Jerry Lesser, MS, RNC, ACRN, Program Director of the Gamma Knife Center, has a terrific Gamma Knife article in the June 2012 issue of InReport, New York Presbyterian Hospital’s (NYPH) Nursing Newsletter. The article gives an informed, moment-by-moment account of what a patient might go through on a typical treatment day at Columbia Neurosurgery’s Gamma Knife Center. We have reprinted Ms. Lesser’s article here:
Developed in Sweden in 1968, the Gamma Knife Perfexion® (GK) uses a single dose of Cobalt 60 radiation through the intact skull to a small, precisely located area of the brain. It delivers targeted treatment doses to lesions while sparing healthy surounding tissue. This targeted treatment can cause certain brain tumors and arteriovenous malformations (AVM’s) to shrink or even disappear over time.
The patient’s conformal dosage plan is based on a treatment day MRI after a stereotactic head frame has been attached by the neurosurgeon and registered nurse (RN). Although the actual GK treatment can take anywhere from 15 minutes to several hours, a significant amount of time needs to be devoted to preparation. The GK treatment is painless and noiseless.the patient often falls asleep during the treatment listening to soft music.
Typically, the GK patient is first seen by a GK neurosurgeon, radiation oncologist and RN to determine whether they are a GK candidate, and to discuss treatment expectations, pros and cons of treatment and what to expect on treatment day. A number of factors are taken into consideration to develop a plan, including the patient’s diagnosis.
The GK can treat brain metastases, primary brain tumors such as meningioma, acoustic neuroma, and/or gliomas, AVMs, and functional disorders such as trigeminal neuralgia, epilepsy, and Parkinson’s disease. At NYPH the functional disorder we treat is trigeminal neuralgia, and we are participating in a clinical trial for epilepsy.
GK is used on lesions measuring 3 centimeters or less. Lesion location and other comorbidities or physical restrictions are taken into consideration. For example, can the patient lie flat for treatment or are they too sick to undergo GK and reap the benefits.
The patient arrives at 6 a.m. on treatment day. Patient identity is verified and vital signs are taken. Ativan (lorazepam) 0.5 mg by mouth or sub-lingually is given and the patient is screened for MRI. In preparation for the head frame attachment, local injections of lidocaine and marcaine are given in the forehead and back of the head where the non-ferromagnetic head frame will be attached based on the location of the lesion(s).
The headframe is placed by the neurosurgeon and the RN. This process generally takes 3–5 min. The patient can expect to feel a lot of pressure during the attachment but should be numb enough not to feel pain. The pressure eases up in about 3 minutes. This is the only time during the process when the patient may feel discomfort.
Painless measurements of the head are taken by the neurosurgeon and the nurse which will be used in the radiation dose planning. The patient is then brought to MRI for a brain scan with contrast to make sure we can see the lesion(s) we need to treat and perhaps discover any new lesions that can be treated. Many patients are claustrophobic in the MRI so more Ativan might be indicated.
Once the MRI is done (in approximately 20 minutes) the scans are sent by computer to the GK where they are used as a basis for the radiation treatment plan. The planning is done jointly by the neurosurgeon, radiation oncologist and medical physicist. This can be a half hour to two hour process, depending on the complexity of the lesions seen. During this time, the patient may sleep, eat or spend time with their visitors.
When the treatment plan is done the patient is informed how long he or she will be on the GK treatment table. The patient is supine on the mattress/table with his or her head frame locked in a fixed position. The machine is quiet, lights are dimmed and soft music is piped in. The patient is monitored by camera and microphone for the duration of the treatment.
When the treatment is completed, the patient’s head frame is removed and the head frame attachment sites are cleaned, packed with antibiotic ointment and covered with bandaids. We rarely see bleeding at these sites. A pressure dressing is applied which the patient may remove in two hours. The patient is discharged to home when stable, usually within a half hour, with a family member or other companion.
If the patient has a headache from the frame, acetaminophen or ibuprophen may be given. Verbal and printed discharge instructions are reviewed with the patient and family with ample time for questions and answers. We also used the time while the patient was on the treatment table to begin review of the discharge information with the family. Emergency phone information is also provided.
Gamma Knife is one of many treatment procedures available at NYPH that allow the patient to continue with his or her daily lifestyle with minimal interruptions for treatment. According to our unit-specific Patient Satisfaction Surveys (we are consistently rated 90-95% in all questions posed), the patients are very happy and satisfied with their care.
Jerry Lesser, MS, RNC, ACRN
The Gamma Knife Center
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