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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. Years of Clinical Experience.

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slide1

Overview of Gamma Knife® SurgeryDr. Sandra Vermeulen, M.D.Swedish Cancer InstituteNorthwest Hospital Gamma Knife CenterSeattle, WashingtonLearn more at:www.DoctorVermeulen.com

years of clinical experience
Years of Clinical Experience

1968The first prototype of Leksell Gamma Knife® was installed in Stockholm, Sweden.

1999Elekta introduces the Leksell Gamma Knife® C.

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

Gamma Knife® Surgery
leksell gamma knife c5

Automatic Positioning System

Cobalt-60 sources

Beam Channel

Helmet with Collimators

Shielding

Helmet Supports

Plastic Cover

Treatment Couch with Mattress

Protection Panels

Shielding Doors

Helmet in Treatment Position

Leksell Gamma Knife® C
the treatment procedure
The Treatment Procedure

3. Treatment Planning

1. Frame Fixation

Á

¾

2. Diagnostic Imaging

4. Treatment

1 frame fixation
1. Frame Fixation
  • Patient Fixation
  • Establish Spatial References
2 diagnostic imaging
2. Diagnostic Imaging
  • The coordinate frame provides stereotactic localization
  • Digital image transfers to the treatment planning computer
3 treatment planning
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.
4 treatment
4. Treatment
  • Automatic treatment, supervised by redundant safety and verification systems
  • Patient communicates via audio visual system
the time factor

Open

Surgery

Daysin ICU

Weeks of

Hospitalization

Several Weeks

Convalescence

Symptom

Diagnosis

Gamma

Knife®

Surgery

The Time Factor
clinical outcome
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 endovasculartechniques extend the capabilities
examples of treated indications
Examples of Treated Indications

Functional Targets

- Trigeminal nerve

Vascular

- Arteriovenous malformations

Tumors

- Meningioma

- Pituitary

- Acoustic Neuroma

- Metastatic

- Gliomas

Research Areas

- Intractable pain targets

- Parkinsonian targets

- Psychonuerosis targets

- Epilepsy targets

- Other functional targets

slide14

Arteriovenous Malformation

Pre-Gamma Knife Surgery

2 Years Post Gamma Knife® Surgery

Courtesy: Douglas Kondziolka, MD, MSc, FRCS, University of Pittsburgh, USA

slide15

Arteriovenous Malformation

  • 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
slide16

Acoustic Neuroma

Courtesy: Douglas Kondziolka, MD, MSc, FRCS, University of Pittsburgh, USA

Pre-Treatment

6 Months Post Treatment

2 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.

slide17

Acoustic Neuroma

  • 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.
slide18

Pituitary 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.

slide19

Pituitary Adenoma

  • 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.
slide20

Metastasis

Courtesy: 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.

slide21

Metastasis

  • 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
slide22

Astrocytoma

Courtesy: Ladislau Stenier MD, PhD, Christer Lindquist, MD, PhD and Dheerendra Prasad MD, UVA Charlottesville, USA

Pre-Treatment

5 Years Post Treatment

The tumors pattern of spread results in high radiosurgical treatment failures.

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.

a globally embraced treatment
A Globally Embraced Treatment

202 Leksell Gamma Knife®Installed WorldwideMay 2004

quality of life
Quality of Life
  • Non-Invasive
    • Less trauma
    • Faster recovery
    • Minimal hospitalization
    • Fewer complications
  • Documented Efficacy