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Gamma Knife Radiosurgery In Singapore
Gamma Knife Radiosurgery is a form of focused targeted radiosurgery (SRS), a non-invasive medical procedure used to treat various brain disorders.
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Dr Keith Goh
What is Gamma Knife Radiosurgery?
Gamma Knife Radiosurgery is a form of focused targeted radiosurgery (SRS), a non-invasive medical procedure used to treat various brain disorders. Despite its name, the Gamma Knife is not a knife in the traditional sense but a sophisticated device that uses stereotactic technology to direct multiple beams of high-intensity gamma radiation to converge on a specific target within the brain.
Each gamma ray has relatively low energy, minimizing damage to the surrounding healthy tissues. At the focal point where all beams intersect, the gamma rays deliver a high dose of radiation with pinpoint accuracy. This precise targeting allows for effective treatment of small to medium-sized lesions, offering an alternative to conventional brain surgery.
Medical Conditions Treated with Gamma Knife Radiosurgery
Gamma Knife Radiosurgery is an effective treatment for a range of neurological conditions, primarily those involving small to medium-sized brain abnormalities.
- Brain Tumors: Both malignant and benign tumours, such as metastases, meningiomas, and acoustic neuromas, can be treated, especially when they are too deep to access safely by conventional surgery.
- Vascular Malformations: Conditions like arteriovenous malformations (AVMs) and cavernous angiomas, which are abnormal tangles of blood vessels in the brain, can be treated with Gamma Knife Radiosurgery.
- Trigeminal Neuralgia: This condition, characterized by severe facial pain, can be managed by targeting the trigeminal nerve root via Gamma Knife Radiosurgery.
- Pituitary Tumors: Non-invasive treatment of pituitary adenomas can reduce the size or stop the growth of these tumours.
- Movement Disorders: Certain cases of essential tremors and Parkinson’s disease-related tremors can be treated by focusing on specific areas of the brain responsible for these movements.
- Epilepsy: Gamma Knife Radiosurgery can be used to treat some types of epilepsy where seizures originate from a small, identifiable area of the brain.
Procedure of Gamma Knife Radiosurgery
The procedure for Gamma Knife Radiosurgery is typically performed in an outpatient setting, and includes the following steps:
- Patient Assessment: Initial consultation involves reviewing the patient’s medical history and imaging studies to determine suitability for the procedure.
- Imaging: On the day of the procedure, high-resolution MRI scans are performed to map the target area in the brain.
- Head Frame Application: A lightweight, stereotactic frame is securely attached to the patient’s head (using local anaesthesia) to immobilize it and ensure precise targeting during treatment.
- Treatment Planning: Using the imaging data, a team of neurosurgeons, radiation oncologists, and medical physicists plan the treatment and determine the radiation dose as well as angles for beam delivery.
- Radiation Delivery: The patient is positioned in the Gamma Knife machine, and the treatment is delivered. This step can last from a few minutes to several hours, depending on the complexity of the case. Throughout the procedure, the patient is continuously monitored, and communication is maintained for comfort and safety.
- Post-Procedure Care: After the treatment, the head frame is removed, and the patient is monitored for a short period before being discharged.
Advantages of Gamma Knife Radiosurgery Over Conventional Surgery
Gamma Knife Radiosurgery offers several advantages compared to traditional open brain surgery, making it a preferred option for certain conditions.
- Non-invasive: As a non-invasive procedure, it eliminates the risks associated with open surgery, such as infection, brain damage and bleeding.
- Precise: Gamma Knife Radiosurgery provides high sub-millimeter accuracy in targeting tumours or lesions and reduces the risk of damage to surrounding healthy brain tissue.
- Outpatient Procedure: Most patients can return home the same day, as the procedure usually does not require hospitalization.
- Reduced Recovery Time: The absence of a physical incision leads to quicker recovery and minimal postoperative discomfort.
- Lower Complication Rates: Gamma Knife Radiosurgery has a lower risk of complications than traditional surgery.
- No General Anesthesia: The procedure often only requires local anaesthesia with sedation, avoiding the risks associated with general anaesthesia.
- Effective in Typically Inaccessible Areas: Gamma Knife Radiosurgery is ideal for treating lesions deep within the brain or in areas not easily accessible by conventional surgery.
Potential Risks and Side Effects
While Gamma Knife Radiosurgery is generally considered safe and less invasive than traditional surgery, it does carry some potential risks and mild side effects, which include nausea, headache, fatigue, hair loss and scalp irritation at the frame attachment sites, usually resolving within a few days. Brain swelling can occur around the treatment area, typically managed with steroids.
In rare cases, radiation necrosis may occur. It is a serious complication where treated brain tissue becomes damaged and dies. If you experience any symptoms such as sudden changes in personality, memory loss, headaches, or seizures, contact your neurosurgeon immediately.
Post-treatment Care and Follow-up
Here are some things to take note of:
- Patients may experience mild discomfort or headache immediately after the procedure. Medications can be prescribed for pain relief if necessary.
- Short-term side effects, such as nausea or swelling, are monitored and managed by the healthcare team before discharge of patients.
- Sometimes the head frame pin insertion sites might have mild fluid leak or infection.
- Regular MRI or CT scans are scheduled to assess the response of the treated area to the radiosurgery and to monitor for any recurrence of the condition.
- Patients may seek periodic evaluations by a neurologist to help identify any changes in brain function or the emergence of delayed side effects.
- If the treatment involves areas near the pituitary gland, regular endocrinological assessments may be required to manage hormonal levels.
Mount Elizabeth Medical Centre,
#09-10, 3 Mount Elizabeth
Singapore 228510
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Mount Elizabeth Medical Centre,
#09-10, 3 Mount Elizabeth
Singapore 228510
Frequently Asked Questions (FAQ)
Is Gamma Knife Radiosurgery Painful?
The procedure itself should not be painful. However, patients may feel discomfort from the head frame and experience mild headaches or nausea afterwards, which can be managed with medication. Inform your neurosurgeon immediately after experiencing any side effects to help effectively manage them.
How long does the Gamma Knife procedure take?
The duration varies depending on the complexity of the case but typically lasts between 15 minutes to a few hours.
Can Gamma Knife Radiosurgery treat multiple brain lesions?
Yes, it can target multiple lesions in a single session, making it effective for certain types of metastatic brain tumours.
How long is the recovery period after Gamma Knife Radiosurgery?
Recovery time is relatively short. Most patients can resume normal activities within a day or two after the procedure, depending on their condition. Talk to your neurosurgeon to ascertain more details on your post-operation recovery timeline.