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Published byBerniece Simpson Modified over 9 years ago
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1 Overview of Gamma Knife ® Surgery Dr. Sandra Vermeulen, M.D. Swedish Cancer Institute Northwest Hospital Gamma Knife Center Seattle, Washington Learn more at: www.DoctorVermeulen.com
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2 Years of Clinical Experience 1968 The first prototype of Leksell Gamma Knife® was installed in Stockholm, Sweden. 1999 Elekta introduces the Leksell Gamma Knife® C.
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3 Leksell Gamma Knife ® C
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4 Gamma Knife® Surgery The delivery of a single, high dose of irradiation to a small and critically located intracranial volume through the intact skull. 201 beams intersecting in one focal point
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5 Leksell Gamma Knife ® C Helmet Supports Automatic Positioning System Treatment Couch with Mattress Protection Panels Shielding Doors Shielding Cobalt-60 sources Plastic Cover Beam Channel Helmet with Collimators Helmet in Treatment Position
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6 The Treatment Procedure 1. Frame Fixation 2. Diagnostic Imaging 3. Treatment Planning 4. Treatment
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7 1. Frame Fixation Patient Fixation Establish Spatial References
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8 2. Diagnostic Imaging The coordinate frame provides stereotactic localization Digital image transfers to the treatment planning computer
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9 3. Treatment Planning Team Approach: The target is defined by the Radiation Oncologist, Neurosurgeon and Medical Physicist. Care is taken to avoid critical areas of the brain while maximizing the dose to the target.
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10 4. Treatment Automatic treatment, supervised by redundant safety and verification systems Patient communicates via audio visual system
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11 The Time Factor Gamma Knife® Surgery Several Weeks Convalescence Open Surgery Days in ICU Weeks of Hospitalization Diagnosis Symptom
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12 Clinical Outcome Peer reviewed scientific articles shows better or equal results compared with microsurgery Reproducible results Fewer complications Treatment solution for inoperable patients Combined treatment with microsurgery and endovascular techniques extend the capabilities
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13 Examples of Treated Indications Vascular - Arteriovenous malformations Tumors -Meningioma -Pituitary -Acoustic Neuroma -Metastatic -Gliomas Functional Targets -Trigeminal nerve Research Areas -Intractable pain targets -Parkinsonian targets -Psychonuerosis targets -Epilepsy targets -Other functional targets
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14 Arteriovenous Malformation Pre-Gamma Knife Surgery 2 Years Post Gamma Knife® Surgery Courtesy: Douglas Kondziolka, MD, MSc, FRCS, University of Pittsburgh, USA
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15 Untreated lesions have a 2-4% risk of bleed per year. After Radiosurgery, the risk of bleed remains unchanged until the AVM occludes. 80% of lesions treated with Radiosurgery-occlude within 1-3 years following treatment. A-V’s amendable to surgery should be resected Arteriovenous Malformation
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16 Acoustic Neuroma Note: These pictures are provided for education purposes only. Elekta makes no claims as to the effectiveness of the Leksell Gamma Knife ® in these treatments. 2 Years Post Treatment Pre-Treatment6 Months Post Treatment Courtesy: Douglas Kondziolka, MD, MSc, FRCS, University of Pittsburgh, USA
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17 90% show no further growth after treatment at 10 years. Tumors that grow slowly respond slowly to Radiosurgery. Larger tumors greater than 3.0cm should be surgically removed if they are causing acute symptoms from brainstem compression. Acoustic Neuroma
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18 Pituitary Adenoma Courtesy: Ladislau Steiner, MD, PhD, UVA Charlottesville, USA, and Christer Lindquist, MD, PhD, Karolinska Institute, Sweden Pre-Treatment54 Months Post Treatment Note: These pictures are provided for education purposes only. Elekta makes no claims as to the effectiveness of the Leksell Gamma Knife ® in these treatments.
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19 Tumors compressing the optic chiasm are not appropriate targets for Radiosurgery. The optic chiasm maximum safe dose tolerance in a single fraction is less than 10 Gy. The dose necessary to control a Pituitary Adenoma is in excess of 10 Gy. Pituitary Adenoma
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20 Metastasis Courtesy: Douglas Kondziolka, MD, MSc, FRCS, University of Pittsburgh, USA Pre-Treatment2 Months Post Treatment Note: These pictures are provided for education purposes only. Elekta makes no claims as to the effectiveness of the Leksell Gamma Knife ® in these treatments.
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21 Appropriate Lesions for Radiosurgery are: Tumors less than 3cm Those not associated with a life-threatening mass effect 4 or less tumors simultaneously presenting in the brain with or without whole brain irradiation Metastasis
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22 Astrocytoma Courtesy: Ladislau Stenier MD, PhD, Christer Lindquist, MD, PhD and Dheerendra Prasad MD, UVA Charlottesville, USA Pre-Treatment5 Years Post Treatment Note: These pictures are provided for education purposes only. Elekta makes no claims as to the effectiveness of the Leksell Gamma Knife ® in these treatments. The tumors pattern of spread results in high radiosurgical treatment failures.
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23 A Globally Embraced Treatment 202 Leksell Gamma Knife® Installed Worldwide May 2004
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24 Cumulative Number of Patients Treated Gamma Knife ® Surgery Cumulative Number of Patients Treated
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25 Quality of Life Non-Invasive Less trauma Faster recovery Minimal hospitalization Fewer complications Documented Efficacy
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