Gamma knife risks: Risks, Side Effects & Recovery Overview
Risks, Side Effects & Recovery Overview
Gamma Knife Risks & Side Effects
Any medical procedure has certain risks and potential side effects, which your doctor will consider prior to making any treatment recommendations. Gamma Knife risks and side effects are similar to those of other radiation therapies, though they tend to be milder because of the targeted delivery of radiation to the area of interest. The side effects you may experience can depend on the size and location of the area being treated as well as the duration and frequency of your treatment.
Possible Gamma Knife risks and/or side effects include:
- Scalp swelling
- Red and/or irritated skin at the treatment site
- Nausea and vomiting
- Numbness and/or weakness
- Temporary or permanent hair loss at the treatment site
- Swelling of the brain
- Difficulty with balance
- Vision or hearing deficits
An important potential risk of any radiation therapy is birth defects, so be sure to alert your doctor if there is any chance you might be pregnant or if you become pregnant prior to your treatment date. Your doctor may choose to reschedule your treatment to avoid any radiation exposure during your pregnancy.
What To Expect After Gamma Knife Radiosurgery
Though your recovery will depend on the size and location of the area being treated, along with your individual health factors, it can be helpful to have a general understanding of what most patients experience following Gamma Knife radiosurgery. Simply knowing what to expect after Gamma Knife radiosurgery can help you feel more at ease with the entire process.
Immediately After Your Gamma Knife Procedure
Gamma Knife radiosurgery is an outpatient procedure, which means you do not have to stay in the hospital overnight. You will be awake throughout treatment, so you will not need to spend any time recovering from anesthesia. Most patients are released to return home within a few hours of the completion of treatment, which can range from 15 minutes to more than an hour.
During this time, if you received treatment requiring the use of a positioning frame, you may have a little bleeding or soreness at the site of the pins. If you have a headache or nausea, your doctor may give you medication to make you more comfortable. You should be able to resume all normal activities within a day or so.
In the Days After Your Procedure
For the first few days following your treatment, you may feel more fatigued than usual. Your body will need a little time to recover, so be sure you get plenty of rest and give yourself a chance to heal. Some patients experience swelling or discomfort at the site of treatment, which will typically resolve within the first week.
Even if you did not experience a headache or nausea immediately following your Gamma Knife procedure, you may start to feel discomfort after a short delay. Should this be the case, be sure you let your doctor know so she can prescribe you medications if necessary.
In the Months After Your Procedure
Some patients treated using Gamma Knife radiosurgery to the head will experience swelling of the brain approximately six months following treatment. This Gamma Knife risk is managed using medication, and neurological problems following treatment are rare.
You may also be undergoing additional treatments during this time. Though many patients benefit from a single session of Gamma Knife radiosurgery, some conditions will require multiple treatments, depending on the size, location and nature of the area being treated.
Long-term Maintenance After Your Procedure
Regardless of your condition, you can expect to have follow-up visits and monitoring with your doctor following your Gamma Knife radiosurgery. You may need to undergo follow-up imaging, additional treatments or even attend physical therapy to assist in the recovery process. Your doctor will be able to give you a more specific idea of what you can expect in the long term for your individual condition and situation.
Rest Easy Before Your Procedure
Knowing more about your condition and upcoming treatment is a great way to play an active role in your healthcare. Having a better understanding allows you to have more meaningful conversations with your doctor and can give you an idea of what to expect before, during and after your treatment.
Keep in mind throughout this process that your doctor has taken into consideration the Gamma Knife risks and benefits as they relate to your specific circumstances. Before making any treatment recommendation, your doctor must be confident that the benefits outweigh the risks and that the procedure is the appropriate choice for you. Rest easy with this knowledge, and focus on what matters most during this time: your recovery.
What it Treats, How Performed, Risks & Benefits
What is Gamma Knife® surgery?
Gamma Knife® surgery is a treatment method that uses radiation and computer-guided planning to treat brain tumors, vascular malformations and other abnormalities in the brain. Despite its name, this procedure does not involve any incisions, not even a skin incision. The Gamma knife is actually a treatment that delivers beams of highly focused radiation. Some 192 “beamlets” of radiation converge and are precisely focused on the targeted area of brain, specifically in the shape of the tumor or lesion, while sparing the surrounding normal tissue.
Gamma Knife surgery is also known as stereotactic radiosurgery, Gamma Knife radiosurgery and Gamma Knife radiation.
What conditions does Gamma Knife surgery treat?
Gamma Knife surgery can treat several brain disorders, including:
The Gamma Knife may be helpful if you have a brain lesion or tumor that can’t be reached by traditional surgery techniques or if you’re unable to undergo surgery due to your condition or age. It can also be combined with traditional surgery to prevent tumor regrowth. The Gamma Knife is also used for some conditions that require urgent treatment.
What happens before the Gamma Knife procedure?
- Your neurosurgeon gathers your medical history and perform a complete physical exam. You may undergo additional tests.
- Tell your provider if you have any of the following: heart pacemaker, aneurysm (brain) clip, implanted medication pump, implanted nerve stimulator, metal implants, metal from trauma, cochlear implant, spine stabilization hardware, severe lung disease, esophageal reflux or are unable to lay flat on your back for 30 to 60 minute periods.
- Tell your provider if you are sensitive to or are allergic to any medications, latex, tape, contrast dyes, iodine or general or local anesthetic agents.
Eating, drinking, medication
- Don’t eat or drink anything after midnight the evening before your procedure (for AVM procedures only).
- Take your morning medications with sips of water the morning of your treatment. Bring all prescribed and over-the-counter medications, including inhalers, with you.
Hair prep, clothing
- Wash your scalp the night before your Gamma Knife procedure. Wear your hair loose. Don’t use clips, pins or bands. Your head will not be shaved.
- On the day of the procedure, wear slip-on shoes; comfortable pants, slacks, skirt or shorts; and a button-up or zip-front shirt with loose-fitting or short sleeves. Don’t wear a shirt that must be put on/taken off over your head.
- A family member or friend will need to bring you on the day of the procedure and drive you home after treatment. They don’t necessarily need to stay during the procedure itself.
How is Gamma Knife surgery performed?
Gamma Knife treatment involves several steps.
The initial steps are different if the Gamma Knife system uses an external rigid head frame or uses a frameless mask. If using a head frame:
- First, a box-shaped head frame is positioned on your head. The head frame is made of aluminum and weighs less than two pounds. The head frame acts as a “frame of reference” in the planning of your treatment and is essential in keeping the target perfectly aligned during the precision treatment. Your neurosurgeon positions the frame.
- You’ll receive four injections of a local anesthetic, one on each side of your forehead and two in the back of your head. These are the areas where specials pins are placed to fasten the head frame to your skull. You may feel pressure as the pins are tightened, but this usually only lasts a few minutes. After the head frame is positioned, a radiation therapist will take measurements of your head. Typically an imaging scan, such as CT or MRI scan is performed with the head frame in place. These measurements and the scans are used for planning your treatment.
Frameless Gamma Knife systems use a thermoplastic mask that is placed over your face. The mask is then secured to an existing frame on the Gamma Knife table. Your head is held completely still.
These remaining steps are the same for both the frame-based and frameless systems.
- You may have an IV line inserted into your arm. This allows contrast agent (a type of dye) to be delivered for your computed tomography (CT) and/or magnetic resonance imaging (MRI) scan. These scans and dye determine the exact location, size and shape of the tumor or lesion to be treated. The scanning usually takes about 30 minutes to complete.
- The IV line can also be used to deliver a small amount of sedation to help you relax (if needed). Most patients are awake but under light sedation during the procedure. Under certain circumstances (usually children), general anesthesia is used.
- Based on the results of the scans and other information, your neurosurgeon, the radiation oncologist and other team members plan your treatment on a computer. They will decide the area(s) to treat, radiation dose and how to target the lesion for best results. You can remain in your room with family or friends during this time. Plan to spend several hours up to 12 hours at the treatment center. Your treatment team will give you a more accurate estimate based on your unique condition.
- Next, your treatment begins. Your head frame or frameless mask is secured to the framework of the Gamma Knife table you lie on so your head doesn’t move during treatment. The Gamma Knife table slowly moves into the Gamma Knife machine that delivers the radiation. The treatment team will be immediately outside the room while you receive your treatment, but you will constantly be observed by cameras and monitored. There is a microphone near your head so you will be able to easily talk with the staff during your treatment.
- Most treatments take 30 minutes to three hours (for the treatment itself), depending on the size, shape, and location of the lesion and number of radiation doses.
- After your treatment, the table moves out of the machine and the staff will enter the room. Your head frame/mask and IV are removed.
Depending on the type and size of the tumor or lesion, more than one treatment session may be needed. Your neurosurgeon and/or radiation oncologist will review your treatment plan with you.
How will I feel during the Gamma Knife procedure?
The actual Gamma Knife treatment is painless. There is no heat or noise nor will you feel any discomfort during the treatment. You may listen to music or nap during the procedure.
What happens after the Gamma Knife procedure?
- Your head frame is removed (if you had an external rigid head frame). The pin sites are cleaned with hydrogen peroxide and an antibiotic ointment and bandages are applied.
- If you experience a headache or nausea or vomiting, you’ll be given medication.
- Staff will review discharge instructions with you and your adult driver companion. You will be observed for 30 minutes to one hour before being discharged.
- Keep your head elevated on a couple of pillows for one week. This helps lessen swelling at the pin sites (if you’ve had the external head frame) and pressure within your head.
- You may wash your hair/scalp 48 hours after your surgery. This allows the pin sites to begin to heal and prevents infection from developing in the wounds.
- You may take non-aspirin pain medication such as ibuprofen (Advil®, Motrin®) or acetaminophen (Tylenol®) if you are having any discomfort.
- You may remove the bandages from the pin sites the morning after your procedure. Clean the sites twice a day with hydrogen peroxide or mild soap and water. You may then apply a small amount of antibiotic ointment such as neosporin or bacitracin to the pin sites for three to four days. Applying bandages over the pin sites for two to three days is sufficient.
Risks / Benefits
What are the risks and/or side effects of Gamma Knife surgery?
While risks related to the procedure are typically low, risks and/or side effects of Gamma Knife surgery may include:
- Swelling of the brain.
- Nausea and vomiting.
- Numbness/tingling sensation on the scalp at the pin placement sites.
- Hair loss (only occasionally if tumor is close to the scalp and hair follicles are irradiated).
- Bleeding (brain hemorrhage).
- Feeling tired.
What are the benefits of the Gamma Knife procedure compare with traditional surgery?
There are many benefits of Gamma Knife surgery over traditional surgery. Gamma Knife surgery:
- Doesn’t require incisions or general anesthesia.
- Can target tumors/lesions deep in the brain that can’t be safely reached by traditional surgery.
- Can target multiple tumors/lesions at the same time.
- Avoids other risks and complications of surgery (such as bleeding and infection from incisions).
- Limits damage to the surrounding healthy tissue.
- Results in little to no post-treatment discomfort or pain.
- Is usually performed as an outpatient procedure (rarely requires an overnight stay).
- Allows return to usual activities in a day or two.
- Usually doesn’t require physical therapy or other rehabilitation.
It’s covered by most insurance and Medicare (but always check with your insurance provider).
Recovery and Outlook
Benefits to Gamma Knife
What’s the outlook after undergoing the Gamma Knife procedure?
The success of the Gamma Knife procedure depends on the size, location, type of lesion, your personal medical history, and other factors. Discuss your expectations and outlook with your neurosurgeon and your radiation oncologist before treatment.
The goal of Gamma Knife surgery is for the radiation to stabilize, shrink or destroy the tumor or lesion. Depending on your condition, you may or may not need additional Gamma Knife treatment or traditional now-more-manageable surgery. You will have follow-up CT and/or MRI scans to check on treatment progress.
It may take weeks, months, a year (or sometimes longer) to see the full effects of treatment. For example, pain relief if you have trigeminal neuralgia can occur anytime between one day and six months, with most people improving within one month. Cancerous tumors typically become stable or get smaller over a period of weeks to months. Many noncancerous tumors stop growing immediately (the main goal), but may not get smaller in size. Arteriovenous malformations may take two to three years to resolve after treatment.
When to Call the Doctor
When should I call the doctor after having the Gamma Knife procedure?
Call if you feel or notice any of the following symptoms:
- The pin sites feel hot to the touch (if you’ve had the external head frame).
- A cloudy or foul smelling drainage is coming from the pin sites.
- You have a fever of 101 degrees F or higher.
If you experience nausea, vomiting, severe headache, visual changes, difficulty speaking, a seizure, or any other symptom unusual for you, contact your physician immediately or go to the nearest emergency room.
A note from Cleveland Clinic
Gamma knife is a highly effective treatment with minimal or no associated adverse effects. Because of its ability to stabilize or reduce the size of a tumor or lesion, often only one treatment is required; however, occasionally gamma knife can be repeated safely and successfully.
Complications of Gamma Knife surgery: an early report from 2 Canadian centers
Gamma Knife surgery (GKS) is used to treat benign and malignant brain tumors, arteriovenous malformations, trigeminal neuralgia, and other conditions. Patients experience reduced neurological morbidity from GKS compared with open microneurosurgery, but risks of radiation injury and technical limitations persist. The authors report treatment complications from the early experience of 2 Canadian GKS programs in Toronto and Sherbrooke.
In Toronto, a prospective administrative database was searched for adverse events and incomplete treatment administrations. In Sherbrooke, data were acquired by chart review. Patients were accrued until August 1, 2007, and a total of 973 patients were included in this report.
During the radiosurgical procedure, 19 patients (2%) suffered anxiety or syncopal episodes, and 2 patients suffered acute coronary events. Treatments were incompletely administered in 12 patients (1.2%). Severe pain was a delayed complication: 8 patients suffered unexpected headaches, and 9 patients developed severe facial pain. New motor deficits developed in 11 patients, including edema-induced ataxia in 4 and one case of facial weakness after treatment of a vestibular schwannoma. Four patients required shunt placement for symptomatic hydrocephalus, and 16 patients suffered delayed seizures.
Gamma Knife surgery is a minimally invasive treatment modality for many intracranial diseases. Treatment is not risk free, and some patients will develop complications; these are likely to decrease as institutional experience matures. Expanding availability and indications necessitate discussion of these risks with patients considering treatment.
Long-term results of Gamma Knife surgery for arteriovenous malformations: 10- to 15-year follow up in patients treated with lower doses
Several adverse effects such as brain edema, necrosis, arterial stenosis, hemorrhage after obliteration, and delayed cyst formation have been reported as early and late complications of Gamma Knife surgery (GKS) for arteriovenous malformations (AVMs). These adverse effects seem to be decreased in a lower-dose treatment regimen compared with the classic higher margin doses of 25 Gy because the radiation insult to the surrounding tissue is minimized. Long-term results of lower-dose GKS for AVMs are presented.
One hundred fourteen patients with AVMs were treated with lower-dose GKS (< or = 20-Gy margin dose). There were 68 male and 46 female patients, aged 10 to 68 years (mean 35.4 years). The evaluation of AVM nidi and dose planning were performed using both angiography and MR imaging in all cases to exclude the surrounding brain tissue. The mean margin dose was 19.5 Gy. Total angiographically documented obliteration was achieved in 65 (85.5%) of 76 patients. Eleven patients underwent a second treatment, including staged treatment for large AVMs; total AVM obliteration has been achieved in six of them to date. Of 38 patients in whom no follow-up examination could be performed, 19 of them were healthy and 10 were lost from follow up. Nine patients experienced bleeding during the latency period, and four of them suffered lethal hemorrhage. Symptomatic early complications were extensive brain edema after repeated GKS in one patient and an adverse effect on the internal capsule in one. Delayed cyst formation was found in one patient as a late complication 10 years after treatment. No treatment-related death has been noted to date.
Lower-dose GKS is an effective and safe treatment for patients with AVMs and may decrease long-term adverse effects to the surrounding brain.
Treating a Brain Tumor With a Gamma Knife – Brain Tumor Center
It’s called a gamma knife, but there’s not a blade on it. This medical device, which involves no cutting at all, delivers radiation to a spinal cord or brain tumor with the intent of destroying the tumor cells.
Gamma Knife Surgery: What It Is and How It’s Done
Gamma knife surgery is a type of stereotactic radiosurgery, which is a form of radiation therapy that aims low-dose radiation beams, coming from all sides of the head, directly at the brain tumor. This results in a high dose of radiation at the center of the tumor, where the many radiation beams meet.
Gamma knife surgery uses three-dimensional imaging techniques to accurately target the tumor before the radiation is given. After taking MRIs (magnetic resonance imaging scans) and CT (computed tomography) scans, your treatment team will plan your treatment with gamma knife surgery.
After a plan is in place and before you receive the treatment, doctors will put a frame around your head to hold it still. To place the frame, your medical team will numb certain areas of your scalp and use tiny screws or pins to position the head frame in place. Wearing this frame, your head is then placed inside a clear helmet which has small holes through which the radiation beams are directed at the brain tumor.
Gamma Knife Surgery: Is It for You?
Gamma knife surgery is particularly effective for people whose tumors are:
- Three centimeters or less in diameter
- Either benign (non-cancerous) or malignant (cancerous)
If you have a spinal cord or brain tumor, talk with your doctor about whether gamma knife surgery is an option for you. Before your medical team makes a decision, team members will carefully review the results of CT and MRI scans, positron emission tomography (PET) scans, cerebral angiography, and other tests.
Benefits of Gamma Knife Surgery
There are many benefits of gamma knife surgery, including:
- It is extremely accurate. Because the gamma knife so precisely targets the brain tumor, areas outside of the tumor are not exposed to much radiation, which can reduce the risk of side effects and damage to nerves and blood vessels in surrounding areas of the brain.
- No incision is required. Since gamma knife surgery is actually not a surgery but a form of radiation therapy, no incision is made and general anesthesia is not required. Therefore, the risks associated with skull incisions and general anesthesia can be avoided.
- Only one treatment is needed. It usually takes just one 10-minute to 70-minute procedure to deliver radiation with the gamma knife.
- It works. There is evidence that treatment of certain malignant brain tumors with gamma knife surgery can increase a patients’ lifespan.
Risks of Gamma Knife Surgery
Potential risks and side effects of gamma knife surgery include:
- Tenderness where the screws or pins were placed
- Nausea and vomiting
- Hair loss where the radiation was directed
- Damage to surrounding tissues in the brain, caused by swelling. These effects may be delayed, and may cause symptoms mimicking a stroke or a recurrence of tumor
Gamma Knife Surgery: Preparation
To prepare for gamma knife surgery:
- Stop taking certain medications before your procedure, as directed by your medical team.
- Take all medications prescribed by your medical team, which may include steroids and anti-seizure drugs.
- Follow your medical team’s instructions regarding what to eat and drink in the days leading up to your procedure.
- Wash your hair the night before your procedure, if your doctor recommends it.
- Arrange to have someone drive you home after your procedure.
In most cases, you will be able to go home the same day of your gamma knife surgery.. Follow your doctor’s instructions regarding how to care for yourself after the procedure. You will most likely be able to resume your normal activities within a couple of days. Contact your medical team if you have any questions, and attend follow-up appointments as directed.
Gamma Knife Radiosurgery Procedure, Use and Safety
What is the Gamma Knife
The Gamma Knife is not actually a knife at all. It is a stereotactic radiosurgical device that non-invasively treats malignant and benign brain tumors, vascular malformations and trigeminal neuralgia in a single patient visit. Patients are treated on an out-patient basis or may require an overnight hospital stay.
How does the Gamma Knife work?
Utilizing advanced diagnostic imaging and three-dimensional treatment planning software, Gamma Knife delivers 201 precisely focused beams of gamma radiation to small targets inside the brain. Radiation is only delivered at a single, finely focused point where all 201 beams converge to treat the diseased tissue, while nearby healthy tissue is spared.
What are the benefits of Gamma Knife Radiosurgery?
Gamma Knife treatment has many benefits. It is bloodless, virtually painless, no loss of hair and rapid return to pre-treatment activities. Gamma Knife treatment also has excellent, well-documented clinical outcomes for a variety of brain diseases and disorders. This single day procedure is usually covered by most major health insurance companies and Medicare. Due to these benefits, Gamma Knife treatment may replace traditional surgery or radiation therapy, where deemed appropriate by the treatment physicians. However, Gamma Knife treatment is also often used in conjunction with traditional surgery and radiation.
In some cases, Gamma Knife treatment may replace brain surgery or other traditional treatment methods in some patients with brain tumors, vascular malformations and facial pain. An individual who would be at risk for complications from conventional surgery may be a candidate for Gamma Knife radiosurgery. Gamma Knife treatment can be used when prior surgery or radiation therapy has failed to control the disease process. It can also be used in conjunction with conventional surgery in previously inoperable cases, with other forms of radiation therapy and chemotherapy.
While Gamma Knife radiosurgery is a form of radiation treatment, it has several differences from conventional radiation therapy for the brain. Gamma Knife treatment is only directed to targeted areas and spares unnecessary treatment of adjacent, normal brain tissue. Only a one-day treatment is required rather than many treatments over several weeks, and the treatment often can be repeated if necessary. Gamma Knife can also be used in combination with other forms of radiation therapy.
What if I am older or have other medical conditions?
Gamma Knife radiosurgery is especially valuable for patients whose neurological disorders require a difficult surgical approach or may be impossible to treat using conventional neurosurgical techniques. Patients of advanced age or in poor medical condition can be at an unacceptably high risk for anesthesia and conventional surgery, making Gamma Knife treatment an ideal solution. Gamma Knife technology also is highly beneficial for patients whose lesions are situated in an inaccessible or functionally critical area within the brain. In addition, the treatment can be used as an adjunct to the care of a patient who has undergone conventional brain surgery, interventional neuroradiology or conventional radiation therapy or chemotherapy.
What conditions can be treated by the Gamma Knife?
Conditions that can be treated by the Gamma Knife include:
- Malignant tumors such as:
- Metastases (cancer that has spread to the brain)
- Malignant gliomas
- Benign tumors such as:
- Acoustic neuromas (vestibular schwannomas)
- Pituitary tumors
- Low-grade glioma and skull-based tumors
- Vascular malformations such as:
- Arteriovenous malformations (AVMs)
- Cavernous angiomas (cavernous malformations)
- Functional disorders such as:
How are patients referred for Gamma Knife treatment?
Most patients are referred to the Gamma Knife program by their doctors. However, some make self-referrals. The Gamma Knife team reviews each patient’s records to determine if Gamma Knife treatment would be advantageous for each patient.
What information is used to determine if Gamma Knife treatment is appropriate?
The Gamma Knife team uses the following information to make its recommendations:
- Medical and surgical history
- Clinical examinations
- Imaging studies, such as MRI, CT and/or PET scans
Is Gamma Knife treatment effective?
The Gamma Knife’s success rate is impressive. Supported by more than two decades of clinical research, this neurosurgical tool has met with unprecedented results. Clinical applications continue to grow, and its many benefits as a non-invasive treatment modality continue to make it the treatment of choice for certain clinical conditions.
What happens during Gamma Knife treatment?
First, a lightweight frame is attached to the patient’s head. Local anesthesia is used before the frame is secured in place. The patient then has an MRI imaging study or, in the case of an arteriovenous malformation, angiography, may be needed in order to precisely locate the diseased area. Data from the imaging study is transferred into the sophisticated treatment planning computer. While the patient rests, the treatment team (a neurosurgeon, radiation oncologist and physicist) uses advanced software to determine the treatment plan. This planning usually takes one or two hours to complete, depending on the complexity and location of the disease. When the individual treatment plan is completed, the patient is placed on the Gamma Knife couch and precisely positioned. The patient is then moved automatically, head first into the machine, and treatment begins. Treatment typically lasts from 15 minutes to over an hour, depending upon the complexity of the case and location of the target. The patient does not feel or see the treatment. Following treatment, the patient is automatically moved out of the machine, and the head frame is removed.
What will I feel during Gamma Knife treatment?
During the actual treatment, the patient feels nothing unusual. The patient does not see or feel the radiation during treatment. Prior to the actual treatment, patients typically feel slight discomfort from the local anesthetic used when placing the head frame, and some patients have reported feeling pressure for a short time while the pins are inserted to fixate the head frame- but no pain is experienced during the treatment process.
Will I be awake during the procedure?
The patient remains conscious throughout the entire procedure and may communicate with the treatment team.
Will my head be shaved?
No, the head is not shaved. In rare cases the treatment may cause some hair loss.
What can I expect after treatment?
When the treatment is finished, the head frame will be removed. Sometimes there is a little bleeding from where the pins were placed on the head. In this case, gauze and pressure will be applied to stop the bleeding and keep the area clean. A temporary head dressing is placed to keep the pin sites clean. It is recommended that the patient take it easy over the next 12 to 24 hours. Pre-Gamma Knife activities can be resumed within a few days.
Is Gamma Knife treatment safe?
The Gamma Knife allows non-invasive brain surgery to be performed with extreme precision while sparing healthy tissues surrounding the targeted treatment area. Also, because neither a surgical incision nor general anesthesia is required, the risks usually involved with open brain surgery, such as hemorrhage or infection, may be reduced. Hospitalization is rarely required and recovery time is minimal. While individual patient outcomes may vary, patients may resume their normal pre-surgery lifestyle within a few days.
How quickly will the treatment work?
The effects of Gamma Knife radiosurgery occur over several days to several years, depending on the type of medical condition treated. The radiation alters the DNA of the tumor or lesion being treated so that the cells no longer reproduce, eventually rendering the lesion static. Some abnormalities dissolve gradually, eventually disappearing. Others simply exhibit no further growth. The effectiveness of the treatment is monitored by MRI scans at regular intervals. The goal of radiosurgery is tumor control, which is defined as stable tumor size or tumor shrinkage. For vascular malformations, control is generally considered total obliteration.
What are the complications of Gamma Knife treatment?
Early complications may include:
- Common side effects:
- Local pain and swelling in the scalp
- Rare complications:
- Skin reddening and irritation
Delayed complications may include:
- Uncommon complications:
- Local loss of hair in superficial lesions
- Local brain swelling in the treatment site
- Local tissue necrosis in the treatment site
- Rare complications:
- Visual loss (dependent on diagnosis and areas treated)
- Hearing loss (dependent on diagnosis and areas treated)
When can I return to my normal activities?
Within a few days. The only restrictions you will have are the same you had prior to your treatment.
Is Gamma Knife treatment more or less expensive than traditional brain surgery?
Cost studies have shown Gamma Knife radiosurgery to be less expensive than conventional neurosurgery because it eliminates lengthy post-surgical hospital stays, expensive medication and potentially months of rehabilitation. Importantly, there are virtually no post-surgical disability and convalescent costs with this procedure.
Will my insurance cover this procedure?
Gamma Knife radiosurgery is reimbursed by most insurance companies, PPOs, HMOs and Medicare.
Gamma Knife RadioSurgery – NYC
At Columbia University Irving Medical Center/NewYork-Presbyterian Hospital’s Gamma Knife Center, over five thousand patients have been successfully treated with the Gamma Knife procedure by a specialized, multidisciplinary team.
The treatment team typically includes a neurosurgeon, a radiation oncologist, a radiation therapist, and a registered nurse. In addition, a medical physicist calculates the precise beam placement and number of exposures necessary to obtain the radiation dose that is prescribed by the radiation oncologist. (Your treatment team may include other healthcare professionals in addition to, or in place of, those listed here.)
A Gamma Knife procedure may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary slightly depending on your condition.
Before the procedure begins, you may be asked to remove any clothing, jewelry, hairpins, dentures, or other objects that may interfere, and you will be given a gown to wear. An intravenous (IV) line may be started in your hand or arm in order to supply you with medications and/or fluids.
Next, the head is prepared for placement of a box-shaped head frame or custom-made face mask. No shaving is required for either method. Which method is used depends on the individual condition and diagnosis of the patient. Frames confer maximum precision, necessary for working with trigeminal neuralgia, essential tremor, epilepsy, and obsessive-compulsive disorder. Face masks, which may be more comfortable, also ensure an extremely high degree of accuracy. The frameless face mask also enables treatment of larger tumors over a series of days usually on an outpatient basis. The frequency and amount of treatments required will be determined by the Gamma Knife team.
If a head frame is used the head frame is attached to the head and will prevent the head from moving during the procedure. This technique is also called frame-based radiosurgery.
If a face mask is used, a thermoplastic mask will be placed and then molded over your face for a customized fit. The mask has an opening for your nose and you will be able to breathe comfortably while wearing it. The mask is then contoured to fit your face perfectly and will have a snug, tight fit, minimizing head movement during the procedure. It will take about 10 minutes or less for the mask to harden, forming a custom face mask. Although tight, the face mask is comfortable to wear throughout the procedure. This technique is also called frameless radiosurgery.
You may receive a mild sedative to help you relax prior to a frame or frameless procedure.
After the head frame or face mask is attached, you will undergo brain imaging so that the location of the brain lesion can be precisely identified. 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. Determining your treatment plan can take between 30 and 90 minutes. To make your treatment plan, the team will combine the results of the imaging scan with other information to determine the optimal dosage and number of exposures. The team will input specific instructions to the computer system on where to focus the gamma rays, ensuring pinpoint precision and accuracy.
When your treatment plan is ready, you will be taken into the room where the Leksell Gamma Knife Icon is located. You will lie down on a sliding table, with your head pointing toward the machine. The table will then slowly slide you into the wide opening of the Gamma Knife unit.
During the entire treatment, you will be monitored by the Gamma Knife team via live video feed. You will have an intercom available to communicate with the team. They will be able to hear and communicate with you at all times.
The Icon machine is silent and you will not feel or hear anything during the procedure. The team will continuously monitor your head placement and radiation dosage. The head frame or face mask will keep your head in alignment. The Leskell Gamma Knife Icon has a safety feature that blocks radiation if movement occurs.
The number of treatment sessions will depend on your specific diagnosis. You may be inside the Gamma Knife unit as briefly as 15 minutes, or up to a few hours; the duration will depend on the treatment plan designed for you.
After the treatment session is over, the treatment table will slide out of the Gamma Knife machine.
The head frame or face mask will be removed. You will then be briefly monitored by the nursing team prior to discharge.
What are the risks for this procedure?
Although Gamma Knife radiosurgery is less invasive than traditional open surgery, there are some possible side effects and risks.
Radiation therapy is not recommended to women who are pregnant. Women of childbearing age may need to provide a urine sample prior to Gamma Knife treatment to ensure they are not pregnant.
Other side effects may include cerebral edema, headache, nausea, numbness or weakness in the face, loss of balance, vision problems, hair loss near the treated area (the hair loss is usually temporary), and seizures. Medication can be used for many of these side effects. Your physician will explain possible side effects before the procedure and manage any side effects after the procedure, should they occur.
There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.
Radiosurgery: Cyberknife and Gamma Knife
What is radiosurgery?
Radiosurgery refers to a radiotherapy procedure in which a small, well-defined tumor is irradiated with high precision. The target tumor can range in size from 0.5 to 4 cm in diameter. Due to the sharp drop in the energy of the rays used at the border of the tumor and healthy tissue, the latter is not damaged and is preserved.
What treatment methods are used in radiosurgery?
Modern high-performance linear accelerators (based on LINAC) can be offered for radiosurgery.They accelerate particles by voltage and direct them with the help of a magnetic field along the desired trajectory.
CyberKnife is a radiosurgical device for radiation therapy. Unlike the gamma knife, which is limited to the head, it can be used to treat tumors all over the body. This technology uses a high dose of photon radiation from a linear accelerator and aligns it with the robot’s freely moving arm exactly towards the target.
The Gamma Knife is a radiosurgery device for radiation therapy. It is used exclusively for irradiation of intracranial structures. The device contains sources of cobalt-60, which are located in a hemispherical shape. From 192 sources, rays are directed to the target tumor, so that there they meet and specifically release their energy. During irradiation, two X-ray cameras track the patient’s position and correct any deviations in the planned images in real time.
Advantages of Radiosurgery Compared to Traditional Radiation Therapy
Radiosurgery allows for precise therapy of areas of the body that are difficult to access for surgery. In addition, it is possible to act on parts of the body that are “hidden” in the depths, so that, unlike conventional radiation therapy, the tissue on the path of the rays from the skin to the tumor is not damaged. This includes tumors in the skull, as access through the cranial bone is difficult. By lowering the dose at the tumor border, the surrounding tissues are kept intact, so that the expected side effects are reduced and the overall treatment is better tolerated.This opens up new treatment options for older people or patients with underlying medical conditions.
Which tumors can be treated with radiosurgery?
Patients with a primary tumor outside the brain who have metastases to the skull may undergo radiosurgery. Patients who have up to four metastases up to 3 cm in size are questioned.
Meningeal tumors (meningiomas)
Tumors that are located inside the cranial bone are difficult to reach and, in addition, are often located near sensitive structures such as cerebral vessels.Therefore, these tumors are especially suitable for radiosurgery. Meningiomas are characterized by a low risk profile and small growth. They can be irradiated after complete or partial surgical removal.
the auditory nerve were the first tumors to be treated with radiosurgery. The goal is to stop tumor growth, which is successful in 90% of cases. Thus, hearing can be preserved in most cases non-invasively.
Vascular malformations (arteriovenous malformations, cavernomas)
Radiosurgery can be used to treat cerebrovascular malformations (
in its functionally important areas. These malformations are characterized by weaker vascular walls and pose a high risk of stroke. Radiosurgery of such malformations, which are not surgically accessible due to their complex location, significantly reduces the incidence of symptomatic bleeding.
Functional neurosurgery – facial pain
Radiosurgery is used to treat facial pain in the background
… Also, radiosurgery helps patients with
or meningiomas at the base of the skull with infiltration of the trigeminal nerve.
Side effects of radiosurgery
Side effects are very rare and strongly depend on the disease being treated, the location of the affected tissue and the required radiation dose.Therefore, it is impossible to make a general statement about this in advance. Individual risks for certain side effects are discussed in advance with your healthcare provider.
If tumors in the auditory area are exposed to radiation, this can lead to dizziness, hearing loss or loss. Typically, irradiated tumors may swell, resulting in squeezing symptoms if the tumor is in the skull. At higher doses, so-called radionecrosis may occur, that is, tissue destruction due to external influences.
Radiosurgery costs and reimbursement by health insurance companies
Typically, costs range from € 7,000 to € 10,000. In many countries, such as the Netherlands and France, radiosurgery is an integral part of routine medical care and is covered by health insurance. In Germany, the costs of radiosurgical treatment are not yet reflected in the general catalog of fixed payments for compulsory health insurance, so automatic billing of the insurance policy is not possible.In principle, however, the health insurance funds in the compulsory health insurance system can pay the costs of such treatment. On the one hand, there is the possibility of making individual decisions, and on the other hand, the conclusion of contracts for complex services with health care providers.
Which doctors are specialists in radiosurgery?
If a person needs a doctor, it is natural that they seek the best medical care. That is why the patient asks himself where he can find the best clinic? Since this question cannot be answered objectively and a real doctor will never claim that he is the best, you can rely only on his experience.
We will help you find a specialist to treat your condition. All of the listed doctors and clinics were checked by us for their high qualifications in the field of stereotactic radiosurgery. They are waiting for your questions and wishes regarding treatment.
Cyberknife in Germany and Switzerland
Centers in Germany
- Munich: Cyberknife European Center for Cybernetic Surgery, Munich-Grosshadern
- Guestrow: Saphir Radiosurgery Center in North Germany
- Bochum: German Cyberknife Center for Cybernetic Surgery
- Berlin: Center of the Charite Cyberknife
- Hamburg: Cyberknife Center Hamburg
- Cologne: Cyberknife Center for Cyberknife at the University Hospital Cologne
- Erfurt: Cyberknife Center, Central Germany
Centers in Switzerland
- University Hospital Bern
- Gammaknife Center Zurich
Gamma Knife in Germany and Switzerland
Treatment of the head area with a gamma knife in Germany is possible in:
- Krefeld: Gammaknife Center in Krefeld
- Aachen: University Hospital RTWH, g.Aachen
- Frankfurt: Gammaknife Center in Frankfurt
- Hanover: Gammaknife Center in Hanover
Gamma Knife in Switzerland:
- Zurich: Klinik im Park and Hirslanden
- Lausanne: Hirslanden and Clinique Cecil
- Tei D. Atsad, Rogelio Esparanza: Stereotactic radiosurgery for metastasis at the craniovertebral junction maintains spine stability and offers symptom relief, J Neurosurg, Spine Volume, 24, February 2016.
- Piper: Internal medicine. 2nd edition. Springer 2012, ISBN 978-3-642-33107-7.
- Hin: Practical pneumology. 2nd edition. Springer 2011, ISBN 978-3-642-10209-7.
- Vannenmacher et al. (Ed.): Radiation therapy. 2nd edition. Springer 2013, ISBN 3-540-88304-5.
90,000 CONGRESS AND CONFERENCE MATERIALS: X RUSSIAN ONCOLOGY CONGRESS
X RUSSIAN ONCOLOGY CONGRESS
RADIOSURGICAL TREATMENT OF INTERNAL CEREBRAL METASTASIS
USING THE INSTALLATION “GAMMA-KNIFE”
A.V. Golanov, S.R. Ilyalov, V.V. Kostyuchenko,
I.N. Pronin, M.B Dolgushin, V.A. Loshakov
Research Institute of Neurosurgery named after acad. N.N. Burdenko RAMS, Moscow
Treatment of cancer patients with brain metastases is an urgent problem of modern neurosurgery, oncology, radiology and chemotherapy. According to autopsy studies, 24-45% of all cancer patients have intracranial metastases. According to rough estimates, the number of patients with metastatic brain lesions is 5-10 times higher than the number of patients with primary brain tumors.More often intracranial metastases are found in patients with lung cancer, breast cancer and melanoma. The development of metastases leads to rapid disability and death of patients. Life expectancy with metastasis to the brain on average does not exceed 8-12 months. with virtually any combination of possible treatments. The 2-year survival rate for these patients does not exceed 8%. The quality of life of patients during this period of time significantly depends on the chosen treatment tactics.
Stereotactic radiosurgery is a special, rapidly developing area of neurosurgery, which combines exceptional precision of action (the use of stereotaxis for fixation, localization and direction of action) and the ionizing energy of various remote sources.The basic principles of this method were formulated by the famous Swedish neurosurgeon Lars Leksell back in the 50s. XX century. Lexell was the first to propose the use of high-precision approach through the intact skull of a single, high dose of radiation to intracranial pathological foci with clear boundaries. Initially, it was supposed to use this method exclusively in functional neurosurgery for the destruction of foci of pathological activity in patients with central pain syndromes, parkinsonism, epilepsy, etc.However, after the spread of neuroimaging methods (computerized X-ray and magnetic resonance imaging), the use of stereotactic radiosurgery, primarily in neurooncology for hard-to-reach and multiple tumors and for the treatment of arteriovenous malformations, gained priority.
As defined by the Radiation Therapy Oncology Group (RTOG), stereotactic radiosurgery is a high-precision, single-dose irradiation with convergence of multiple beams at the isocenter with a high dose gradient, to small lesions with the mandatory use of a stereotaxic frame.
A session of radiosurgical treatment with the Gamma Knife installation involves four main stages.
- Fixation of the stereotaxic frame of the Leksell system on the patient’s head. This frame provides rigid fixation of the head, excluding the slightest possibility of changing its position during treatment. In addition, the frame is part of the coordinate system in which the position of the pathological focus in space is determined. The fixation of the frame is carried out, as a rule, under local anesthesia.
- Conducting MRI or, if contraindicated, spiral CT. Scanning is carried out in modes that allow obtaining thin, up to 1 mm, high quality sections (“SpGR”). In combination with intravenous administration of a double volume of contrast agent, this method allows detecting small metastases (up to 1-2 mm in diameter). The use of a special localizer combined with a stereotaxic frame during the study allows you to accurately determine the coordinates of each detected tumor.
- The digital images in DICOM format are transferred from the server of the neuroradiology department to the server of the radiosurgery department, and from there to the workstation equipped with the planning system “Leksell GammaPlan Wizard 5.34”. With its help, the plan of irradiation of each focus is calculated, depending on its location, volume, prescribed dose, as well as the total number of foci. By default, the planning program is designed for simultaneous irradiation of 10 intracranial foci.However, if necessary, a radiosurgery plan can be drawn up for more metastases.
- The finished plan is transmitted to the control panel of the Leksell Gamma Knife installation. The patient is placed on the working couch of the apparatus, and his head is fixed in an automatic positioning system that allows setting the coordinates of each isocenter with high accuracy. This ensures that the maximum conformal irradiation can be carried out.
Irradiation was carried out on the model “C” of the “Gamma Knife” apparatus (“Leksell Gamma Knife C” of the “Elekta” company), Sweden with 201 sources of radioactive cobalt (Co60) with a half-life of 5.3 years, the total total radioactivity of 6600 Ku and the dose level measured during calibration> 3 Gy / min.Cobalt sources are located around the perimeter of the hemisphere in such a way that they are focused into the isocenter with high accuracy. This model is equipped with an automatic system with an APS positioning accuracy <0.2 mm with a mechanical isocenter radius <0.3 mm and a helmet positioning accuracy <0.1 mm. Timer error <0.2%. Four interchangeable collimator helmets with diameters of 4, 8, 14 and 18 mm are used. The optimal dose distribution is created by a change in the localization of the isocenter, a combination of collimators of different volumes and exposure time.Scanning and irradiation processes are provided with a developed quality system.
From May 2005 to September 2006, 101 patients with metastases of cancer in the brain underwent stereotaxic radiosurgery using the Gamma Knife apparatus (SRSGN). Among them there were 57 women (57%) and men – 44 (44%). Seven patients had single metastases, the rest had multiple metastases. On average, for each patient with multiple tumors, there were about 8 metastases (from 2 to 32). The average age of patients was 53 years, with the prevalence of patients of the most efficient age from 40 to 59 years – 58 (57.4%).Primary tumors were located in the mammary gland – 27, in the lung – 29, in the kidney – 11, in the intestine – 6, on the skin – 11. In 4 cases, a different localization of cancer was noted, and in 12 cases the primary focus was not established. The average volume of pathological foci was 1.43 (0.003–17.0) cm3, and the average tumor diameter was 2.2 cm. mm, 21-30 mm and 31-40 mm are 24, 18 and 15 Gy, respectively, with the maximum dose not lower than 30 Gy, and the isodose along the edge – from 40 to 80%.The number and location of metastases in relation to such functionally important structures as the brain stem, visual pathways, etc. significantly influenced the choice of a therapeutic dose. In this case, the volume of the skull, irradiated with a dose of more than 10 Gy, and the integral dose to the skull are taken into account as the safety criteria for single-stage irradiation. According to numerous studies, they should not exceed 100 cm3 and 10 J, respectively.
Radiosurgical treatment is possible, including in patients with aggravated somatic status.The state according to the Karnofsky scale in most patients at the time of stereotactic radiosurgery was estimated at 70 points or more. The observation period of patients was up to 1 year. The average life expectancy of patients with an initial Karnofsky assessment of 90-100 points was 171 days versus 104 and 60 days for patients with a Karnofsky assessment of 70-80 and 50-60 points, respectively. In this case, the main cause of death was the progression of extracranial metastases or its combination with the appearance of more than 10 new intracerebral metastases.Continued growth of metastasis after SRHGN, which resulted in the death of the patient against the background of the lack of activity of the primary focus and metastases in other organs, was noted only in 1 case after 6 months. after treatment. In general, control over the growth of metastases was observed in 27 of 30 (90%) patients who underwent control MRI. In 3 cases, there was a continued growth of metastases at the time of 2, 6 and 10 months. after SRHGN.
Control studies were carried out at 1, 3, 6, 9 and 12 months. For diagnostics, MRI was used with the introduction of a double volume of contrast agent.The results were assessed qualitatively and quantitatively (the number of tumors, their sizes before and after treatment, the nature of contrast enhancement) both by comparing MRI images and comparing MR images in the digital DICOM format. When new metastases were detected, patients underwent either irradiation of the entire brain or repeated radiosurgical treatment. The choice of the method was determined primarily by the prevalence of the process.
With an increase in the size of previously irradiated metastases, differential diagnosis was made between continued tumor growth and the formation of a local area of radiation necrosis.For this, positron emission tomography with fluorodeoxyglucose, spiral CT in perfusion mode, or MR spectroscopy were used. Taking into account the data obtained, the patients either underwent a second session of radiosurgery (in the case of continued growth) or were followed up (in the presence of data on the formation of radiation necrosis) with steroid therapy (in the case of a symptomatic course). Two patients underwent surgical removal of radiation necrosis foci due to persistent edema and the development of a mass effect.
Currently, there is no standard therapy for cerebral metastases – all known methods are effective to some extent, and each of them has both advantages and disadvantages over the others. With regard to solitary and oligometastases (2-3), most specialists prefer surgery or radiosurgery. Whole-brain irradiation in these situations is considered only as an adjuvant method. This is due to the presence of a large number of studies confirming a significant improvement in local control when using surgery / radiosurgery in combination with whole-brain irradiation compared to using only total irradiation.At the same time, as many researchers note, life expectancy does not change significantly. The risk of developing long-term consequences of whole-brain irradiation is most often associated with fractionated treatment with a total focal dose of 30 Gy or more.
Comparison of surgical and radiosurgical treatment is given in table. 1.
Surgical and radiosurgical methods for the treatment of brain metastases.
Controversial: the discussed limitation of the use of the radiosurgical method to 1-3 metastases.The experience of many years of application of radiosurgery abroad and the first experience accumulated by us indicate the possibility of successful radiosurgical treatment of a much larger number of tumors at a time.
In the case of multiple (4 or more) metastases, “aggressive” treatment in many cases is not indicated because of the general suffering of the body, the activity of the extracranial process and an extremely unfavorable prognosis for life expectancy. In such situations, only palliative irradiation of the entire brain is preferred.Surgery remains “in reserve” for tumors with “mass effect”, and radiosurgery – for radioresistant tumors (Table 2).
Comparison of whole-brain irradiation and radiosurgery.
|Whole brain irradiation||Radiosurgery|
- The efficiency of SRHGN of intracerebral metastases is 90% and, according to primary estimates, does not depend on the histological variant and primary localization of the tumor, the number and localization of intracerebral foci.
- Life expectancy is determined by the effectiveness of complex treatment of the primary focus and metastases in other organs.
- SRHGN is an effective and safe method of treating cancer patients with metastatic brain lesions.
Carrying out a gamma knife operation in Israel
The level of development of modern medicine is simply amazing – today doctors have access to such methods of treatment that a few decades ago seemed like something fantastic and unrealistic. So, in Israel, they successfully use the capabilities of stereotaxic radiosurgery (gamma knife) to remove neoplasms of the brain and spinal cord.Treatment involves targeted irradiation of the tumor with a high-frequency beam of radiation (emitted by radioactive cobalt), which destroys the structure of abnormal cells, slows down their growth and does not affect the surrounding healthy tissues.
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The main difference between the gamma knife and traditional radiation therapy is that the latter can last for weeks, and the radiosurgical effect usually consists of a single irradiation. And, what is important, the intervention is performed without traumatizing tissues and opening the cranium.This reduces the risk of complications and excludes long-term rehabilitation (the patient can go home a few hours after the procedure).
Advantages of the gamma knife and limitations of its use
The capabilities of stereotactic radiosurgery are indispensable for inoperable brain tumors. The gamma knife is one of such possibilities of modern radiosurgery. It allows you to focus the multi-beam exposure at one point. Thus, the greatest effect is achieved – the maximum targeted effect on tumor cells.
But there are also limitations for carrying out stereotaxic surgery – formations larger than 3.5 cm and rapidly progressing tumors. In the first case, a very large dose of radiation must be applied, which may be unsafe, and in the second, an immediate result is needed, which is impossible in the case of a gamma knife, since the effect of its use occurs after several months.
Stages of the operation using a gamma knife
- A special rigid stereotaxic frame is fixed on the patient’s head.
- Then, depending on the disease, angiography, multilayer computed tomography or magnetic resonance imaging with the introduction of a contrast agent is performed.
- A spatial diagram of the location of the tumor with its exact coordinates is created. This allows you to clearly define the area of radiation exposure. If earlier it could only be in the shape of a circle, then modern equipment makes it possible to create any model. This allows the beam to be directed so precisely that healthy tissues are absolutely not exposed to radioactive effects.
- Directly the irradiation session. The duration of exposure does not exceed 60 minutes.
The Gamma Knife is also used after surgery. It allows you to destroy the remaining tumor cells after removal of the tumor and thus reduce the risk of metastases and recurrence. The intensity of exposure and the dose of radiation depend on the stage of the disease, the size and location of the tumor, the age, and the state of health of the patient.
Continuous improvement of therapeutic techniques allows using the capabilities of stereotactic radiosurgery to eliminate not only oncological, but also vascular pathologies (arteriovenous malformations) and neurological diseases (trigeminal neuralgia).
Gamma Knife in Israel, according to patients, is a real cure for brain cancer without surgery.
Diagnostics before the operation
Depending on what pathology needs to be treated – oncological, vascular or neurological, the patient is sent for a consultation with a specialized specialist – oncologist, vascular surgeon, neurologist, respectively.
Then, before using the gamma knife in Israel, the patient undergoes a comprehensive examination.It is important to assess the stage of development of a neoplasm when it comes to removing a tumor, to study its nature, size, rate of development, and localization. For this, modern diagnostic methods are used – MRI, CT, PET-CT or PET-MRI. In the presence of vascular pathology, an angiographic examination of the vessels is prescribed.
Further, a consultation of specialists develops individual therapeutic tactics. This allows you to avoid medical errors and achieve high treatment efficiency.
Cost of gamma knife treatment
Israeli clinics offer a loyal price policy for diagnostics and treatment. For example, in America, Canada and Europe, medical care will cost 30-50% more. At the same time, the comfort of stay and the quality of medical services are no different. You can find the approximate cost on the websites of medical centers. And the final prices will be formed after passing the diagnostics.
Prices for treatment using a gamma knife in Israel are controlled by the state and are the same for both citizens of the country and for foreign patients.
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Advantages of using gamma knife
- Treatment is carried out by leading specialists with extensive experience in performing radiosurgery.
- Innovative equipment allows you to accurately diagnose and accurately determine the location and nature of the pathology.
- The development of postoperative complications was excluded due to the lack of surgical intervention.
- Significant reduction in the likelihood of side effects due to precise, short-term and gentle exposure.
- Affordable cost: the gamma knife in Israel is a modern method of treatment that is available to many.
- Accompanying a representative of the international department will make your stay at the clinic comfortable. He will deal with organizational and household issues so that you can fully focus on the treatment.
(8 votes, average: 5 out of 5)
Effective minimally invasive method of tumor removal – Gamma Knife
Radiosurgery to treat tumors works by damaging or destroying the DNA of tumor cells so that these cells cannot multiply or grow.Over time, the brain tumor shrinks and dissolves ..
For malformations of blood vessels, such as arteriovenous malformation, Gamma Knife treatment causes the deformed blood vessels to gradually close.
When nerves are targeted for treatment, such as trigeminal neuralgia, pain, radiosurgery reduces the function of the malfunctioning nerves, which provides relief.
When is this procedure performed?
Gamma Knife radiosurgery is used to treat certain pathological conditions of the brain, many of which could only be treated with open surgery if this option had not become available.At Gamma Knife Medical Centers in Turkey, Germany, Spain and Israel, experienced neurosurgeons and radiation oncologists most often use the Leksell Gamma Knife Icon to treat the following brain diseases:
- Primary brain tumors
- Acoustic neuroma / vestibular schwannoma
- Pituitary tumor
- Glomus Yugulare tumor
- Brain tumors in children
- Arteriovenous malformation
- Trigeminal neuralgia
- Essential tremor
- Obsessive-compulsive disorder
Other conditions may also respond to Gamma Knife radiosurgery.It may be the procedure of choice when brain damage cannot be achieved with traditional surgical techniques. The Gamma Knife can also be used in place of surgeries that require a craniotomy for those patients who must avoid open surgery.
Because the therapeutic effects of Gamma Knife appear over time, it may not be suitable for people whose condition requires more immediate therapy.
Radiosurgery Gamma Knife can be used to treat children and adults.
How is this procedure performed?
The treatment group usually includes a neurosurgeon, a radiation oncologist, a radiation therapist, and a registered nurse. In addition, the medical physicist calculates the exact position of the beam and the amount of exposures required to obtain the dose of radiation that is prescribed by the radiation oncologist.
Gamma Knife can be done on an outpatient basis or as part of your hospital stay. Procedures may vary slightly depending on your condition.
Before starting the procedure, you may be asked to remove any clothing, jewelry, hairpins, dentures or other items that might interfere with you and you will be given a dress to wear. An intravenous (IV) line may be started in your arm or arm to supply you with medications and / or fluids.
The head is then prepared to accommodate a box frame or custom face mask. No shaving is required for any method. Which method is used depends on the individual condition and the patient’s diagnosis.The footage provides the utmost precision needed to deal with trigeminal neuralgia, essential tremor, epilepsy, and obsessive-compulsive disorder. Face masks, which can be more comfortable, also provide an extremely high degree of accuracy. The frameless face mask also allows large tumors to be treated over a number of days, usually on an outpatient basis. The frequency and number of procedures required will be determined by the medical team.
If a head frame is used, the head frame is attached to the head and will inhibit head movement during the procedure.This technique is also called wireframe radiosurgery.
If a face mask is used, a thermoplastic mask will be placed and then applied to your face for a custom fit. The mask has an opening for your nose and you can breathe comfortably while wearing it. The mask will then be contoured to fit your face perfectly and fit tightly, minimizing head movement during the procedure. It will take about 10 minutes or less for the mask to harden, forming a special face mask.Despite the fact that the mask is tight, it is comfortable to wear throughout the entire procedure. This technique is also called frameless radiosurgery.
You can receive a mild sedative to help you relax before a wireframe or frameless procedure.
Once the head frame or face mask is attached, you will receive images of the brain so that the location of the brain lesion can be pinpointed. The brain imaging procedure can be computed tomography (CT), magnetic resonance imaging (MRI), or cerebral angiogram.
After the brain scan is complete, you will be allowed to rest and relax while your doctor completes your treatment plan. It can take 30 to 90 minutes to determine your treatment plan. To create a treatment plan, the doctor will combine the scanned images with other information to determine the optimal dosage and amount of radiation. The doctor will enter specific instructions into the computer system about where to focus the gamma rays, ensuring accurate and precise accuracy.
When your treatment plan is ready, you will be taken to the room where the Gamma Knife apparatus is located. You will lie on a sliding table with your head pointed at the car. The table will slowly slide you into the wide opening of the Gamma Knife block.
During the entire session, medical personnel will monitor you in real time. You will have an intercom to communicate with the team. They will be able to hear and communicate with you at any time. Your doctor will constantly monitor your head position and radiation dose.A head frame or face mask will keep your head in the correct position.
The number of treatments will depend on your specific diagnosis. You can stay inside the Gamma Knife block for no more than 15 minutes or up to several hours; the duration will depend on the treatment plan developed for you.
The head frame or face mask will be removed and you will then be checked by the nurse for a short time before discharge.
What are the risks for this procedure?
Although Gamma Knife radiosurgery is less invasive than traditional open surgery, there are some possible side effects and risks such as:
- radiation therapy is not recommended for pregnant women,
90,087 Women of childbearing age may need to have a pre-urinalysis before Gamma Knife treatment to make sure they are not pregnant.
Other side effects may include:
- cerebral edema,
- numbness or weakness in the face,
- loss of balance,
- vision problems,
- Hair loss near the treated area (hair loss is usually temporary) and cramps.
Medicines can be used for many of these side effects. Your doctor will explain the possible side effects before the procedure and deal with any side effects after the procedure if they occur.
There may be other risks, depending on your specific health condition. Be sure to discuss all issues with your doctor prior to your procedure.
How do I prepare for this procedure?
Your doctor will explain the procedure to you and offer you the opportunity to ask questions. You will be asked to sign a consent form to authorize your healthcare team to treat the tumor. Please read the form carefully and ask questions if something is not clear.
How long will I stay in the hospital?
The Gamma Knife or Gamma Knife is usually done on an outpatient basis, so at the end of the day you will head home.
Do I need to take any special medications?
No, you do not need to take any special medications for this procedure. If you feel some discomfort after the procedure, such as headache or nausea, medications can help.
When can I resume sports?
Once you return home, you can resume most of your normal activities.You can return to exercise and other vigorous activity about 18-24 hours after your procedure, unless your doctor instructs you otherwise.
Will I have any long term restrictions due to Gamma Knife radiosurgery?
Patients usually have no long-term limitations as a result of Gamma Knife radiosurgery. Some activities may be contraindicated or limited by a doctor, but in this case, your doctor will definitely tell you about them.
Didn’t find the answers to your questions? Call us or leave a request and our coordinating doctors will provide you with detailed and individual information about the best clinics and specialists abroad.
90,000 What you need to know about brain tumors
Yuri Pestryakov, Head of the Department of Neurosurgery, Regional Clinical Hospital
, answers questions about neurooncology
– Yuri Yakovlevich, is it possible to calculate the risks of a brain tumor?
– Reliably proven risks of brain tumor formation – age over 45 years and a hereditary factor – the presence of volumetric processes in the brain in direct ancestors or relatives in one generation.
Established contact with carcinogens and radiation is also a reliable risk of a tumor.
But smoking and alcohol are not proven risks for the development of neurooncology.
– What types of tumors are there?
– Among all oncology, brain tumors occupy about 1.5-2%, their classification is very complex, it has more than 100 items. Bulk processes can be divided into several large groups.
First, these are tumors that grow directly from the cells of the medulla. They can be of varying degrees of malignancy.
The second group – tumors that grow from the membranes of the brain. They can also be of varying degrees of malignancy, but most are still benign.
The third group – tumors growing from the pituitary gland. Clinically, they manifest themselves in different ways. The course of the disease depends on in which zone of the pituitary gland the tumor grows, the production of which hormones is impaired.
Tumors growing from the cranial nerves occur.
There are embryonic brain tumors. Mostly they are diagnosed in children and are very often malignant, because they consist of poorly differentiated cells.
Another large section – metastases brought into the brain from the outside. For example, cancer of the lung, breast, kidney, thyroid gland, stomach and other organs metastasizes.
– How are brain tumors different in terms of danger to life?
– By the degree of malignancy.That is, by the rate of tumor growth and, as a consequence, by the rate of onset of fatal consequences for a person.
The location of the tumor matters. There are “dumb” areas of the brain, in which the tumor can grow to a large size and not manifest itself in any way. And it happens the other way around: the tumor is small, but it develops in the area responsible for vital functions.
– Does a brain tumor have symptoms?
– The first and foremost is a headache.Its origin is clear: volume is added in the skull, intracranial pressure rises.
Pain can be different: in the morning, in the evening, someone is associated with stress, someone is not. But if a headache appears in a healthy person, this is the first predictor of some kind of disease of the central nervous system, and an urgent need to consult a doctor.
Another important symptom is convulsions that first appear in a healthy person.
If hearing, smell or vision suddenly disappear, this may also be due to the effect of a tumor.
So the general cerebral symptoms are as follows: headache, less often – convulsions.
– How are brain tumors diagnosed?
– There are two informative and highly accessible methods today – computed tomography and MRI.
By the way, it is because of the prevalence of tomographs that the detection of brain tumors has increased. There used to be one tomograph for the whole city, now they are on every corner. People sometimes go directly to computed tomography, and with the results they go to the doctor.There are not so many neglected patients today.
Thanks to diagnostics, the number of operations is growing – 17 years ago, when I just started working in the regional hospital, we performed 80-90 operations per year, and now – more than 300.
But, according to my observations, there is still more oncology.
– How are brain tumors treated?
– The main principle remains unchanged: the tumor must be removed.
Oncology oncology strife.There are benign and malignant tumors. We see examples of the latter in socially protected people – Dmitry Hvorostovsky, Zhanna Friske, Mikhail Zadornov. All of our stars had glioblastoma, and lifetimes with this diagnosis are very short.
Previously, up to 80% of people with glioblastoma survived to six months. Today, some of the patients have lived for more than two years, and this is a victory. Moreover, the victory is not of a single surgeon, but of the entire team, including the patient, because he must have the will to live, fight, endure and wait, because everything does not end with the operation – then chemotherapy will follow.
In Krasnoyarsk, neurosurgical care is available, there are all the possibilities for chemotherapy. We do not have only radiohurgy – this is a gamma knife and a cyber knife – when tumor cells are destroyed with the help of neuronavigation purposefully and the whole brain does not suffer.
The gamma knife has contraindications, it is not suitable for everyone, therefore there are few radiosurgery clinics in the world.
The level of neurosurgery in the regional hospital is quite high, there is the necessary equipment to perform the most complex operations, the state provides free neurosurgical care, while abroad the cost of neurosurgical operations reaches tens of thousands of dollars.
– Tell us more about glioblastoma. Is it possible to recover from it?
– Glioblastoma is a malignant, poorly differentiated tumor that affects almost the entire brain. It cannot be radically removed.
The result of treatment largely depends on the tissue that makes up the tumor. The more tumor cells are related to the surrounding tissues, the better the prognosis, and vice versa. Glioblastoma is a tumor of “primitive”, “germ”, undifferentiated cells that multiply rapidly.The prognosis is very bad.
We operated on such patients 4-5 times, but the tumor returned.
But in my practice I have a special, unique case – a patient with glioblastoma has been living after surgery for more than 10 years. The patient was operated on on time and received postoperative treatment. I see him often, the tumor does not recur. But it is still impossible to say that he was completely cured – the tumor may return in 10 or 15 years.
Cyber Knife and Gamma Knife – what is the difference and which is more effective
Comparisons of technologies and their advantages
Radiotherapy of tumors has reached such a level of development that some of its technologies are comparable in accuracy and efficiency with surgical removal of neoplasms.Therefore, the word “knife” appeared in their name, and the methods themselves are called radiosurgical, although no cutting instruments are used in this case. These include the Cyber Knife and Gamma Knife methods.
The Gamma Knife method appeared about half a century ago, and all this time it has been continuously developing and improving. In its modern form, it is a high-tech procedure for stereotaxic radiosurgical treatment of brain tumors and other diseases localized in the skull. For the entire time of use, the Gamma Knife has been used by more than half a million people in hundreds of medical centers around the world.
The essence of the method is as follows. The source of gamma radiation is radioactive cobalt. The installation generates thousands of radioactive beams coming out from different angles. The power of each of them is low enough to significantly damage the tissue. But, converging in a tumor, they provide such a powerful damaging dose that one session is enough to achieve the effect.
The focusing accuracy of the Gamma Knife is tenths of a millimeter. It is achieved thanks to preoperative planning using three-dimensional magnetic resonance imaging, computer programming of the gamma unit and extremely rigid head fixation.
To exclude tumor displacement and ensure maximum accuracy of radiation delivery to the pathological focus, the patient’s head is fixed with screws in a stereotaxic frame. This minimally invasive procedure is performed under local anesthesia. Adjustment of the movement of the beam during the procedure is not provided in the Gamma Knife system, therefore, additional tomograms are not done during the procedure.
The accuracy of irradiation focusing is especially important in cases of neoplasms of the brain, where many of the most important structures and conductive nerve pathways are concentrated in a limited area, ensuring the vital activity of the whole organism.With the help of the Gamma Knife, it is possible to destroy brain tumors 3-4 cm in size.These are benign and malignant, primary and metastatic neoplasms:
- pituitary adenoma
- tumors originating from glial cells – gliomas, glioblastomas, astrocytomas
- neuromas, including acoustic neuroma
- retinal melanoma
- metastatic lesions of the skull bones
A session of radiosurgery with a gamma knife is performed by a team of specialists – neurosurgeon, oncologist-radiologist, medical physicist.It continues for several hours. In the evening or the next day, the patient is discharged. The effect of the Gamma Knife builds up over several months, gradually reaching a maximum. As in all cases of the use of radiotherapy, it is due to the suppression of the growth and multiplication of tumor cells due to the destruction of the DNA structure.
The CyberKnife system belongs to robotic radiosurgery. A small-sized linear photon accelerator is built into the robot’s “arm” with 6 degrees of freedom. This allows the tumor to be irradiated from different positions, at different angles, while the dose is distributed evenly throughout its volume.As a result, tumor cells are affected with equal intensity in the center of the tumor and in the periphery.
The previously prepared computer model of the tumor and the treatment scheme are put into the CyberKnife computer. A fraction of a second before each radiation pulse, the system makes a computed tomogram, compares it with the initial data, and changes the direction of each of the rays in accordance with the position of the tumor at a particular moment in time. Thus, it monitors its displacement during breathing and other involuntary movements, which ensures the accuracy of exposure within 0.5 mm without setting stereotaxic frames, as in the Gamma Knife method.This provides the patient with complete comfort.
The undoubted advantage of the method is the minimum level of radiation in the areas bordering the tumor. This allows the Cyber Knife to be used to treat neoplasms adjacent to vital structures.
A course of treatment can consist of any number of fractions. More often, 1-4 sessions are required, each lasting from half an hour to one and a half hours. The only minimally invasive manipulation that takes place under local anesthesia and is sometimes necessary for a session is the installation of “beacons” for tumors of the liver, prostate and other internal organs.The Cyber Knife is used to treat tumors 3-6 cm in size in any part of the body, head and neck.
Radiosurgical methods Cyber-Knife and Gamma-Knife have expanded the possibilities of treating oncological pathology, becoming an effective alternative to traditional surgical interventions in cases where they carry a high risk or the patient has contraindications to them.
Medical Institute. Sergey Berezin (MIBS) is the largest non-governmental medical organization in the Russian Federation specializing in the complex high-tech treatment of oncological diseases in accordance with modern protocols used in Europe and the United States.
The Oncology Clinic , which is part of MIBS , has everything necessary for cancer treatment (surgery, drug and radiotherapy), being the technological leader in Russia in the field of radiation therapy. Proton Therapy Center MIBS provides the most advanced radiation therapy for cancer today using heavy charged particles – protons. Diagnostic Service applies high-tech instrumental methods to identify pathologies and control the disease during and after treatment.
An individual treatment plan for each MIBS patient is developed by a multidisciplinary team, which includes highly qualified doctors of various specialties: oncologists, radiotherapists, neurosurgeons, surgeons, chemotherapists, anesthesiologists.
The leading specialists of the MIBS have been trained and trained in the best oncological clinics in Europe, the USA and Japan. Our doctors include active members of professional communities: International Stereotactic Radiosurgery Organization (ISRS), European Society for Functional and Stereotactic Neurosurgery (ESSFN), European Society of Radiologists (ESR), European Society of Oncology (ESMO), Global Gamma Knife Users Society (LGKS) …
MIBS in figures:
- 2500 radiosurgical interventions per year
- 600 90,039 patients received treatment at the Proton Therapy Center in 2 years of its operation
- 4000 MRI examinations daily in 100 diagnostic centers of the international network
90,087 90,038 12,000 90,039 patients treated with the Gamma Knife
SPECTRUM OF SERVICES
- Preparation of a treatment plan and cost calculation;
- Organization of logistics for foreign patients at all stages of treatment;
- Visa support;
- Accompanying the patient from the moment of treatment until the end of treatment;
- Translation of medical records.
MIBS has all types of instrumental diagnostics (PET / CT, MRI, CT, ultrasound), including not only the best equipment, but also modern software. The capabilities of the diagnostic service allow you to create a virtual three-dimensional model of the location of the tumor, surrounding tissues and critical structures, which helps to choose the most effective tactics for performing complex operations and radiation treatment.
If cancer is suspected, an MIBS patient undergoes a biopsy under visual control (MRI, CT, ultrasound), including fusion biopsy, which is increasingly used in modern medicine.The collected material is sent to our own pathomorphological laboratory, where histological and immunohistochemical examination of a tissue sample is carried out in a short time and the most accurate verification of the diagnosis is carried out.
Onco Check-up programs, specially designed for men, women, as well as for patients from groups at increased risk of cancer, are focused on identifying the most common types of cancer. The survey is carried out in 1-2 days.
The MIBS Oncology Clinic has been specializing in the complex treatment of almost all known tumor diseases for more than ten years.
Surgical Department of the Clinic is represented by a modern operating unit with an anesthesiology, resuscitation and intensive care unit. MIBS surgeons perform operations both in the traditional (open) way and using laparoscopic equipment.
In Chemotherapy Department , all types of drug treatment used in the world’s leading cancer centers (modern chemotherapy, hormone therapy, immunotherapy) are carried out.
Conformal Radiation Therapy Unit is equipped with two Varian Medical Systems linear accelerators with unrivaled beam precision and unique control of patient position during irradiation.
Center for Radiosurgery and Stereotactic Radiotherapy operates Gamma Knife, Cyber Knife and TrueBeam stereotaxic radiosurgical linear accelerator. Due to the presence of several radiosurgical units in the MIBS arsenal, doctors can choose an instrument, focusing only on clinical expediency.
In two treatment rooms of the Proton Therapy Center MIBS on the Varian ProBeam device, the most modern radiation treatment of oncological tumors is carried out. High precision of destruction of cancer cells is provided by the most advanced technology for delivering a dose of radiation to the target – the so-called “pencil beam scanning”. Proton therapy, due to its minimal effect on healthy tissue surrounding the target, is considered the best method of radiation destruction of tumors adjacent to vital organs.Due to minimal side effects, including secondary cancers, it is recommended for the treatment of cancer in children.
How it works
- Send your request through the feedback form or contact us by phone;
- Submit your medical records and opinions;
- We will determine the possibility of providing medical care in your case;
- We will prepare a preliminary treatment plan and coordinate it with you;
- We will arrange the arrival and placement of the patient.