SUCEESSFUL TREATMENT OF 19 YEAR OLD WITH AVM USING CYBERKNIFE
CASE HISTORY: This 19 years old college student presented with the complaints of acute onset headache, right hemiparesis and right hemianopia. MRI revealed haemorrhagic infart in left inferior thalamus extending to capsule and old left posterior capsular infart. DSA revealed left temporal AVM (feeder Medial lenticulostride branches of Left MCA draining into vein of galen through basal vein. On examination patient had right hemianopia. Patient underwent treatment with cyber knife radio surgery on 22.6.2009. Patient is on regular follow up with Volume analysis which showed good regression of nidus. January 2011 CT angio revealed complete resolution of AVM. Patient’s vision has dramatically improved.
This 19 year old girl is now 21 years, she is also entering into married life soon. We wish her a very happy married life.
DOCTOR NAME: DR. RATHNA DEVI SR. CONSULTANT RADIATION ONCOLOGIST & CYBERKNIFE SERVICES
For more information you may blog your comments or write to lakshmipriya_b@apollohospitals.com
Showing posts with label Cyberknife in Neurosurgery. Show all posts
Showing posts with label Cyberknife in Neurosurgery. Show all posts
Thursday, February 9, 2012
Cyberknife Radiation Successful For Treating Tigeminal Neuralgia
Cyberknife Radiation Successful For Treating Tigeminal Neuralgia
A small study published online in the Journal of NeuroInterventional Surgery shows that a technique in which highly concentrated beams of radiation are used, known as Cyberknife, can relieve the stabbing pain of the facial nerve condition trigeminal neuralgia.
For their study, the researchers treated 17 patients with trigeminal neuralgia between the ages of 36 and 90, with Cyberknife radio surgery between 2007 and 2009. All patients had suffered between 1 and 11 years from the condition and failed to respond to common methods of treatment.
The treatment consisted of zapping a maximum radiation dose of 73.06 Gy into a 6mm length of the trigeminal nerve, just 2 to 3mm from the root, after which the patients were frequently monitored for an average period of just less than 12 months.
Whist 14 patients reported either a partial or complete relief of symptoms; complete data was available for 16 patients. The average time before the symptoms were relieved was slightly less than two months, with variations from three weeks to half a year. The researchers noted a relapse after the procedure in four patients, occurring between 3 and 18 months later.
None of the patients reported any major complications as a result of the procedure, with only two patients reporting any sensory side effects. The researchers conclude that radio surgery provides a viable alternative to more invasive approaches and should be further investigated.
Written by Petra Rattue
Copyright: Medical News Today
Source: http://www.medicalnewstoday.com/articles/240938.php
To know more about cyberknife you may please reply with your comment or write to lakshmipriya_b@apollohospitals.com
Thursday, November 5, 2009
TRIGEMINAL NEURALGIA
CYBERKNIFE IN TREATMENT OF TRIGEMINAL NEURALGIA
Dr.M.Balamurugan, Senior Consultant - Neuro Surgery
"The Suicide Disease" or tic douloureux(also known as prosopalgia) is a neuropathic disorder of the facial trigeminal nerve. The trigeminal nerve the fifth cranial nerve, is responsible for sensory data (pressure, tempereature & pain) and also responsible for the motor function of the muscles involved in chewing but not facial expression.
SYMPTOMS
The disorder is characterised by episodes of intense facial pain that usually last from a few seconds to several minutes or hours. The attacks are said to feel like stabbing electric shocks, burning, pressing, crushing, exploding or shooting pain that becomes intractable.
Unfortunately, the symptoms of trigeminal neuralgia are often falsely attributed to a pathology of dental origin. Because of this difficulty, many patients go untreated unless a correct diagnosis is made.
There is evidence that points towards the need to quickly treat and diagnose TN. It is thought that the longer a patient suffers from TN, the harder it may be to reverse the neural pathways associated with the pain. Therefore it is essential that physicians are made aware of the seriousness of TN and the level of pain that their patient
TREATMENT OPTIONS
Medical treatment may involve usage of Anticonvulsants such as carbamazepine, oxcarbazepine, topiramate, phenytoin, or gabapentin and sometimes low doses of some antidepressants such as amytriptiline is used.
Surgically there are five options available . Of the five surgical options, the microvascular decompression is the only one aimed at fixing the presumed cause of the pain. Three other procedures use needles or catheters that enter through the face into the opening where the nerve first splits into its three divisions. Excellent success rates using a cost effective percutaneous surgical procedure known as balloon compression are available. This technique has been helpful in treating the elderly for whom surgery may not be an option due to coexisting health conditions. Balloon compression is also the best choice for patients who have ophthalmic nerve pain or have experienced recurrent pain after microvascular decompression.
Other options involve using glycerol injections and radiofrequency rhizotomies. Glycerol injections involve injecting an alcohol-like substance into the cavern that bathes the nerve near its junction. This liquid is corrosive to the nerve fibers and can mildly injure the nerve enough to hinder the errant pain signals. In a radiofrequency rhizotomy, the surgeon uses an electrode to heat the selected division or divisions of the nerve. Done well, this procedure can target the exact regions of the errant pain triggers and disable them with minimal numbness.
Stereotactic Radio Surgery The nerve can also be damaged to prevent pain signal transmission using Gamma Knife or a linear accelerator-based radiation therapy (e.g. Trilogy, Novalis, CyberKnife).
Cyberknife Radiosurgery : Of these, the development of CyberKnife radiosurgery (Accuray, Inc., Sunnyvale, CA) in 1994 added a promising new treatment option for this disease. Using noninvasive head immobilization and advanced image-guidance technology, the CyberKnife dynamically tracks skull position and orientation during treatment, thereby ensuring targeting accuracy throughout the entire procedure, and patients are spared the discomfort of frame fixation onto their skulls. CyberKnife radiosurgery offers the ability to deliver nonisocentric, conformal and homogeneous radiation doses to nonspherical structures such as the trigeminal nerve. There are no risks of infection, cerebrospinal fluid leak or wound healing from Cyberknife Radiosurgery. However, some patients may develop additional numbness in the face or may experience abnormal facial sensations. This occurs in less than 10% of patients.
For more information please write to : lakshmipriya_b@apollohospitals.com;
Dr.M.Balamurugan, Senior Consultant - Neuro Surgery
"The Suicide Disease" or tic douloureux(also known as prosopalgia) is a neuropathic disorder of the facial trigeminal nerve. The trigeminal nerve the fifth cranial nerve, is responsible for sensory data (pressure, tempereature & pain) and also responsible for the motor function of the muscles involved in chewing but not facial expression.
SYMPTOMS
The disorder is characterised by episodes of intense facial pain that usually last from a few seconds to several minutes or hours. The attacks are said to feel like stabbing electric shocks, burning, pressing, crushing, exploding or shooting pain that becomes intractable.
Unfortunately, the symptoms of trigeminal neuralgia are often falsely attributed to a pathology of dental origin. Because of this difficulty, many patients go untreated unless a correct diagnosis is made.
There is evidence that points towards the need to quickly treat and diagnose TN. It is thought that the longer a patient suffers from TN, the harder it may be to reverse the neural pathways associated with the pain. Therefore it is essential that physicians are made aware of the seriousness of TN and the level of pain that their patient
TREATMENT OPTIONS
Medical treatment may involve usage of Anticonvulsants such as carbamazepine, oxcarbazepine, topiramate, phenytoin, or gabapentin and sometimes low doses of some antidepressants such as amytriptiline is used.
Surgically there are five options available . Of the five surgical options, the microvascular decompression is the only one aimed at fixing the presumed cause of the pain. Three other procedures use needles or catheters that enter through the face into the opening where the nerve first splits into its three divisions. Excellent success rates using a cost effective percutaneous surgical procedure known as balloon compression are available. This technique has been helpful in treating the elderly for whom surgery may not be an option due to coexisting health conditions. Balloon compression is also the best choice for patients who have ophthalmic nerve pain or have experienced recurrent pain after microvascular decompression.
Other options involve using glycerol injections and radiofrequency rhizotomies. Glycerol injections involve injecting an alcohol-like substance into the cavern that bathes the nerve near its junction. This liquid is corrosive to the nerve fibers and can mildly injure the nerve enough to hinder the errant pain signals. In a radiofrequency rhizotomy, the surgeon uses an electrode to heat the selected division or divisions of the nerve. Done well, this procedure can target the exact regions of the errant pain triggers and disable them with minimal numbness.
Stereotactic Radio Surgery The nerve can also be damaged to prevent pain signal transmission using Gamma Knife or a linear accelerator-based radiation therapy (e.g. Trilogy, Novalis, CyberKnife).
Cyberknife Radiosurgery : Of these, the development of CyberKnife radiosurgery (Accuray, Inc., Sunnyvale, CA) in 1994 added a promising new treatment option for this disease. Using noninvasive head immobilization and advanced image-guidance technology, the CyberKnife dynamically tracks skull position and orientation during treatment, thereby ensuring targeting accuracy throughout the entire procedure, and patients are spared the discomfort of frame fixation onto their skulls. CyberKnife radiosurgery offers the ability to deliver nonisocentric, conformal and homogeneous radiation doses to nonspherical structures such as the trigeminal nerve. There are no risks of infection, cerebrospinal fluid leak or wound healing from Cyberknife Radiosurgery. However, some patients may develop additional numbness in the face or may experience abnormal facial sensations. This occurs in less than 10% of patients.
For more information please write to : lakshmipriya_b@apollohospitals.com;
Monday, October 12, 2009
CME on Robotic RadioSurgery in Brain & Spine - Recent Advances by Prof. John Adler on 5th October
During a recent visit to Chennai , on the 5th of October 2009 ,Professor Dr. John Adler presented a CME on Robotic RadioSurgery in Brain & Spine - Recent Advances was conducted . Around 65 Drs attended (Neuro Physicians & Surgeons / Spine Surgeons / Radiation Oncologists from different institutions in Chennai) attended the CME and were benefitted by the insights and guidance of Dr. Adler, on the usage of Cyberknife in Neurosurgery.
Some of the photographs taken during the CME
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Some of the photographs taken during the CME
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