A Wonder Brain Disease Treatment

"This is such a wonderful experience!" sighed Mr. Islam with relief upon emerging from the Gamma Knife treatment room. "I was so worried - almost devastated - with the diagnosis of my brain tumor. I constantly thought about a painful brain surgery. I even thought of death from it," he continued. "Then through a local doctor I contacted Dr. Paul, a Bangladesh-born doctor in Bangkok Hospital. He assured me that I do not in fact need an open surgery. "Your brain tumor could be treated by Gamma Knife (GK), Dr. Paul wrote to me in an e-mail," says a happy Mr. Islam.

"At first I could not believe Dr. Paul's suggestion. My doctors in Bangladesh and another reputed hospital in Thailand told me that I must have open brain surgery," explained Mr. Islam. "Finally, I arrived at Bangkok Hospital. There, I met Dr. Dittapong Boonampol, a neurosurgeon specialized in GK treatment who confirmed that GK is the treatment of choice for my specific condition".

What is GK?

It is a single treatment modality unit which emits 201 Gamma Ray beams stereo-tactically and precisely to the brain lesion without harming the surrounding tissues. It was invented by Professor Lars Leksell in 1968 at the Karolinska Institute Stockholm, in Sweden. It is a great medical contribution to humanity, and is no widely acknowledged as the best choice for the treatment of many brain diseases. This treatment requires highly trained and knowledgeable staff including physicians, nurses, medical physicists and technologists.

"The technology of GK itself is a major breakthrough" explains Dr. Dittapong. "It maximizes its accuracy and capacity by using imaging techniques like CT, MRI. and Cerebral Angiogram which enable a physician and medical physicist to precisely locate the lesion, and then calculate the volume and strength of the required radiation" he adds.

For treatment, the stereo-tactic frame is applied to the precise spot of the lesion to treat it. When an application session is finished, the frame will gradually degenerate, and the entire treatment procedure will be completed. The actual treatment usually lasts 30 minutes up to 2 hours.

After completion of the treatment procedures, the physicians at the hospital will observe the patient for a night before discharge.

I was not given any general anesthesia but had no pain, no incision, or bleeding. Dr Dittapong asked me to listen to my favorite music while I underwent two hours of GK treatment. Via microphone he -spoke with me from time to time from his treatment monitoring room." continued Mr. Islam. Mr. Islam was surprised when at one point during the treatment the doctor told him, '`You could go to toilet or have some snacks, and then continue treatment'. His conditions improved dramatically after only one week of treatment.

How GK Treatment is Given

The following are the step by step procedures for GK therapy:

  1. Frame Fixation: The stereo-tactic frame, which is fully adjustable, is applied to the patient's head. This is like a motorcyclist's helmet, albeit a larger one.
  2. Imaging of the Lesion: CT scan, MRI or Angiogram is conducted to draw up 3D images of the lesion(s).
  3. Computing Treatment Plan: The information obtained from the imaging devices is loaded into a computer program to generate a treatment plan. Radiation dosage is then calculated according to patients' specific situation.
  4. Treatment: The patient is brought into the treatment room. Helmet and frame will be applied to the patient's head and then the radiation process will commence. The calculated dosage will be automatically emitted into the brain. The treatment process takes only 30-120 minutes.
  5. Rest and Observation: Usually the patient will be observed for a night after treatment. But in many instances it is not necessary to do so.

Indications of GK Treatment

According to Dr Dittapong, GK is used for a wide variety of brain conditions. While some of them have very good responses, the physicians are perfecting treatment modalities for the others. In short, the established indications for GK treatment are as follows:

  1. Vascular Disorders: At present Arteriovenous Malformation (AVM) of the brain is the main target of GK therapy. Over 80% of patients resulted in total obliteration of the lesion in two wears. It is very difficult to treat AVM by open brain surgery, so GK is now becoming the primary choice of treatment. In recent years, vascular aneurysm and other vessel disorders are also treated by GK.
  2. Benign Tumors: Over one-third of all GK treatment were applied on various types of benign brain tumors e.g. acoustic neuroma, meningioma, pituitary tumor or macroadenoma, pineal tumor, trigeminal neuroma etc. 90-95% of patients have had very good control of tumor growth. Facial nerves are consistently preserved in almost all of the cases unlike conventional open surgery, which often resulted in facial paralysis. Also, 80% of acoustic neuroma cases treated by GK did not lose hearing after GK although it is very common to occur after an open surgery.
  3. Malignant Tumors: Brain Metastasis (single or multiple) can be surgically radiated by Gamma Knife and has resulted in good control of tumor growth. Up to 8 lesions can be treated simultaneously by GK. This is almost impossible to do by an open surgery. Glial (malignant) tumors are increasingly treated by GK because of much better results than open surgery. Recently, progress has been made in the treatment of ocular melanoma bv GK.
  4. Functional Targets: Response to GK treatment for Trigeminal Neuralgia is quite good in patients with intractable (severe) pain. With medications alone. some patients suffer from severe pain and disability for long time. GK is also promising results for the treatment of Parkinson's disease. epilepsy. intractable pain and even some psychoneurotic conditions.

Why a Patient should Choose Gk Treatment

According to Dr. Dittapong, GK is truly an alternative for the treatment of brain diseases, particularly for the treatment of tumors. AVM, various types of brain lesions, and functional disorders. As compared to conventional surgery, it is much safer and easier for the patient. He summarizes the followings as some of the advantages of GK:

For a deep lesion such as a brain stem lesion, Gamma Knife surgery is a better and less riskv alternative because the radiation can access the location of the lesion for treatment without harming the surrounding tissues. There is very high risk in treating a deep lesion through conventional open surgery.

Gamma Knife surgery does not require anesthesia. This greatly reduces the risks for the elderly and patients with heart or lung diseases. Coventional open surgery reeuires general anesthesia.

A maximum of two days of hospitalization may be required. Conventional surgery ma-v require intensive care. and more than 10-20 days of hospitalization. In comparison. there is no risk of blood loss, infection or pain, no incision, no scar or hair shaving. It is inexpensive and requires no post-surgery care.

How Widely GK is Used

At present, there are approximately 180 Gamma Knife centers worldwide. Most of these centers located in developed countries like USA, Japan, Europe and Australia. In Southeast Asia such facilities are available in Japan. Korea, Thailand and Singapore.

"Bangkok Neurosurgical Gamma Center is the first and only one in the Thailand," explains Dr. Yingdao Krairiskh, Director of Bangkok Hospital. She adds, "It is an independent center and therefore maintains a policy of being an open center and welcome any qualified physicians from both government and private hospitals to bring their patients who are in need of Gamma Knife treatment. At present there are seven well qualified surgeons associated with our center". "This is part of our overall commitment to bring in most modern and sophisticated technology for the highest level of care for our clients", says Dr Yingdao.

Since the inception of the Bangkok Neurosurgical Gamma Center in 1996, it has treated 960 patients. "Proportional indications of GK use in our center are similar to that of the global data" comments Dr. Dittapong. "As a result, we have the same experience of GK treatment like that of USA or Europe. So a patient in Asia could avail the western standard of medical treatment in Bangkok but only for a fraction of the cost that they would have to pay in the developed countries," observes Dr. Dittapong. He concludes, "GK is truly a wonder treatment for brain diseases, and continues to bring happy outcome for people like Mr. Islam".

Dr Shakti Paul is an Internal Medicine specialist in Bangkok Hospital. He is the only Bangladesh born licensed medical practitioner in Thailand. He is also among the handful of foreign doctors in this country.

Submitted By
Shakti r. Paul, Md

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