BY NANCY McVICAR
Being told you have a tumor growing in your head is undoubtedly one of the scariest diagnoses anyone can receive, but technological advances that allow some tumors to be zapped without surgery – with no hospital stay and no anesthesia – can lessen the fear and trauma.
Doctors Hospital in Coral Gables was the first in Florida to install a Gamma Knife 18 years ago to treat brain tumors and other abnormalities. It uses 200 intersecting gamma rays to selectively destroy tumors without damaging adjacent tissue, nerves or blood vessels.
“The whole principle of radiosurgery is that each beam of radiation is extremely low dose, but the area where the beams cross gets a very high dose,” says Dr. Hal Pikus, chief of neurosurgery at Doctors Hospital, and director of radiosurgery for Baptist Health South Florida, who took over the reins of the program earlier this year.
The technology used to target the rays toward the tumor has been refined, allowing greater accuracy and success with the procedure, Pikus says.
“It’s become much more automated. It’s basically a robotic process where a computer using treatment planning software determines the shape and amount of radiation to be delivered,” Pikus says. “Our ability to create a critical treatment plan, to protect delicate tissue, has gotten much more sophisticated.”
To ensure precision, the patient’s head is encased in a frame that is attached to the table on which the patient lies during the procedure, which can last from 20 minutes to two hours, depending on the complexity of the case.
Gamma Knife can zap very small targets deep within the brain, and several tumors at different locations can be treated during the same session because the patient can be moved into different positions.
During the procedure, the patient is monitored by video and, because anesthesia is not needed, the patient is awake and can be in constant communication with the medical team.
The patient feels no pain during the procedure.
Pikus says the treatment works well for several types of tumors, including tumors of the spine, pituitary gland, acoustic neuroma – a tumor on the nerve between the ear and the brain – and meningiomas, which occur on the lining between the skull and the brain.
“There are a variety of tumors that the Gamma Knife is extremely useful for,” Pikus says. “It is highly effective against metastatic tumors [tumors that have spread to the brain from another location], breast, lung, colon, even melanoma.”
Gamma Knife is also used to treat other conditions, such as trigeminal neuralgia, a nerve disorder that causes a stabbing or electric-shock-like pain in parts of the face; and arteriovenous malformations, or AVMs, congenital abnormal connections between arteries and veins which can be life-threatening in some cases.
“If not treated, they can rupture and bleed and create havoc in the brain,” Pikus says.
But not everyone is a good candidate for Gamma Knife, he says, and Doctors uses a multidisciplinary team approach to gauge the best treatment option.
“We don’t [just use] the Gamma Knife because we have one,” he says. “We can offer all of those approaches.”