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FAQs
What are the tell-tale signs of brain tumors?
Generally speaking, brain tumors manifest their presence in
two ways: symptoms that reflect increased intracranial pressure
and secondly, destruction or dysfunction of a particular area
of the brain. Thus, one may have headaches, nausea or vomiting,
and changes in alertness which are all pressure-related or
one may exhibit language problems, hearing loss, paralysis
or seizures which on the other hand be speak of structural
problems in a particular area of the brain.
Do all brain tumors or brain blood vessel problems require
an operation?
A majority of brain tumors and vessel problems (doctors call
these vascular anomalies) require surgery. Unfortunately,
there are cases that are inaccessible or unsuitable for operation,
even in the best of hands. Only a certified neurosurgeon or
a neurologist can help one decide what is best for a particular
problem.
What are the important factors that a doctor and his patient
consider when one designs the best treatment option?
Common sense tells us that among many, the two more important
considerations are the size and the location of the lesion.
A competent doctor will help you in discussing other important
factors such as the biologic behavior of the tumor (benign
or malignant), the overall health status of the patient (e.g.
age, medical condition), the pros and cons of the various
treatment modalities and the overall ideal goal of treatment.
No patient is an exact replica of another.
I heard that surgery for brain tumors and certain brain
vessel diseases is now obsolete and one does not need to be
operated on. Is this true?
i Because the premise of the question is obviously sweeping,
the answer is NO. Surgery remains as the hallmark for treatment
for most cases. I can understand the desire and need for an
ideal treatment that does not require surgery and yet cures
or controls the problem. Despite all advances we still do
not have the panacea of miracle cure. However, there's a new
development in neurosurgery called Stereotactic Radiosurgery
(SRS)which allows a non-invasive approach in treating brain
tumors. No skin incision is done and the neurosurgeon does
not have to actually handle the brain to obliterate tumors
and vascular malformations. I want to emphasize however that
this is limited to certain specific brain tumors and brain
vessel disease that has to comply with the strictest criteria
to enhance the treatment effectivity. This is a wonderful
development but this is certainly not the miracle cure we
want it to be.
Have heard of the Gamma Knife. Is this what you are referring
to?
Yes, the Leksell Gamma Knife is the "gold standard"
of brain Stereotactic Radiosurgery. The Leksell Gamma Knife
uses precise doses of radiation which is delivered in one
sitting to a specific target or targets in the brain like
brain tumors, guided by computer generated imaging and localization
modalities. Originating in Sweden, it has a clinical track
record of more than 95,000 patients treated worldwide with
an average of more than 10,000 patients being treated per
year.
But I thought we had this sophisticated equipment for sometime
already?
This is not true. What we have had available is the Modified
Linear Accelerator (LINAC) based radiosurgery instrumentation
found in certain medical centers. There are only three Gamma
Knife centres in India, started since January 1997. Although
both systems work on the same principles, the fact is there
are significant differences between the two systems that may
have to be considered when deciding on the best treatment
option for a particular patient.
What in your mind are the major differences between the
LINAC instrumentation and the Gamma Knife?
The hallmark of the Leksell Gamma Knife is its precision and
accuracy in safely delivering therapeutic radiation doses
to inaccessible targets in the brain. The Gamma Knife instrumentation
can define a better target conformity especially for irregularly
shaped brain tumors or lesions, and has less radiation spillover
into normal surrounding brain tissue. Small targets near critical
areas of the brain can be treated with more confidence. The
excellent tumor control and cure rates for Gamma Knife radiosurgery
have been well documented. Furthermore, certain functional
disorders like Parkinson's disease, epilepsy, and intractable
pain are best treated with the Gamma Knife, when indicated.
Unlike the local LINAC instrumentation, the Gamma Knife is
a dedicated tool specifically used only for the brain, with
standard techniques and protocols used at more than 95 worldwide
sites - assuring the doctor and his patient of predictable
reliable results.
What does this mean to Indian Neurosurgery?
It simply means that we are keeping up with medical progress
worldwide. All treatment options are made available to the
Indian patient in his own country. One does not have to travel
abroad to seek Gamma Knife treatment.
Who are the candidates for Gamma Knife treatment?
Candidates for Gamma Knife treatment include patients with
the following disorders:
 Arteriovenous
Malformations
Benign
intracranial tumors, including acoustic neuromas, meningiomas,
pituitary adenomas, craniopharyngiomas, pineal
tumors and hemangioblastomas.
Metastatic
intracranial tumors
Other
malignant tumors, such as glial tumors, chordomas, glomus
tumors and nasopharyngeal carcinoma
Other candidates are
Patient
with residual lesions left unresected by previous open neurosurgical
procedures.
Patients
undergoing conventional radiation therapy, needing boost dose.
Patients
with recurrent tumors
Patients
at high risk for surgical complications, due to age or underlying
medical problems.
Patients
who refuse open surgery/craniotomy
Patients
with functional problems such as: Tic doloreaux, Parkinsonism,
Epilepsy, Intractable pain
Can you give us a brief description of how one undergoes
Gamma Knife Radiosurgery in your Center?
The typical Gamma Knife treatment consists of four (4) stages
Frame Fixation, Diagnostic Imaging, Treatment Planning and
Actual Treatment. During frame fixation, a metal stereotactic
frame is fixed on the patient's head by the neurosurgeon using
local anesthesia. The frame acts as a reference point for
the subsequent calculation of target coordinates in the brain
using neuroradiological images. After fixing the frame, the
patient then undergoes a head scan (computerized tomography
scan or magnetic resonance imaging scan). An angiogram is
required for patients with arterio-venous malformations. The
next step is treatment planning, which uses the previously
taken diagnostic images to accurately compute the radiation
dose with the help of a powerful computer workstation and
software (Leksell Gamma Plan). Lastly, treatment is given
at the Gamma Knife suite. After the procedure, the frame is
removed and the patient can go home in the same evening or
the next morning, depending on the advice of the attending
neurosurgeon.
What are the advantages and benefits of Gamma Knife Radiosurgery
compared to conventional brain surgery?
Reduced Health Risks
Because the Gamma Knife requires no incisions and in most
cases requires only local anesthesia, many of the risks associated
with conventional surgery (infections, hemorrhage, spinal
fluid leakage, adverse reaction to general anesthesia and
death) are virtually eliminated.
Shorter Hospitalization
Gamma Knife treatment is accomplished within a brief time
frame. The usual hospital stay for Gamma Knife treatment is
one night, usually with no associated convalescence period.
Most patients resume their normal activities upon hospital
discharge.
Cost effectiveness
The relatively low cost of the Gamma Knife procedure (as compared
to traditional craniotomy and surgical resection), shorter
hospitalization period, and elimination of hidden costs (no
convalescence, rehabilitation or extended job absence), combine
to make this a very cost-effective treatment option.
Patient comfort
Patients experience only the mild discomfort of local anesthetic
injection during application of the stereotactic frame; mild
sedation may be used. Patients do not experience hair loss,
and most patients have no post-treatment side effects.
Compared with conventional open brain surgery (craniotomy),
Leksell Gamma Knife treatments allow patients to return to
their pre-operative lifestyles quickly. Gamma Knife radiosurgery
is also cost-effective. When compared with conventional craniotomy,
cost reductions of 30-70% have been reported.
How long will it take for me to get better after Gamma
Knife treatment?
The effects of Gamma Knife treatment can be seen only after
some period of time which ranges from several weeks to a few
years. The tumor or arteriovenous malformation can show gradual
shrinkage or decrease in size before disappearing completely.
Other tumors just stop growing. For functional disorders like
Tic Doloreaux, the facial pain can be relieved as early as
three weeks after treatment.
Is general anaesthesia required for Gamma Knife radiosurgery?
General anaesthesia is usually not required at all for Gamma
Knife radiosurgery asc frame in place on the head. Only in
the minority cases (e.g. very young children) will sedation
(or sometimes a general anaesthesia) be required for Gamma
Knife radiosurgery.
Are there any side effects immediately after the treatment?
Most patients have no immediate side effects from the treatment.
Occasionally some mild side effects such as nausea/vomiting,
headache and scalp numbness may be possible.
How can local and foreign patients be referred to Rancan
Gamma Knife Centre?
Both local and foreign patients can be referred to the Rancan
Gamma knife Centre for treatment.In most cases, patients may
still be eligible for Gamma knife treatment even if they have
previously undergone open neurosurgery, radiation therapy,
chemotherapy or embolisation (for AVM patients)
How can I obtain further information?
For more information, please contact:
Rancan Gamma Knife Centre
VIMHANS
1, Institutional Area, Nehru Nagar
New Delhi-110065
Tel : 91-11-29849000
Fax : 91-11-29849006
E-mail: helpline@gammaknifeindia.com |
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