (Nephrology) Post Graduate Institute of Medical Education and Research, Chandigarh(1989), MD (Medicine) Armed Forces Medical College, Pune (1982), MBBS - Stanley Medical College, Madras (1975), Fellow of American College of Physicians (2008)
  • 30 years experience

Dr. Rajesh Garg

  • MBBS, MD -Medicine , DM ( Neurology)
  • 30 years experience

Dr. V. P. Singh

  • DNB Neurosurgery, National Board of Examinations, 1989, MCh Neurosurgery, All India Institute of Medical Sciences, New Delhi, 1987, MBBS, All India Institute of Medical Sciences, New Delhi, 1982
  • 30 years experience

Dr. Deepu Banerji

  • M.Ch (Neurosurgery)
  • 28 years experience

Dr. Harjinder S Bhatoe

  • M.Ch, MS, MBBS
  • 27 years experience

Dr. Anand Kumar Saxena

  • MBBS - University of Delhi, 1989, MD - Medicine - University of Rajasthan, Jaipur, 1994, DM - Neurology - G B Pant Hospital / Moulana Azad Medical College, New Delhi, 2006
  • 27 years experience

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About Gamma Knife Radiosurgery

Also known as stereotactic radiosurgery, Gamma Knife radiosurgery, is an extremely accurate form of therapeutic radiology. Even though it is called surgery, a Gamma Knife procedure does not involve actual surgery, nor is the Gamma Knife actually a knife at all. The technique relies on beams of highly-focused gamma rays to treat small to medium size lesions, generally in the brain. Several beams of gamma radiation are combined to focus on the lesion under treatment, giving a powerful dose of radiation without a surgical incision or opening.

Gamma Knife radiosurgery is called “surgery” due to its result that remains similar to an actual surgical procedure is created by a one-session radiation therapy treatment. The beams of radiation are precisely focused to reach the tumor, lesion, or other area being treated with minimal effect on surrounding healthy tissue.

Gamma Knife radiosurgery is most often used to treat tumors and other lesions in the brain. It is also used to treat certain neurological conditions, such as trigeminal neuralgia (a condition in which pressure on the trigeminal nerve causes spasms of extreme facial pain) and acoustic neuroma (a noncancerous tumor in the brain that affects the nerves that control hearing).

This surgery may be a feasible option in situations where the brain lesion cannot be accessed by conventional surgical techniques. It may also be used in individuals whose condition is such that they might not be able to tolerate a surgical procedure, such as craniotomy, to treat their condition.

Gamma Knife treatment generally involves these steps:

  • Head frame placement: - In order to keep the head from moving during treatment, a box-shaped frame is attached to the head. Pins designed specifically for this purpose fasten the head frame to the skull. The head frame also is a guide to focus the gamma ray beams to the exact location of the lesion being treated.
     
  • Tumor or lesion location imaging: - Once the head frame is in place, the exact location of the lesion to be treated will be determined using computed tomography (CT scan) or magnetic resonance imaging (MRI).
     
  • Radiation dose planning: - After the CT or MRI scan has been completed, the radiation therapy team will determine the treatment plan. The results of the imaging scan, along with other information, will be used by a medical physicist to determine the best treatment.
     
  • Radiation treatment: - After being positioned for the treatment, a type of helmet with many hundreds of holes in it is placed over the head frame. These holes help to focus the radiation beams on the target. Treatment will last a few minutes up to a few hours, depending on the type and location of the area being treated. Generally, only one treatment session is required for a lesion.

There are basically two types of radiosurgery –

  • Linear accelerator (LINAC) systems: - Linear accelerator (LINAC) systems use high-energy x-rays to treat a tumor or other lesion. Some common types of LINAC systems include CyberKnife®, X-Knife®, Novalis®, and Peacock®.In addition to using x-rays rather than gamma rays, LINAC systems also differ from the Gamma Knife in that the machinery moves around the patient during treatment. For this reason, LINAC systems are able to treat larger tumors and larger affected areas than the Gamma Knife. Areas other than the brain can be treated with a LINAC system.
     
  • Proton beam therapy or cyclotron: - Proton beam therapy is a type of particle beam radiation therapy. Rather than using rays of radiation, such as gamma rays or x-rays, particle beam therapy uses particles such as protons or neutrons. Proton beam therapy is the most widely-used type of particle beam therapy.Proton beam therapy may be used for radiosurgery procedures or for fractionated radiotherapy (several smaller doses of radiation over a certain period of time).There are only a few facilities in North America that provide proton beam therapy.

Potential Risks

If you are pregnant or suspect that you may be pregnant, you should notify your physician. Radiation exposure during pregnancy may lead to birth defects.

Other risks may include, but are not limited to, the following:

  • Swelling of the brain
  • Headache
  • Nausea
  • Numbness

Some risks and side effects may be related to the location and size of the area being treated by the Gamma Knife procedure. These may include:

  • Hair loss near treated area (generally temporary)
  • Seizures
  • Weakness
  • Loss of balance
  • Vision problems

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

The Procedure

  • You will be asked to remove any clothing, jewelry, hairpins, dentures, or other objects that may interfere with the procedure, and will be given a gown to wear.
     
  • An intravenous (IV) line may be started in the hand or arm in order to give medications and/or fluids during the procedure.
     
  • The skin on your head will be cleansed at the locations where the pins for the head frame will be placed.
     
  • A local anesthetic will be injected at the head frame pin insertion sites. Once the anesthetic has taken effect, the head frame will be attached to your head with pins that are inserted into your skull.
     
  • You may feel some pressure during the placement of the head frame, but this sensation should go away in a few minutes.
     
  • After the head frame is attached, you will undergo brain imaging so that the location of the brain tumor or lesion can be precisely identified for planning the treatment. The brain imaging procedure may be a computed tomography (CT) scan, a magnetic resonance imaging (MRI) scan, or a cerebral angiogram.
     
  • After the brain imaging has been completed, you will be allowed to rest and relax while the treatment team completes your treatment plan. The images from your imaging procedure will be used by a computer in planning your specialized treatment.
     
  • When your treatment plan is ready, you will be taken into the room where the Gamma Knife equipment is located. You will lie down on a sliding table. A special helmet, called a collimator helmet, will be fitted over the head frame. The collimator helmet has 201 holes in it, which allow radiation beams to pass through it into your brain in a very precise pattern that is determined by a computer.
     
  • Once the helmet is in place, the table will slide into the Gamma Knife unit. You may hear a clicking sound as the collimator helmet moves into place in the machine.
     
  • The treatment team will go into another room when the treatment begins. You will have an intercom available to communicate with the treatment team. They will be able to hear you at all times. You will also be observed with a video monitor.
     
  • The number of treatments will depend on your specific situation. The entire treatment session may last from two to four hours, but the length of the session will depend on the treatment plan designed for you.
     
  • You will not feel or hear anything from the Gamma Knife unit during the treatment session.
     
  • After the treatment session is over, the treatment table will slide out of the Gamma Knife machine. You will be allowed to get up at this time, unless you had an angiogram prior to the Gamma Knife procedure.
     
  • The head frame will be removed. The pin insertion sites will be cleaned and a sterile dressing will be applied.

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