Treatment Slides

FAQS-

Frequently Asked Questions about
Gamma Knife Radiosurgery

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