Clinical
Briefing: AVM Obliteration with Gamma KnifeŽ Surgery
January/February 2007
The Leksell Gamma Knife® represents the most recent technical advance in the field of stereotactic surgery. Gamma Knife radiosurgery delivers a precise and powerful dose of ionizing radiation from 201 cobalt-60 sources. The gamma radiation is guided to a precise target previously defined by advanced imaging. At the point where the 201 beams simultaneously intersect, enough radiation is delivered to destroy the target, while minimizing the dose to the surrounding tissue.
The imaging, treatment planning and non-invasive radiosurgical procedure all are performed on the same day. Although most patients treated with the Gamma Knife have either benign or malignant brain tumors, Gamma Knife can also be used to treat arteriovenous malformations (AVM) of the brain. Successful obliteration of the target is usually complete in two to three years.
Case Study
Miss L, a 29-year-old female without significant medical
history, presented to the Penn
Neurological Institute for migraine evaluation. Referred
by her PCP, the patient described a several-month history
of headaches that worsened in intensity and duration despite
pharmaco - therapy that included gabapentin and topiramate.
The headaches were significantly impacting her quality
of life as she planned to be married in less than a year.
Neuroradiologic testing, including volumetric MRI and angiogram, revealed a medium-sized arteriovenous malformation located in the cerebellar vermis with deep drainage into the vein of Galen. All available options were discussed with the patient and her family. Together, the patient and neurosurgical team selected stereotactic radiosurgery (Gamma Knife) as the best option to obliterate the malformation with minimal risk to the surrounding brain and would allow her to proceed with her wedding plans.
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Anterior and lateral projection
angiograms performed during
the Gamma Knife procedure.
The outlined area represents
the prescription isodose line.
The entire nidus enclosed within
the prescription isodose line
received 20 Gy or more. |
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The treatment plan proved to be quite challenging. However, by carefully fusing the angiogram results with the MRI scan, the Penn Gamma Knife team consisting of a neurosurgeon, an interventional neuroradiologist and a radiation oncologist, crafted a precise plan for her. A powerful dose of 20 Gy to the periphery and 40 Gy to the center of the lesion was administered in a single session. The total treatment time was 40 minutes, and the patient was discharged on the same day.
Six months post surgery the patient celebrated her wedding and moved into a new home.Her headaches continue to subside and she will continue to receive MRI scans at serial intervals to monitor resolution of the AVM.
Our Team of Faculty
The Penn Gamma Knife Center is quickly becoming Philadelphia's regional leader in stereotactic radiosurgery. Our team brings together physicians and support staff who provide coordinated care throughout the entire treatment process. Our goal is to meet the unique physical and emotional needs of each patient in a caring, professional environment.
Neurosurgery
John Y.K. Lee, MD
Medical Director,
Penn Gamma Knife Center
Assistant Professor
Peter LeRoux, MD, FACS
Associate Professor
Kevin D. Judy, MD
Associate Professor
James M. Schuster, MD, PhD
Assistant Professor
Radiation Oncology
John R. Glassburn, MD, FACR
Section Chief
Clinical Professor
Robert Lustig, MD
Clinical Associate Professor
Jeffrey G. Rosenstock, MD
Clinical Associate Professor
Penn Gamma Knife Center at
Pennsylvania Hospital
Sheila McFarland, RN
Nurse Coordinator
Radiation Physics
Leonard Shabason, PhD
Radiation Physicist,
Radiation Oncology
Clinical Assistant Professor
Kapil Shukla, MS
Medical Physicist, Radiation
Oncology
Otorhinolaryngology: Head and Neck Surgery
Douglas Bigelow, MD
Director, Division of
Otology/Neurotology; Co-Director,
Center for Cranial Base Surgery
Associate Professor
Michael J. Ruckenstein, MD
Associate Professor
Radiology
Carol Dolinskas, MD
Chief, Neuroradiology
Clinical Associate Professor
Linda Bagley, MD
Associate Professor
Access
Patient appointments are available at
Pennsylvania Hospital
Penn Gamma Knife Center
Spruce Building, First Floor
801 Spruce Street
Philadelphia, PA 19107
To refer a patient and/or consult with a doctor:
Please contact your UPHS physician liaison with any concerns or problems you may experience when referring your patient.
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Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
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