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Special mention of tumors
E. Ependymoma
Ependymoma is a tumor that arises from the ependyma, a tissue of the central nervous system. Usually, in children the location is intracranial, while in adults it is spinal. The common location of intracranial ependymoma is the fourth ventricle. Ependymomas are also seen with Neurofibromatosis Type II. Ependymomas make up about 5% of adult intracranial gliomas and up to 10% of childhood tumors of the central nervous system (CNS). Their occurrence seems to peak at age 5 years and then again at age 35.
About 85% of ependymomas are benign myxopapillary ependymoma . It is a localized and slow growing, low-grade tumor. Although some ependymomas are of a more anaplastic and malignant type, most of them are not anaplastic.
Treatment:
Surgical removal. Incomplete removal or malignant tumor requires radiotherapy.
Gamma Knife Surgery- A surgery without incision
Gamma Knife Surgery represents one of the most revolutionary means available to treat the brain diseases.It is painless, bloodless and precise therapy with a very short duration of therapy and hospitalisation. In this technique there is no need to open the brain. Although it is termed as surgery but in true sense it is not the conventional surgery.Gamma knife is a highly precise stereotactic focussed Gamma Radiation directed at the diseased part of the brain . It can be applied in cases where conventional surgery is difficult. It is a non invasive technique.
History
In 1950 Swedish Neurosurgeon Professor Lars Leksell at Karolinska Institute in Stockholm and radiation biologist Borge Larsson of the Gustaf Wermer Institute,Uppsala University began to investigate combining radiation beams with stereotactic (guiding ) devices capable of pinpointing targets within the brain.In 1967 the first Gamma Knife device was constructed and Professor Leksell termed as `Stereotactic Radiosurgery `Professor Leksell and his colleague built his second Gamma Knife machine in 1975.It was for the Neurological service.The subsequent devices are installed in different countries.
Technology
The Gamma Knife contains 201 Cobalt -60 sources approximately placed in circular array in a heavily shielded assembly.The unit directs the Gamma radiation to a target point ie. abnormal brain tissue .Patient wears a specialized helmet that is fixed to their skull so that brain tumour remains stationary at target point of Gamma rays.The powerful radiation treats the diseased brain tissue while the surrounding brain tissue is intact. It is as precise as 0.3 mm.So a relatively inoperable area can be treated safely in Gamma Knife.A single dose radiation therapy is capable of treating the brain disease.
The procedure
A patient who comes for Gamma Knife therapy must be assesed first by the treating neurosurgeon . On the day of surgery under local anaesthesia and if necessary sedation a frame is fixed in the head. An iamging is done thereafter.Now while the patient can relax now the Gamma Knife team works on 3 dimensional computurised technology to plan the treatment.Once the planning is complete patient is palced in the Gamma Knife unit for the radiation therapy.Gamma Knife is a metal helmet like device that emits radiation.After the radiation the frame is removed. Patient is discharged in the next day.
Indications
- Gamma Knife therapy can be directed for both benign and malignant tumours
- Benign tumours like Meningioma,Acoustic Scahwannoma,Pituitary adenoma,Craniopharyngioma and Pineal region tumour
- Malignant tumours like Metastases,Chordoma, Medulloblastoma, Medulloblastoma, Astrocytoma. Ependymoma
- Arterio vascular malformation (AVM )
- Painful condition like Trigeminal Neuralgia
- Movement disorder like Parkinson`s disease
- Gamma Knife therapy is restricted to a mean spherical diameter of the tumour 35 mm.Larger volume of tumour may be treated but it may lead to ineffective total dose from radiological stand point.This may cause suboptimal outcome.
Results
Gamma Knife stops tumour growth in 90-95 % of cases. It also causes shrinkage of the tumour growth in the majority.It takes from a week to a year to exhibit its effect depending on how rapidly the tumour cells are dividing.
Team of Specialists:
- Dr. Arun Saroha Head - Neurosurgery (Unit I) View Profile
- Dr. Alok Gupta Head - Neurosurgery (Unit II) View Profile
- Dr. Praveen Gupta Head - Neurology View Profile