Gamma Knife Surgery

Gamma Knife is a lifesaver!

This is the MRI of George Plym, 10 time survivor. Seven conventional surgery, and three gamma knife surgery. All tumors have been mixed glioma. YES! I do have a hole in my head!!

Drs. Stephen Tatter and Edward Shaw prepare a patient for Gamma Knife radiosurgery. The 22-ton unit aims 201 "pencil beams" of radioactive cobalt-60 at the target brain tissue, sharply focused to minimize radiation effects to surrounding healthy brain tissues. Using computers, a team of neurosurgeons, radiation oncologists and radiation physicists precisely conform the radiation dose to the size and shape of the lesion.

It sure beats the alternative...open surgery!

A lot of folks have been asking about the Gamma Knife. Not what how it works, but what can they expect if they ever have Gamma Knife Surgery. SO, here is the straight scoop, written by George Plym, a 10-time brain tumor survivor, three-time GK patient and President of WNC Brain Tumor Support in Asheville, NC.

It starts early in the morning. I was wheeled to the MRI area with three other patients. They all were all scared. You could see it in their distant glassy eyes. All three had been diagnosed with a brain tumor. I tried to have them relax and assured them that the procedure is really not bad at all. Especially concerning the alternative...open surgery! I asked them "what did your doctor tell you was going to happen?" They all said that doctor told them that it is a relatively pain free procedure and all that they will feel will be a "little stick" from the needle when they numb the area with a local anesthetic. Well folks...it ain't a "little stick!" A flu shot is a "stick." Anytime some one jabs a needle in your scalp and forehead; it's not a "little stick!" The good news is that all though it hurts, it is only for a very short time. Probably only 5 to 10 seconds at most. Now that is 5 to 10 seconds per pin site. There will be four areas that the frame will be attached. Although the area is now numb and you don't feel the pain from the needle anymore, hold onto your chair, you are ready to into phase two...

The surgeon then affixes the stereotactic frame to the patient's head using small pins the size of a pencil tip. The head frame is a guiding device, which makes sure the Gamma Knife beams are focused exactly where the treatment is needed. A nurse or technician will hold the frame with their hands as the doctor screws in the pins. They may put cotton in you ears as they locate the frame. Why do you need to hold onto your chair you may be thinking? Well, even though the anesthetic has deadened the pin sites, you will feel pain as the pins are screwed into place. And if they hit the occipital nerve, you may jump out of your chair! Hint:Try to stay relaxed. Take some deep breaths through you nose, and exhale out with you mouth open. If your facial and head muscles are tense, the more pain you will feel. Easy to say, hard to do! No hair is shaved during the application. The frame is used to provide landmarks, which help the physician target the site to which the radiation beams will be directed. It also serves to immobilize your head during treatment, and positions the head correctly within a device called the collimator helmet, during treatment.

Now that the frame is secured, the rest is a piece of cake. Phase 3 is just an MRI with a weird hat on! (frame). You will notice that when the MRI cranks up, it is much louder. That's because every knock, knock, knock, vibrations, shutter, and buzz is going directly though the frame into the core of you dome! Pain? No. Irritating? You bet! The patient then undergoes the MRI and the frame is the key to a successful procedure. It precisely localizes the target tissue to be treated in reference to the attached head frame. After the MRI, the patient returns to their room where they may relax and have some food or a snack if it is OK with your doctor approves. While the patient rests, the team of Gamma Knife physicians and technicians utilizes three dimensional computer imaging to develop the patient's radiosurgical treatment plan. This typically takes one to two hours to complete. The team may consist of neurosurgeon, oncologists-radiologist, physicists and a plumber. Just kidding. No plumber!

Phase four is the actual gamma knife it self. Once the individualized treatment plan is completed, the patient is placed on the Gamma Knife couch. The stereotactic frame is attached to the collimator helmet containing the 201 portals through which the radiation beams are focused and set to the target coordinates. After all stereotactic coordinates are checked the couch is moved into the unit by an electrical motor and treatment begins. During the treatment, there is no noise and the patient feels no pain. You may feel some pressure as the helmet is attached to the collimator helmet Communication is maintained with the patient at all times via video cameras and an intercom. Treatment time typically varies between 20 minutes and two hours depending on the complexity of the treatment plan and number of isocenters required. At the conclusion of the treatment, the stereotactic frame is removed. You may bleed at the pin sites. Band-Aids and antibiotic ointment is applied as well. The patient is sent to his or her room after a brief period of observation. You may experience a headache, and it will very tender at the pin sites also. Occasionally, patients are observed overnight before being discharged and sent home. They may be told that they can return to work and full activity the next day. I don't advise it. The stress and trauma can be overwhelming. Go back to work when you feel up to it if you can. Fluid may ooze from pin sites and on to you pillow.Hint: Lay with your head up by placing two or three pillows. Use clean pillowcases. If it continues, call your doctor. If you have a temperature of over 100.00 degrees, call you doctor. Also, in most cases, there will me some edema, or swelling in the brain causing a headache. That normally occurs in the third or fourth day post GK. And, it may not happen at all! Listen your body.

In 1967, I was zapped with a fixed beam radiation. Things have really changed. Here is a picture of what it looks now. Thanks to Tim Grossman, one of our online members for the great picture. Tim is AA III.

Here is a better explanation from Tim.

It's a form fitted mesh mask that locks my head to the table so my head cannot move, which is very important, don't want to hit the wrong spot with the "vitamin R'(radiation). They shoot me from 3 different angles to hit as much of the area as possible without affecting other areas of the brain or the stem. On the first visit they do the simulation, they use lasers to pin-point the areas to shoot. This is the longest session. Marks are made on the mask with colored markers( you can see the areas in the pictures I attached. Blue and green outlines, One from the back of the head and two on the right side) instead of tattooing the marks on your head. Each time I go for a treatment, they use the lasers again to line up on the marks on the mask. The treatments only take about 5-10 minutes but my face still looks like a waffle when I'm done. This goes away after about 20-30 minutes.

Thanks Tim!