The Methodist Hospitals Presents The Gamma Knife Center...a first for Northern Indiana.
The Gamma Knife is not a "knife" at all. This non-invasive procedure targets lesions (an abnormal change in structure of an organ or body part due to injury or disease) of the brain with up to 201 beams of highly focused cobalt radiation. These beams are delivered with pinpoint accuracy while preserving the surrounding healthy tissue. Gamma Knife Saves Lives: Learn about Olympic Skater Scott Hamilton's experience at the Cleveland Clinic's Gamma Knife Center.
- The Gamma Knife procedure is an alternative to surgery for:
- Brain lesions
- Malformed blood vessels (AVM)
- Facial pain relief for trigeminal nerve problems
- Pituitary tumors
- Acoustic neuromas
 More than 30 Years of Positive Results
The Leksell Gamma Knife® is backed by over three decades of clinical experience and documented results. The safety and clinical effectiveness of this technique has been established since 1968 in over 170,000 treated individuals.
*Leksell Gamma Knife® and Gamma Knife® are U.S. federally registered trademarks of Elekta Instrument S.A. of Geneva Switzerland. The trademarks are also registered in a number of other jurisdictions. All rigts reserved.
Benefits to Patients
Cost Effective –
- Accepted by Medicare
- Accepted by most third party payors
Outpatient Procedure –
- Performed as an outpatient service
- Conventional surgery (craniotomy) requires an average 5-10 day hospital stay in Neuro Intensive Care and Intermediate Care Units.
- Quick return to every day activities
- Bloodless procedure
Arranging Referrals
An office appointment with a Gamma Knife Team member is necessary for evaluation and initiation of the plan of care.
Gamma Knife referral to the Neurosurgeon may be for structural, vascular or functional intervention in the brain.
- Structural diagnosis includes tumors of the brain and central nervous system, cancerous tumors, primary (originating in the brain/head) and metastatic (a result of cancer diagnosed at a different location in the body)
- Vascular diagnosis includes malformation of the veins and arteries within the brain (aneurysm or arterial venous malformations)
- Functional diagnosis includes Trigeminal Neuralgia, Acoustic Neuroma and Pituitary Tumor
- Following diagnostic testing, including radiographic imaging (CT, MRI), the neurosurgeon presents the individual case to the Gamma Knife Advisory Board.
The Day of the Gamma Knife Procedure
Pre-treatment Preparation
Transportation and Support
You will need to arrange for someone to accompany you and stay in the Gamma Knife facility during treatment. This person(s) will be allowed to stay with you for most of the time before treatment. This person should be able to drive you home, assist in any care you may need, and be able to authorize emergency medical treatment if it becomes necessary. Plan to limit your activity the day of the procedure.
Eating
Do not eat or drink anything after midnight the day before your procedure. This will decrease the chance of stomach upset during the procedure.
Medication
Discuss all medications you are taking with your neurosurgeon and the Gamma Knife nurse prior to treatment. Notify us of any blood thinners or seizure medications that you are taking. During your initial meeting with the Gamma Knife nurse, you will be instructed on what medications you may take the morning of the procedure. Please bring all of your medications with you in their original containers on your preoperative visit.
Hair
Please wash your hair the night before the procedure. Having a clean scalp helps the staff to position the frame better. After washing, do not use hairspray, gels, or any other hair products.
Clothing
On the day of the procedure, you may wear comfortable clothing. Sweat pants and a short sleeve t-shirt are ideal. If you wear this type of clothing, you may be able to avoid wearing a hospital gown. Please do not wear new or favorite clothing. Please do not bring valuables, including jewelry.
Before the Procedure Begins
On the morning of the procedure, patients are asked to remove all jewelry, eyeglasses, contact lenses, wigs/hairpieces, dentures and any other portable devices or prostheses. Patients are also asked to refrain from wearing makeup or nail polish and to leave valuables at home.
An intravenous (IV) line may be inserted into your arm to prevent dehydration since you cannot eat or drink. The IV line will also allow easier administration of any medicines you may require. You will usually receive medication to assist you in relaxing. If at any time you become anxious or uncomfortable, talk to the staff about the possibility of more medication to assist you.
If you are being treated for an AVM or similar problem you will have an angiogram the day of your treatment. If so, your groin area may be shaved before treatment.
Placement of the Head Frame
The procedure begins with the placement of a guiding device or stereotactic frame, which will be affixed firmly to your head. The head frame is a vital part of the treatment that ensures that the Gamma Knife beams are focused exactly where the treatment is needed. While the frame may look unusual, it is made of a lightweight aluminum alloy that only weighs three kilograms, or about 6 1⁄2 pounds. The frame can also be seen on the imaging equipment and provides your treating staff with an exact set of coordinates so that your lesion or tumor is precisely targeted. The stereotactic frame is a rectangular ring to which four metal posts are attached. This frame then fits over your head. Before attachment of the frame you will receive injections of a local anesthetic to numb the area. There is no pain during the placement of the frame but you may experience a feeling of pressure or tightness that will disappear in about 15 minutes. This guiding device will stay on your head until the Gamma Knife treatment is completed. Four pins are used to secure the frame. Two pins are located in the front and two are located in the back. Glasses cannot be worn with the frame on. You may wish to remove the ‘temples’ from a pair of old glasses and have the nurse tape them to your nose and forehead so that you can see better while waiting for treatment. During the actual treatment and during scanning, the glasses will have to be removed.
Imaging Before the Procedure
After the head frame is securely attached, you will be taken to an imaging area. If you have a tumor, an MRI or CT scan will be performed, which will show the location in relation to the head frame. Sometimes both an MRI and a CT scan are performed. If you are having an AVM or other vascular dysfunction treated, you will have an Angiogram. Contrast media will be used to demonstrate the blood vessels in your brain in relation to the head frame. A doctor and a nurse will be with you at all times during this process. When you return to the Gamma Knife center, a clear plastic helmet with many holes in it will be placed on your head over the frame in order to measure the configuration of your head.
When the imaging studies have been completed, you will be allowed to rest, watch TV or listen to music while the medical staff plans your treatment. This is a team approach, which involves the neurosurgeon, radiation oncologist and medical physicist. At this point, you will be able to relax for at least an hour, maybe two. The team is now working together with a computer to plan your treatment. They will decide how many areas to treat, the appropriate radiation dosage and how to target each area in order to optimally irradiate the lesion or tumor. This information is then “locked in” to the computer for your treatment. During this time, family members may join you until treatment begins.
The Treatment Procedure
After the final plans for your individual treatment have been meticulously reviewed, your neurosurgeon will come to talk to you. You will then be taken to the Gamma Knife suite and transferred onto the treatment couch. Your physician will tell you how many treatments to expect and how long each treatment will be take. The Cobalt60 source of radiation in the Gamma Knife emits radiation at a constant dose. Each treatment is calculated to allow the proper amount of time so that the correct level of radiation is received.
While lying down on the treatment couch, your head frame will be attached to a helmet that was specifically selected for your treatment. The helmet has 201 holes, which means that each individual “ray” of radiation received is muted and will not damage healthy tissue. Each helmet used has different sized holes for usage in different areas of the brain. The team may change the helmet during the treatment. Some of the holes in the helmet may be “plugged” to protect certain areas of your brain or eyes.
At this point, the staff and physicians will go to the other room to administer your treatment. However, you will be able to speak with the team at any time through a microphone in the helmet and the team is also able to see you at all times through a camera in the room. You may also bring along a CD to listen to during treatment. Please provide the CD to the staff before entering the Gamma Knife suite so that they can make sure it is in the CD player and the volume is adjusted prior to treatment.
The bed of the unit will begin to move backwards into the treatment hood. When this is about to happen, a chime will sound to inform you and the staff that the bed is about to move. You will hear a click as the helmet locks into the Cobalt60 radiation source and the ports begin to open. During the treatment, you will not feel or hear anything from the Gamma Knife unit. When the treatment is complete, the chime will again sound and the bed will move back out of the unit. You will hear a click when the unit closes.
The total treatment time may take two to four hours, depending on the size of the area to be treated and the dosages needed for effective treatment. You should be mentally prepared to spend this much time in the treatment room.
Recovery
Immediately after your treatment is completed, the head frame will be removed. There may be some minor bleeding from the pin sites. Gauze and an antibiotic ointment are applied at this time. Some people experience a headache or nausea once the frame is removed. You may be given Tylenol prior to removal of the frame. Tell your nurse or doctor if you have a headache or nausea and need something to make you more comfortable.
At this time, you will be able to eat and drink. You will be carefully monitored and generally released within a short period of time. The Gamma Knife nurse will provide you with individualized discharge and follow up orders. The Gamma Knife nurse will also call you the next day to check on your progress. Please provide a phone number where you can be reached the following day.
If you have any questions or comments at any time, please feel free to contact us.
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