Gamma Knife Surgery - One of the Most Effective Solutions for Treating Brain Abnormalities

Recognized as stereotactic radiosurgery, Gamma Knife Surgery is one of the most effective treatment solutions to many brain abnormalities which were earlier considered untreatable. It is effective both in terms of the time it takes for the treatment and the cost.

Stereotactic Surgery is a highly precise form of radiation therapy used for treating tumors and other brain diseases. It is an advanced treatment procedure that is performed without marking an incision on the brain tissue. Gamma Knife is completely a non-invasive technique and provides doctors to operate on the brain lesions without giving any incisions.

The treatment procedure comprises a machine that directs the gamma radiations to a focused area of a brain and destroys the diseased tissue without affecting the healthy tissue. 192 highly precise beams of gamma radiations are directed through a protective helmet to destroy only the diseased tissue.

Who should have Gamma Knife Surgery?

Gamma Knife is effective in treating a wide range of brain abnormalities. Gamma Knife has proved to be an effective treatment for patients who have abnormal Arteriovenous Malformations, Trigeminal Neuralgia, Tumors, and Parkinson's Disease.

Conditions such as AVM in which there are abnormal tangles of blood vessels in the brain can bleed causing seizures and hemorrhagic stroke, the surgery is highly effective. Also, the condition called Trigeminal neuralgia in which there occurs pain around the cranial nerves near the base of the brain. This pain tends to radiate out to pressure points in the face making the condition unbearable for some patients. In such conditions the surgery proves to be very relieving.

Evidence has shown that it can stop tumors from growing in 90 percent of cases. It also helps tumors to shrink in the majority of the cases. Benign tumors such as acoustic neuromas and malignant tumors that have spread can also be effectively treated.

The Treatment Procedure

Precisely, the treatment procedure involves the following steps:

• Application of the Stereotactic frame
• Image acquisition
• Planning of the dosage and
• Radiation delivery

The key component in a gamma Knife Surgery is a Stereotactic Head Frame which is a tool that allows the physician to locate the tumor or diseased tissue and perform treatment on the same. The Headframe is attached to the patient's head with screws so as to ensure that the radiation beams are targeted precisely. It also prevents any unwanted movements of the head during the treatment procedure so that only the targeted brain areas receive radiations.

After the head frame is in place, the tumor, brain lesion or abnormality is examined by CT or MRI to precisely locate its location, size, and shape. An angiogram may also be required for treating a blood vessel abnormality. The markers on the head frame and the images taken help the physician to plan out the treatment procedure for the lesion. On completion of the treatment plan, the patient is laid down on the treatment table with the head frame attached to the helmet. The gamma rays are irradiated and the abnormal tissue is damaged saving the surrounding healthy tissues.

The Increased Survival Rate with Gamma Knife

Initially considered to be a palliative treatment procedure, which was supposed to improve the symptoms only, Gamma Knife has actually proved to be effective in improving survival rates among the patients. There has been evidence which prove that patients treated with Gamma Knife survive for years.

Advantages of Gamma Knife Surgery

• More accurate treatment
• Faster treatment and time
• Greater patient comfort
• The lesion being treated receives a high dose of radiation with minimum risk to nearby tissue and structures.
• No anesthesia
• Surgery without an incision
• Lower costs than conventional brain surgery
• Minimal discomfort
• The ability to resume normal activities sooner
• The absence of an incision eliminates the risk of hemorrhage and infection.

When Strokes Happen To Young People

We tend to think of strokes as something that happens in old people. It would be more accurate to say "older" because the cut-off is about age 55. Strokes do occur more often in adults 55 and older. But, while strokes are decreasing among older people, the numbers are rising in those aged 20 to 54. In a recently published study, the percentage of strokes in adults younger than 55 rose from 13% in 1993 to 19% in 2005. That 6% difference may not seem like much, but in real numbers it means an additional 47,700 relatively young people having a stroke each year. As a result, the average age of people in the study had their first stroke fell from 71 in 1993 to 69 in 2005.

Consider this... according to the American Stroke Association, 795,000 Americans suffer strokes annually. That means that in 2005 about 151,050 of those strokes occurred in someone between the ages of 20 and 54. Why is this number rising?

One reason is that as medical technology improves, we are able to diagnose more strokes. Sometimes a person may only have a vague sense of not feeling well. In the past, a doctor asked a lot of questions and then examined you from head to foot. He or she determined what was wrong with you and, more often than not, was right. But a vague sensation of not feeling well and a small stroke with a normal examination might be very difficult to diagnose. Nowadays a doctor asks questions and does an examination but now we have CT scans and MRIs. We order a brain CT in someone with that vague feeling and see a stroke, the place where brain cells are injured, dying, or dead. That is a patient whose stroke might not have been diagnosed before CT scans were available. So our new equipment helps us find more strokes. Unfortunately, that is only a small part of the answer. There really are more strokes occurring in younger adults. But why?

We take it for granted that young people are healthy. Their bodies have not had time to develop real problems and so, when a stroke occurs, it must mean that something is very wrong. In adults younger than 45, trauma is the most common cause of stroke. It accounts for about 22% of strokes in this age group. With hemorrhagic strokes, where there is a blood vessel rupture and bleeding, the second most likely cause is arteriovenous malformation. This is an abnormal collection of arteries and veins that a person is born with. Lupus, certain cancers, illicit drugs like ecstasy, cocaine and amphetamines, some blood diseases including sickle cell disease and thrombocytopenia. These are just a few of the conditions that can increase the risk of stroke in the young. Women can have strokes associated with birth control pills. About 5% of strokes in young women occur after having a baby.

Strokes in young people can also be caused by the same factors that cause strokes in older adults. And that is the problem. The number of strokes in young adults is increasing because people are developing those stroke risk factors at younger ages. More young adults and even children are overweight. Some are obese. Many have high blood pressure and diabetes. Increasing numbers have high cholesterol and smoke cigarettes. Most strokes occur after someone has had those risk factors for many years. These traditional stroke risk factors are present at earlier ages and so, the consequences are occurring at younger ages.

Smoking is a very important and modifiable risk factor. It is responsible for a higher percentage of strokes in young adults than in older adults. With all that we've learned about smoking and its contribution to cancer, heart attacks, lung diseases, etc. why does anyone take up this habit? How can anyone afford it?

Young adults are also more likely to be involved in other risky behaviors that increase stroke risk:

• Rough contact sports that result in head and neck injuries
• Motor vehicle accidents including motorcycles, ATVs, etc.
• Heavy alcohol use
• Illicit drugs
• The misuse of legal drugs like caffeine and pseudoephedrine found in over-the-counter products
• Illegal anabolic steroids

Many doctors are seeing younger stroke patients. And more of them. This is bad news for many reasons. Younger brains may recover better after a stroke, but there may still be significant permanent damage. Think about this. Having a stroke is awful at any age. But an 80-year-old who has a stroke is probably retired. Their children are likely to be adults. Maybe that person now has to live in a nursing home. How long might that be? Five years? Ten? A 45-year-old, paralyzed for the rest of his or her life, may be unable to ever return to work and forced to live in a nursing home for decades. Their children are younger and more likely to still be living at home.

How old are you? What were you doing at age 45? If you're younger, what do you see yourself doing in the future? Most 45-year-olds are working, raising kids, taking care of their homes. The activities we all take for granted like playing with our children, going out with friends, shopping, riding a bicycle, hiking, skiing, could become suddenly impossible.

Young people often think of themselves as immune and indestructible. Many do not see doctors because they feel fine and do not think anything serious could happen to them. Poor lifestyle changes may not kill you today, but they have a way of catching up with you later. No matter how old or young you are, do these things:

• Stop smoking!
• See your doctor. Identify your stroke risk factors and start working on them.
• While seeing the doctor get treatment for any medical conditions you have.
• Eat a healthy diet. Try the Mediterranean Diet.
• Achieve and maintain your proper weight. For many of us, that means losing weight.
• Exercise regularly.
• Limit your alcohol intake.
• Avoid sports and other activities associated with head and neck injuries. If you can't avoid the activity, use the proper safety equipment.
• Avoid illicit drugs.
• Share this information with a young adult today. Prevention is the key!

Every day... say NO to stroke!

Anomalies in the Cerebrospinal System

Arteriovenous malformation (AVM), Secondary subarachnoid hemorrhage and Venous thrombosis are forms of Cerebrovascular anomalies. The pathogenesis of the first two aforementioned diseases is the occurrence of a cerebral hemorrhage, entering the subarachnoid space through the surface or the ventricles. While in Venous thrombosis, simple cerebral venous occlusion is the main cause.

Arteriovenous malformation (AVM)
These developmental anomalies consist of abnormal communications between the arterial and venous systems resulting in a cluster of dilated vessels. They vary in size from a few millimeters to huge masses lying in the cortex or white matter, usually in the posterior half of the cerebral hemispheres. They usually become symptomatic in the second or third decade. They present initially as subarachnoid hemorrhage, focal epilepsy, vascular headaches, hemiparesis or any focal neurological deficit. The combination of epilepsy with subarachnoid hemorrhage should suggest this possibility. X-ray skull may reveal abnormal venous channels with crescentic linear calcification. Arteriography delineates the abnormal vessels. Surgical treatment includes artificial embolization of the feeding vessels, ligation of feeding arteries, and resection of the AVM.

Secondary subarachnoid hemorrhage
This occurs when blood from cerebral hemorrhage enters the subarachnoid space through the surface of the ventricles. Other less common causes of subarachnoid hemorrhage include malignant tumors, trauma, bleeding disorders like thrombocytopenia, purpura and hemophilia and hemorrhagic meningitis. In these cases, the clinical evidence of the underlying disorder will be evident.

Venous thrombosis
This is either secondary to bacterial thrombophlebitis or due to simple cerebral venous occlusion (Phlebothrombosis). Intracranial thrombophlebitis is usually secondary to infections in the middle ear, paranasal sinuses, mastoids or skin over the face. The lateral sinuses, cavernous sinuses, and superior longitudinal sinus are commonly involved. In lateral sinus are commonly involved. In lateral sinus, thrombosis, the infection spreads to involve the jugular bulb to give rise to the jugular foramen syndrome with paralysis of IX, X, XI cranial nerves. In such patients, compression of the ipsilateral jugular vein fails to produce a rise of CSF pressure while doing the Queckenstedt's test, although the test is normal if the other jugular vein is compressed.

Cavernous sinus thrombosis is usually secondary to infections of the ethmoid or maxillary sinuses or the skin around the eyes and nose. The clinical features include high-grade fever, chemosis of the conjunctiva, proptosis, and edema of the ipsilateral eyelid. Later the fundus shows papilledema with retinal hemorrhage and there is involvement of the third, fourth, sixth and ophthalmic division of the fifth cranial nerves. Within a few days, the infection spreads to the other cavernous sinus through the interconnecting vessels. Sooner or later meningeal infection supervenes and meningitis develops.

In superior longitudinal sinus occlusion, symptoms start with unilateral convulsion and hemiplegia. Subsequently, when the occlusion spreads to involve the superior cerebral veins of the opposite side, it produces paraplegia. In all these instances, high-grade fever and toxemia are present. Treatment consists of a high dose of appropriate antibiotics and general measures to prevent cerebral edema and convulsions. Once the infection is controlled, the focus of infection in the offending ear or sinus should be tackled surgically to prevent a recurrence.

Sometimes, even in the absence of intracranial infection, occlusion of the superior sagittal sinus or lateral sinus develops with the rise of intracranial tension. The predisposing causes include postpartum and postoperative states, congenital cyanotic heart disease, polycythemia vera, and sickle cell disease. A stroke occurring in the background of such a clinical setting is suggestive of venous thrombosis. Venous thrombosis evolves more slowly and it has a greater epileptogenic potential than arterial occlusion. There is a great tendency to develop hemorrhagic infarction. The treatment includes correction of the basic disease, reduction of brain edema, antiepileptic medication, and treatment of infection if present.

Hemorrhagic Stroke

A hemorrhagic stroke is a drastic form of brain stroke. The public should find ways to be aware of this condition. It can abruptly affect anyone. The information about a stroke should always be focused on its symptoms, causes, risk factors, diagnoses, complications, and treatments. Hemorrhagic stroke concerns the brain. This organ has several protective layers. The major protective layers of the brain consisting of the dura mater and the skull. At birth, the suture lines of the skull override with each other. The skull completely closes as a person grows older which enables the brain cavity to expand to its normal volume and standard pressure.

Hemorrhagic stroke occurs when there is a seeping of blood from the tissues or the blood vessels. Blood that seeps out from its origin causes irritation of the brain's tissues and the swelling of the brain's structures. The blood coming from these sources accumulates and forms a hematoma. Since the normal structure of the brain cavity does not include a hematoma, the intracranial pressure will increase. This is due to the pressure the hematoma causes on the brain tissues which can further cause serious damage.

There are various types of hemorrhagic stroke according to the site where bleeding occurs. The bleeding can happen inside the brain matter, termed as intracerebral hemorrhage. Intracranial aneurysms are the bulging of weak walls of the arteries that can rupture at any point in a person's life. The rupture can occur most specifically when a person is at a heightened emotional state and a stressful event.

However, the weakness of the arteries may not just result from previous diseases like hypertension. It also may be caused by congenital malformations like arteriovenous malformations. This condition causes the entanglement of arteries and veins inside the brain. The reason for the malfunctions of the capillary beds is due to the entanglement within the vessels. The last type of hemorrhagic stroke is subarachnoid bleeding. It is the most fatal form of stroke because it involves the artery which is considered to be the main blood supply to the brain.

The symptoms of stroke, specifically for hemorrhagic stroke, comprise various manifestations depending on the location of the bleeding and the amount of damage. The most typical report of a patient who experiences this condition is a headache. A wide-range physical and psychological assessment will reveal the level of the neurological dysfunctions that occurred. There are instances that the symptoms exhibited by the patients are just side effects of the treatment regimen given to them. The risk factors that are associated with the occurrence of stroke are gender, age, and ethnicity.

This is an emergency situation. The diagnosis of its incidence is very important to determine the appropriate treatment for the patient. It entails a number of high-quality screening examinations. These screening tests are composed of imagery tests, electrical activity tests, and blood flow tests. Complications may also arise during these conditions due to hypoxia such as seizure, cerebral vasospasm, increased intracranial pressure, and systemic high blood pressure. Treatments for this condition are diverse. The treatments should be performed immediately to avert fatal damage or sudden death of the patient. The management of hemorrhagic stroke uses a combined approach of utilizing medications and undergoing surgical interventions.

Hemorrhagic Stroke-Risk Factors And Prevention

In the era where infectious diseases are effectively treated with antibiotics, safer cars are built and more restrictions are placed on firearm possession, but no restrictions are placed on the things people eat, conditions such as cancer, heart disease, and cerebrovascular disease arise as the main causes of morbidity and mortality.

Of those diseases, heart disease and stroke (cerebrovascular disease) are the ones that are rising. The explanation is simple: There is a growing percentage of people who are overweight, which leads to insulin resistance, metabolic syndrome, hypertension, diabetes, and vascular disease.
Of those, cerebrovascular disease (stroke) is the one that leads to more disabilities.

Cerebrovascular disease (stroke) comes in two flavors:

• Ischemic stroke which is the one that results from the interruption of blood flow to any part of the brain (cerebral infarction) due to blood clotting directly inside a damaged artery of the brain or when thrombi that are originated inside the heart (due to arrhythmias or prothrombotic conditions) travel through the arteries and "gets stuck" inside a brain vessel (thrombotic or thromboembolic stroke).

• Hemorrhagic stroke is the one that results from the rupture of any vessel of the brain or any vascular malformation (aneurysm or arteriovenous malformation). It also disrupts blood flow to the brain, increases intracranial pressure, can cause secondary ischemia and have a mass effect on the structures that it damages.

There are two types of hemorrhagic stroke:

• Intracerebral Hemorrhage
• Subarachnoid Hemorrhage

Hemorrhagic stroke accounts for about 17 percent of stroke cases. Stroke kills about 140,000 Americans each year—that's 1 out of every 20 deaths. Someone in the United States has a stroke every 40 seconds. ... Every year, more than 795,000 people in the United States have a stroke. About 610,000 of these are first or new strokes.

Risk factors that can be eliminated:

• Smoking
• Drugs that increase blood pressure (cocaine, amphetamines)

Risk factors that can be treated:

• Isolated Systolic Hypertension
• High Blood Pressure
• Hemorrhagic Disorders

Risk factors that cannot be modified

• Age
• Gender (male)
• Vascular malformations

What Is A Hemorrhagic Stroke?

A hemorrhagic stroke occurs when a blood vessel inside the brain bursts. The bleeding damages the surrounding brain tissue. The brain cells are much more gentle and sensitive than any other cells in the human body. The bleeding increases the pressure applied to the brain cells that surround the bleeding and this is what causes the damage.

The most common cause of hemorrhagic stroke is high blood pressure. Another cause is an aneurysm. It causes the blood vessel wall to become thinner and bust at some point. Stroke can also be caused by the accumulation of a protein called amyloid within the artery walls, particularly in the elderly. This makes the arteries more prone to bleeding.

Hemorrhagic strokes form nearly 20% of all stroke cases. It may occur in all ages and the average risk age is lower than the ischemic stroke risk age.

The symptoms of the hemorrhagic stroke include weakness or inability to move some part of the body, numbness or loss of sensation, decrease or lost vision, speech difficulties, disorientation and inability to recognize familiar faces, sudden headache, dizziness, etc.

The hemorrhagic stroke can be treated through surgery or with medication only. Depending on the severity, treatment includes lifesaving measures, relief of symptoms and repair of the cause of the bleeding. Surgery can help to reduce the brain damage caused by the stroke as well as quicken the recovery. Regardless of the treatment chosen a person who has suffered a hemorrhagic stroke needs a serious long term treatment. Most of the patients need physical therapy, others need behavior modification or family counseling.

There are different types of hemorrhagic stroke - subarachnoid hemorrhage and intracerebral hemorrhage. The subarachnoid hemorrhage occurs when a blood vessel in the area between the brain and the skull starts bleeding. The intracerebral hemorrhage occurs when a blood vessel deep inside the brain starts bleeding. Both types may be caused by structural problems with the arteries such as an aneurysm or Arteriovenous Malformation. The aneurysm is a week area in the blood vessel wall that fills with blood and bulges. High blood pressure or an injury may cause the bulge to rupture and start bleeding. Arteriovenous Malformation is a malformation of the brain's blood vessels. This kind of malformation is usually present since birth and develops slowly with time. It characterizes weak blood vessels that increase the risk of a hemorrhagic stroke.

AVM Surgery

Arteriovenous malformations are masses of abnormal blood vessels that grow in the brain. They consist of a blood vessel "nidus" (nest) through which arteries connect directly to veins, instead of through the elaborate collection of very small vessels called capillaries. Some people are born with the nidus, but as the years go by, it tends to enlarge as the great pressure of the arterial vessels can not be handled by the veins that drain out of it. This causes a large collection of worm-like vessels to develop (malformed) into a mass capable of bleeding at some future time. These malformations are most likely to bleed between the ages of 10 - 55; after 55, the chances of bleeding diminishes rapidly. Before 55, the likelihood of hemorrhaging is between 3 and 4% per year (with a death incidence of about 1%). Once an AVM patient has hemorrhaged, the risk of having another one might approach 20% during the first year, and gradually lessen to about 3 - 4% over the next few years.

AVM s can occur in any area of the brain and can be either small or large. When they hemorrhage, they usually do so with a limited amount of blood, unlike the hypertensive hemorrhages of other stroke patients. The loss of neurologic function depends on both the location of the AVM and the amount of bleeding. Many patients have very small hemorrhages, often multiple. They may display convulsions before even knowing about the presence of an AVM. Some patients suffer from headaches, often unrelated to the AVM which is usually found with a CT scan or brain MRI. In rare instances, children are born with large AVM's and are found to have heart failure because the malformation makes the heart work beyond its capacity.

These lesions are surrounded by a very discrete layer of abnormal, nonfunctioning brain tissue, thus allowing their removal with relative safety to the surrounding brain. This factor is of the utmost importance to the brain surgeon, who can take advantage of this natural separation between normal brain tissue and the abnormal vascular malformation.

TREATMENT OPTIONS

Radiation

If there is a very small AVM, and it is deep-seated in the brain, the patient is fortunate. It is possible to give focused beam radiation to the malformation and avoid surgery. Within two years the malformation will most likely disappear.

Embolization

Larger malformations may be made more surgically manageable with a technique called embolization. With this procedure, an angiogram becomes a therapeutic tool. The interventional angiographer is capable of filling the malformation with agents which help decrease the blood supply to the malformation (coils, glues, plastic spheres, balloons, etc). This makes surgery easier in some cases. The technique has been used as the primary treatment as well and has apparently been successful in some cases.

Surgery

Perhaps surgery is still the best way to go if the decision has been made to do something to eliminate the AVM for good. Surgery cures these lesions by totally removing them, thus disallowing them from ever recurring again. The author's personal bias (quite strongly held) is that most AVMs are best cared for with surgical removal. Even with patients who have large and complex AVMs, surgery provides the cure when the malformation is completely removed.

Benefits of surgery 

A team of specialists in all the disciplines are present to make an accurate diagnosis and arrive at the best course of action to eradicate the disease. Since the success of your surgery is largely dependent on your choice of surgeon, the objective of the doctor is to provide appropriate pre and post-surgery care.