The Leksell Gamma Knife® Icon™ dramatically streamlines workflow and expands the treatable conditions compared to previous models of the Gamma Knife.

Benefits include faster set-up and treatment delivery to multiple tumors in a single session, and the potential to treat lesions in areas not able to be reached by older models, including tumors in the sinuses, orbits, and upper cervical spine. Icon™ allows treatment of a wider range of targets faster and more efficiently than ever before.

The radiosurgery system’s unique radiation-focusing device ensures superior radiation delivery and accuracy while reducing the dose to unintended areas. Icon ™ is fine-tuned to the task, resulting in fast, efficient treatments.

What is Gamma Knife®?

Gamma Knife – despite its name, there is no knife or scalpel involved, but Radiosurgery – a non-invasive neurosurgical procedure that uses powerful doses of radiation to target and treat diseased brain tissue while leaving surrounding tissue intact. The ‘knife’ refers to 192 precise beams of radiation that attacks tumours and abnormalities, shrinking them over time or stopping their growth. There is no incisions in patient’s head, instead it is very precisely focused beams of radiation are directed to the treatment area in the brain.

This modern technology allows physicians to operate on brain lesions often considered inoperable. Gamma Knife treatment offers new hope for patients with brain tumours, vascular malformations and functional disorders.

Benefits of Gamma Knife Treatment

Gamma Knife surgery offers a safe and effective treatment for more than 70,000 patients every year. The treatment procedure is simple, painless and straightforward. Other benefits of Gamma Knife treatment are:

• It is a non-invasive surgery where it involves no incisions, hence there is minimum to no trauma to the brain
• May be utilised for inoperable cases – for example, when tumours lie deep within the brain or in most cases where illness prevent surgery.
• The treatment is focused at the abnormal lesion; therefore, there is a greatly reduced chance of damage to surrounding tissue or nearby structures.
• It is only a one-day treatment and does not require hospital stay, if any would be overnight at the most, compared to maximum of 14 days for conventional surgery.

Most patients will return to normal activities within few days.

Treatment Procedure

You will have an initial consult with a Gleneagles Kuala Lumpur Neurosurgeon and a Radiation Oncologist to determine if Gamma Knife radiosurgery is for you. If so, the procedure will be scheduled.

Procedure Flow

1. Securing Accuracy A lightweight frame is attached to your head. The head frame ensures that the radiation beams can be exactly located and directed with precision to the target. A mild local anaesthetic is applied to the skin of your forehead.	2. Target Localization Magnetic resonance imaging (MRI), computed tomograpgy (CT) or angiography is required to determine the exact size, shape and position of the target in the brain.	3. Treatment Planning Once your images have been taken, you can rest while your doctor develops a treatment plan. The treatment plan is done in a specially designed software and computer and calculates how the treatment should be performed.
4. Treatment You are awake during the procedure. When the treatment begins, the couch will move into the dome section of the unit. The treatment is silent and totally painless.	5. After Treatment When the treatment is complete, the head frame will be removed. Some patients might experience a mild ache or minor swelling where the frame was attached, but most report no problems.	6. What Happens Next? In a day or so you should be able to return to your normal routines. The effects of the treatment will occur over time. Your doctor will stay in contact with you to assess the progress, which may include follow-up MRI, CT or angiography images.

Always consult your doctor if you have any questions.

Pre-Procedure Instructions

• During your clinic appointment with the neurosurgeon or radiation oncologist:
  • Please let us know if you have had any of the required tests performed in the past year. If so, please bring copies of the test results with you.
  • Doctor will record your medical history, perform a physical examination and obtain your consent to perform the Gamma Knife procedure.
  • Please let your nurse or medical assistant (MA) know if you are diabetic or on blood thinner medication (Anticoagulant, aspirin or aspirin-containing products etc.). While we don’t necessarily have to stop these medications, we may need to make additional arrangements for your care.
  • You will have an opportunity to ask questions about the procedure and expected results. We recommend that you write down your questions before your appointment to ensure you don’t forget them.
• One Week before your procedure:
  • Stop all aspirin or aspirin-containing products. You may continue to take other medication only after you have consulted the doctors.
• The night before your procedure:
  • Nothing to eat or drink after midnight the night before your procedure. Take your medications the morning of the procedure with a small amount of water. If you must take your medicine with food, please have something light (toast, muffin, bread). NO EGGS, MILK, OR SUGARY FOODS OF ANY KIND.

  Preparation for your procedure:

  • Please wear comfortable clothing to your procedure. Sweatpants and a t-shirt are fine (nothing with metal pieces/buttons or hoods). The temperature in our facility is quite cold, so please dress accordingly. Bring socks to keep your feet warm.
  • Don’t wear mascara or makeup as this may introduce problems with the imaging services.
  • You may wear your contact lenses as you may not be able to wear spectacles during the treatment.
  • Bring the medications you are currently taking with you on the day of the procedure.
  • You are welcome to bring food/snacks. Food will be allowed after the treatment phase has been completed. A meal or sandwich will be provided.
  • You may want to bring a book or magazine to help pass the time between the planning and treatment phases. You may bring your own music in the form of a CD or USB that we can play for you while you are undergoing your treatment.
  • Please have a designated person available in case of an emergency and to drive you home.
  • You will need to admit as inpatient for your treatment the day before the surgery day. Your family may wait for you in the waiting area until you return from MRI, at which time the nurse will bring them back to stay with you during the planning phase of the treatment.

Hospitalization:

• Hospitalization Day 1: Admission
  • Patient enters assigned ward after finishing admission process at the ground floor of the main building in the afternoon on the day before surgery. Patient washes their hair with sterilization shampoo and goes to bed after having dinner.
• Hospitalization Day 2: Procedure
  • Patient is sent to Gamma Knife Centre at about 8am.
  • The stereotactic frame is placed on your head while in a sitting position. It is applied in the pre-operative area. The frame acts as a guide to find the exact location of the brain lesion. Your head will not be shaved. Children are given general anesthesia before the frame is attached and remain asleep during the Gamma Knife procedure. A neuro-anesthesiologist gives the anesthesia and stays with your child throughout the procedure.
  • Before the procedure, patient will undergo imaging studies, such as magnetic resonance images (MRI) or computed tomography (CT) scans or cerebral angiogram. During the studies, we ask that the family member or friend return to the outpatient surgical waiting area. He or she can return after the imaging studies are done, prior to treatment. These studies help doctors locate the brain lesion as it relates to the stereotactic frame.
  • While patient take a rest on the treatment couch, treatment planning will take one to several hours depending on the size and shape of the target area. Your doctors will locate the brain lesion in three dimensions using computer software and data from your imaging studies. The position of your head in the helmet, radiation dose and length of treatment will be decided.
  • After the doctors plan your treatment, you will be brought to the Gamma Knife area and placed on the treatment bed, lying on your back. Your blood pressure and pulse will be monitored throughout the treatment. The stereotactic frame will be fitted into a steel helmet and fixed in position. You are awake during this procedure, and can communicate with your nurse and physician the entire time. This procedure takes about fifteen (30) minutes or more depending on the shape and number of lesions.
  • After your Gamma Knife treatment, the stereotactic frame is removed and you will be transferred to your ward for recovery. You may have a headache, and not having eaten all day may add to your discomfort. Medication for the headache will be provided as needed. You will be monitored, including your blood pressure and pulse. In most cases, patients are discharged the same day, next day discharge is available on request. You may resume normal activities, eat and drink as you feel able.
  • The entire procedure from frame application until treatment completion usually takes half of the day.
• Follow Up – After Discharge
  • Patient needs to visit your physician 1 month later, and if necessary, takes MRI scans once in every 3-6 months.

FAQ

1. What are the medical conditions can be treated by the Gamma Knife? Conditions for which the Gamma Knife is considered are:

• Malignant tumors such as metastases (cancer that has spread to the brain) and malignant gliomas
• Benign tumors such as meningiomas, acoustic neuromas (vestibular schwannomas), pituitary tumors and low grade glioma and skull-based tumors
• Vascular malformations such as arteriovenous malformations (AVMs) and cavernous angiomas (cavernous malformations)
• Functional disorders such as trigeminal neuralgia

2. Is Gamma Knife treatment suitable for older patient who has other medical conditions?

• Gamma Knife radiosurgery is especially valuable for patients whose neurological disorders require a difficult surgical approach or may be impossible to treat using conventional neurosurgical techniques. Patients of advanced age or in poor medical condition can be at an unacceptably high risk for anaesthesia and conventional surgery, making Gamma Knife treatment an ideal solution.
• Gamma Knife technology also is highly beneficial for patients whose lesions are situated in an inaccessible or functionally critical area within the brain. In addition, the treatment can be used as an adjunct to the care of a patient who has undergone conventional brain surgery, interventional neuroradiology or conventional radiation therapy or chemotherapy.

3. Is Gamma Knife treatment effective?

• The Gamma Knife’s success rate is impressive. Supported by more than two decades of clinical research and over 700,000 procedures done worldwide, this neurosurgical tool has met with unprecedented results. Clinical applications continue to grow, and its many benefits as a non-invasive treatment modality continue to make it the treatment of choice for certain clinical conditions.

4. What happens during Gamma Knife treatment?

• Once a patient’s condition is reviewed by our multidisciplinary team and Gamma Knife treatment is deemed appropriate, the patient will be scheduled for a treatment day. On the day of treatment, there are several steps that take place. First, a lightweight frame is attached to the patient’s head. Local anaesthesia is used before the frame is secured in place. The patient then has an MRI or CT imaging study, or in the case of an arteriovenous malformation, angiography, may be needed in order to precisely locate the diseased area. Data from the imaging study is transferred into the treatment planning computer. While the patient rests, the treatment team (a neurosurgeon, radiation oncologist and physicist) uses advanced software to determine the treatment plan. This takes one or two hours to complete, depending on the complexity and location of the disease.
• When the individual treatment plan is completed, the patient is placed on the Gamma Knife couch and precisely positioned. The patient is then moved automatically, head first into the machine, and treatment begins. Treatment typically lasts from 15 minutes to an hour or more, during which time the patient feels nothing unusual.
• Actual treatment time varies based on the condition being treated and its location. Following treatment, the patient is automatically moved out of the machine, and the head frame is removed.

5. What will I feel during Gamma Knife Treatment?

• During the actual procedure, the patient does not see or feel the radiation during treatment. Before the treatment takes place, patients typically feel slight discomfort from the local anaesthetic used prior to head frame placement and have reported feeling pressure for a short time while the pins are inserted to fixate the head frame, but no pain.

6. Will I be awake during the procedure?

• The patient remains conscious throughout the entire procedure, and may communicate with the treatment team.

7. Will my head be shaved?

• No, the head is not shaved. In rare cases the treatment may cause some hair loss.

8. What can I expect after the treatment?

• When the treatment is finished, the head frame will be removed. Sometimes there is a little bleeding from where the pins were attached to the head. In this case, gauze and pressure will be applied to stop the bleeding and keep the area clean. A temporary head dressing is placed to keep the pin sites clean. It is recommended that the patient take it easy over the next 12 to 24 hours. Pre-Gamma Knife activities can be resumed within a few days.

9. Is Gamma Knife treatment safe?

• The Gamma Knife allows non-invasive brain surgery to be performed with extreme precision while sparing healthy tissues surrounding the targeted treatment area. Also, because neither a surgical incision nor general anaesthesia is required, the risks usually involved with open brain surgery, such as haemorrhage or infection, may be reduced. Hospitalization is rarely required and recovery time is minimal. While individual patient outcomes may vary, patients may resume their normal pre-surgery lifestyle within a few days.

10. What should I bring to the procedure?

• You may bring music to listen to during your treatment. We can accommodate iPods or CDs. As there is limited room, only one to two family members can be with you at a time prior to your treatment. Please keep all valuables at home.

If you have any questions or for enquiries on our Gamma Knife Promotional Package, please contact the Gamma Knife Resource Centre at +603 4141 3091 or +603 4141 3528 or +603 4141 3530