Gamma knife: Advanced Non-Invasive Treatment for Brain Tumour

Author : Dr. Sandeep Vaishya , Director at Fortis Memorial Research Institute, Gurgaon

Brain tumour, without any doubt, is one of the deadliest diseases. Mention of brain tumours evokes fear and anxiety in the hearts of patients and their families. In response to this challenge, researchers in medical sciences are continuously attempting to make tumour treatment even more precise and safer.

Gamma Knife Radiosurgery: Highly Advanced Brain Tumour Treatment

With significant revolution in medical technology, India is witnessing remarkable breakthroughs in cancer treatment driven by cutting-edge technologies and innovative approaches.

Gamma knife radiosurgery is one of its game-changing advances, now available at Fortis Memorial Research Institute, Gurgaon.

It is radiation based precised therapeutic approach which inhibits the growth of brain tumour cells without harming surrounding healthy cells in the brain. The tumour cells don’t grow further and shrink in size over time.

When I mention “knife,” don’t worry—we’re not talking about slicing apart your brain tumour. In fact, contradictory to its name, not even a single incision is required during this treatment. Instead, it’s a non-invasive radiosurgery designed to target and treat small brain tumours with precision and care.

Since it sounds so fascinating, I get many queries regarding the type of cancer that we can treat with a Gamma knife. So far, a gamma knife has been used to treat small and medium brain lesions of less than 3 cm.

In a Gamma knife, there are around 192 small radiation sources that don’t move and focus on one point together, so even if there are 10 or 20 metastases, they can be treated with a Gamma knife easily.

Highly Precise and Safe

Gamma knife radiosurgery is a highly precise treatment option for a wide range of patients with brain tumours, including young children and pregnant women.

It has made the treatment of arteriovenous malformations (AVM) and trigeminal neuralgia located in a difficult-to-reach area more precise and more manageable. The session takes 30 minutes, and the patient can return home the same evening. 

The main challenge in treating brain tumours in pregnant women is that we have limitations in using therapeutic drugs. These drugs may pose a risk of teratogenic effects on the foetus, and of course, we can’t do that.

So, a Gamma knife, being precise and safe, can be employed in this case. We usually go for a frameless gamma knife approach, and the patient can be treated in 2-3 days.Gamma knife is also a game-changer for conditions like epilepsy, Parkinson’s disease, and various other brain complications.

Understand the Steps in a Gamma Knife Session

It’s crucial for a brain tumour patient to understand what we actually do during the session. Let me summarise it for you.

• As a preparatory measure, we obtain written consent from the patient after conducting regular investigations and documentation.
• Then, we conduct a Pre-Gamma knife MRI to locate the lesion or tumour accurately.
• Afterwards, we evaluate the patient’s overall health condition before the session.

Right now, we have two facilities available at Fortis Memorial Research Institute, Gurgaon,

• Frame-less: We use a thermoplastic mesh-like face mask that rests over your face and fits around your head. The mask is secured to an existing frame on the Gamma knife setup, so your head is completely still during the session.
• Frame-based: We use this approach for claustrophobic patients who may resist the frame positioning on the Gamma knife setup and get anxious. A fitted metal band goes around your head frame to prevent your head from moving during the session.
• Based on the CT scan and previous medical examinations, our team creates a treatment plan for the patient, including the frequency and duration of gamma rays.
• Now, we position the patient on the Gamma knife table.
• To help the patient feel more comfortable, we play music based on the patient’s choice. This eases the anxiety of the patient.
• Then, we slide the table into the machine, and the patient is exposed to Gamma rays as planned under our monitoring.
• The session may last from a few minutes to a few hours, and the duration depends on the type and location of the area being treated. 

Usually, one session of gamma knife is sufficient to treat brain tumours in patients. In some medical conditions, some patients may require a gamma knife in multiple sittings for 3-5 days, so, in that case, we follow the frameless approach.

We have patients from different professional backgrounds, from homemakers to company CEOs. Their main concern is how much time this entire session takes. 

So, we assure them that the entire session usually takes 1-2 hours in the hospital. You arrive at the hospital at the scheduled time, get all medical examinations done, and undergo the therapy, which usually lasts for 30 minutes to a few hours. After the session, you are free and can return home.

A Preferred Treatment Option for Brain Tumour Patients

Now, you might be wondering why we need a Gamma knife when there are other treatment options available. Well, it’s all about the accuracy and precision it offers in targeting tumours.

Even if you consider some advanced treatment approaches, such as LINAC, Cyberknife, ZAP X, etc., achieving such a high degree of precision in tumour treatment remains a significant challenge. Many of these treatments use whole-brain radiation, which means even small movements during the session can affect accuracy.

As a neurosurgeon, I can assure you that the Gamma knife effectively addresses this challenge with remarkable precision. Additionally, we employ a frame-based approach to ensure that the patient’s head remains perfectly still during the session. This positioning allows us to target the brain tumour with exceptional accuracy.

We understand the patient may feel anxious seeing large machines, so to ease the patient and provide comfort, we provide a calm environment to ensure that the patient feels safe. For example, we play slow music based on the patient’s choice and also the religious tunes if they want.

Understanding Risks

While we’ve already explored the promising aspects of Gamma Knife, it’s essential to acknowledge that, like any medical intervention, there’s a possibility of side effects. Some patients have faced mild swelling or little discomfort at the site of treatment.

However, considering its more than 90% success rate for treating small AVMs and other lesions less than 3 cm, we have developed enough measures to manage these complications.

Conclusion

With the growing advancements in brain tumour treatment, Gamma knife emerges as a highly-precised, non-invasive, radiation-based treatment for brain tumours.

In most Western nations, Gamma knife radiosurgery has been welcomed for the treatment of brain tumour patients, among which 60-70% had multiple metastases. Unfortunately, the adoption of Gamma Knife radiosurgery in India is still limited. Hence, our aim is to make this treatment available to every brain tumour patient. 

To begin with, we need to create awareness and train a team of neurosurgeons in India about the Gamma knife so that they can approach the right patient regarding tumour treatment. Thus, by empowering healthcare professionals and informing patients, we can make this life-changing treatment accessible to more brain tumour patients.