CYBERKNIFE SUCCESS STORY FEATURED IN "THE WEEK" magazine

The 1st Cyberknife Success Story , featured in " The Week " Nov 15 edition on Week-IMRB exclusive survey on Best Hospitals 2009.

The Success story of Master Sanka Subradey , aged 15 from Tripura was the 1st Patient in India to undergo Cyberknife Treatment at Apollo Speciality Cancer Hospital, Chennai.

Post treatment , the follow up in September 09 showed in MRI significant reduction in tumour size & he is back to normal life busy preparing for his Class X board examination , thanks to Robotic Radiosurgery system like Apollo Cyberknife

FOR MORE INFORMATION ON TREATMENT PLEASE WRITE TO lakshmipriya_b@apollohospitals.com

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;

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

CYBERKNIFE® AT APOLLO – THE FIRST SUCCESS STORY

PROFILE

Master Sankha Subhra Dey, 15 year old bright young boy from Tripura and the only son of Mr. Bimalendu Dey visited Apollo Speciality Cancer Hospital, Chennai which houses the Asia Pacific’s first and latest Cyberknife® on the 31st of January 2009.

Mr. Bimalendu Dey, is a School Teacher with Govt of Tripura and belonged to the lower income group. When his son was first brought to the Apollo Hospitals, he complained of severe headache, and was registered with our Neurosurgery department.

Before coming to Apollo, the boy was treated at local hospitals in Tripura but there was no relief. Instead his symptoms worsened. That was when, Mr. Bimalendu Dey decided to bring him to Apollo Speciality Cancer Hospital. He was seen by one of our eminent Neurosurgeon Dr.M.Balamurugan.

SYMPTOMS

At the time of presentation patient had neck pain, weakness of upper limb associated with tingling numbness. Poor cough reflex and difficulty in swallowing was also seen. His motor sensation and power was 4/5 all four limbs.


DIAGNOSIS
He was hospitalized and investigated MRI brain Angio and Venogram revealed expansile lesion involving the medulla and Cervico medullary Junction extending to C2 -C3 level.



TREATMENT
After Pre – operative wok up and consent the patient was taken up for tracheostemy , and occipito-cervical craniotomy, decompression was performed.
During surgery highly vascularised tumor seen in brainstem, possibility of Hemangioblastoma was decided.Surgery was abandoned because of high vascularity,critical position and poor out come. His post-op period was uneventful.

Patient was referred to Dr.RathnaDevi, Senior Consultant Radiation Oncology for possibility of Radiation therapy treatment. This was the time that Apollo Hospital had introduced Cyberknife® system the world’s first and only robotic radiosurgery system designed to treat tumors with sub milli-meter accuracy. Cyberknife can also be used to treat tumors previously considered inoperable.The location of the lesion was in a critical area of the brain stem. It was a challenge to treat the lesion with such accuracy without affecting other adjacent critical structures which was possible only with CyberKnife radiosurgery.



A TOUGH DECISION MADE EASY!



As there was no possibility of surgery the only option of treatment was Radiosurgery.

Having a thought that Master Sankha Subhra Dey could find an answer in Cyberknife® ® treatment, Dr.Rathna Devi discussed the case in Cyberknife® ® advisory board, and the same was opined and agreed by the Cyberknife® board.

The doctor also posted the case in the CK society and opinion was sought with renowned CK specialists all over the world.Fortunately, Dr.John Adler (Father of Cyberknife® ) visited our hospital to inaugurate Cyberknife®. His valuable advise was also sought.

Patient and his father was counseled about Cyberknife treatment and that was the only option of treatment. They understood clearly and consented for Cyberknife treatment and even waited till the Cyberknife machine was commissioned and functional. HE WAS OUR 1ST CYBERKNIFE PATIENT.

CYBERKNIFE TREATMENT

After proper immobilization and imaging planning was done taking utmost care to protect the critical organs which were at risk. An additional benefit with Cyberknife is that it can be done on a Outpatient basis. After successful planning and verification, treatment delivery was done. Patient underwent 21Gy in three sittings from 24th to 26th March. Patient tolerated the treatment well.

This was also a moment when we saw the deep emotional bonding in the family. Master Sankha Subhra Dey was unable to speak during treatment because of he had tracheostomy. During treatment the patient and the father always communicated with their eyes. (Guess that was their special language and it carried so much of emotions). Of course, they had lot of hope and trust on us . They were extremely cooperative as well.



FOLLOW UP

Patient reported for his first follow up after three months. There was a dramatic improvement in his health. His cough reflex improved. Dysphagia (difficulty in swallowing)disappeared. There was no weakness of upper limbs and no neck pain.

Tracheotomy tube was removed. He had a good weight gain, his skin and eyes were literally glowing. He was handsome and beaming with confidence.

Follow up MRI revealed reduction in the size of lesion, contrast enhancing portion of the lesion has reduced significantly.

This young boy who was unfortunately suffering of brain stem SOL, and had no options of surgery was benefited by Cyberknife Robotic Radio Surgery. The patient who comes from a middle income group for whom the same treatment abroad would have been next to impossible could find a cure……………. a treatment ………………. Fortunately at Apollo!


Treatment at par with international standards at a very affordable price.. made this a fantastic first success story that every Apolloites are very proud to talk about………………..!, TOUCHING LIVES


         CT PICTURES BEFORE AND AFTER CYBERKNIFE


 LESION IN THE BRAIN STEM SIGNIFICANT REDUCTION AFTER CK
                                             

CONTRAST ENHANCING PORTION         ALMOST DISAPPEARED

FOR MORE INFORMATION PLEASE WRITE TO lakshmipriya_b@apollohospitals.com

CYBERKNIFE IN TREATMENT OF ACOUSTIC NEUROMAS

CYBERKNIFE IN TREATMENT OF ACOUSTIC NEUROMAS

Dr.Sanjay Chandrasekhar – Senior Consultant Radiation Oncology


Acoustic Neuromas have always been considered ideal targets for radiosurgery.
These tumors generally cause diminished hearing or loss of hearing, giddiness or dizziness, loss of equilibrium or balance and facial nerve paralysis.

Traditionally these tumors have been treated either surgically or with radiation. Surgical removal of these tumors has been associated occasionally with injury to the facial nerve.

Either conventional radiotherapy, Stereotactic radio therapy or single fraction Gamma knife or X-knife radio surgery have been used for patients with Acoustic Neuromas depending on size, symptoms at presentation, cost factor etc.,

Small Acoustic Neuromas are considered ideal targets for stereotactic radiosurgery. Large series of such patients treated with either Gamma Knife or X-knife have been published. The earlier experience with Gamma knife or X- Knife in treating these tumors with a single fraction radio surgery had yielded reasonably good responses and long term tumor control rates.

The incidence of facial nerve injury and diminution of hearing in a sizeable number of patients while using single high dose radio surgery prompted investigators to explore the possibility of using fractionated radio surgery of Acoustic Neuromas.

Fractionated radio surgery has evolved recently with the increased use of the CyberKnife as a potent tool in the management of these benign tumors. The frameless feature of the cyberknife has resulted in bettering patient compliance and comfort. The entire treatment is completed over 3-5 days on an outpatient basis. In addition, the entire treatment is robotically guided increasing the accuracy to a sub millimeter level.

The cyberknife experts worldwide are convinced about the efficacy and safety of the use of fractionated Cyberknife radiosurgery in the treatment of Acosutic Neuromas. The long term tumor control rates and hearing preservation rates have been extremely satisfactory according to them(University of Stanford experience).

You can also read a success story through the following link : accuray.com/uploadedFiles/Suzanne_Patient_Story.pdf