1 overview of gamma knife ® surgery dr. sandra vermeulen, m.d. swedish cancer institute northwest...
TRANSCRIPT
1
Overview of Overview of Gamma KnifeGamma Knife®® Surgery Surgery
Dr. Sandra Vermeulen, M.D.Dr. Sandra Vermeulen, M.D.Swedish Cancer InstituteSwedish Cancer Institute
Northwest Hospital Gamma Knife CenterNorthwest Hospital Gamma Knife CenterSeattle, WashingtonSeattle, Washington
Learn more at:Learn more at:www.DoctorVermeulen.comwww.DoctorVermeulen.com
2
Years of Clinical ExperienceYears of Clinical Experience
1968The first prototype of Leksell Gamma Knife® was installed in Stockholm, Sweden. 1999
Elekta introduces the Leksell Gamma Knife® C.
3
Leksell Gamma KnifeLeksell Gamma Knife®® C C
4
Gamma Knife® SurgeryGamma 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
5
Leksell Gamma KnifeLeksell Gamma Knife®® C 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
6
The Treatment ProcedureThe Treatment Procedure
1. Frame Fixation
2. Diagnostic Imaging
3. Treatment Planning
4. Treatment
7
1. Frame Fixation1. Frame Fixation
Patient Fixation
Establish Spatial References
8
2. Diagnostic Imaging2. Diagnostic Imaging
The coordinate frame provides stereotactic localization
Digital image transfers to the treatment planning computer
9
3. Treatment Planning3. 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.
10
4. Treatment4. Treatment
Automatic treatment, supervised by redundant safety and verification systems
Patient communicates via audio visual system
11
The Time FactorThe Time Factor
Gamma Knife® Surgery
Several WeeksConvalescence
Open Surgery
Daysin ICU
Weeks ofHospitalization
DiagnosisSymptom
12
Clinical OutcomeClinical 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 endovasculartechniques extend the capabilities
13
Examples of Treated IndicationsExamples 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
14
Arteriovenous MalformationArteriovenous Malformation
Pre-Gamma Knife
Surgery
2 Years Post
Gamma Knife®
Surgery
Courtesy: Douglas Kondziolka, MD, MSc, FRCS, University of Pittsburgh, USA
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
16
Acoustic NeuromaAcoustic 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-Treatment 6 Months Post Treatment
Courtesy: Douglas Kondziolka, MD, MSc, FRCS, University of Pittsburgh, USA
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
18
Pituitary AdenomaPituitary Adenoma
Courtesy: Ladislau Steiner, MD, PhD, UVA Charlottesville, USA, and Christer Lindquist, MD, PhD, Karolinska Institute, Sweden
Pre-Treatment 54 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.
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
20
MetastasisCourtesy: Douglas Kondziolka, MD, MSc, FRCS, University of Pittsburgh, USA
Pre-Treatment 2 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.
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
22
AstrocytomaCourtesy: Ladislau Stenier MD, PhD, Christer Lindquist, MD, PhD and Dheerendra Prasad MD, UVA Charlottesville, USA
Pre-Treatment 5 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.
23
A Globally Embraced TreatmentA Globally Embraced Treatment
202 Leksell Gamma Knife® Installed Worldwide
May 2004
24
177846
213718
251681
6978 11304 1674126673
4040058066
78461100532
125227
150982
0
50000
100000
150000
200000
250000
300000
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Gamma Knife® Surgery
Cumulative Number of Patients TreatedCumulative Number of Patients Treated
25
Quality of LifeQuality of Life
Non-Invasive
Less trauma
Faster recovery
Minimal hospitalization
Fewer complications
Documented Efficacy