Gamma Knife Perfexion

Stephen Tatter, MD, PhD, neurosurgeon, and Michael Chan, MD, radiation oncologist, co-directors of the Gamma Knife Program at the Comprehensive Cancer Center at Wake Forest Baptist Medical Center, use the Leksell Gamma Knife® Perfexion™, the most advanced stereotactic radiosurgery available, to treat a metastatic brain tumor.

About the Procedure

The Radiation Oncology team at the Comprehensive Cancer Center at Wake Forest Baptist Medical Center has a long history of excellence in the delivery of radiation therapies.

Home to the first Gamma Knife in North Carolina, the stereotactic radiosurgery (SRS) team is among the most experienced in the country. Since 1999 they have treated more than 3,000 patients with Gamma Knife.

The SRS team recently added the latest technology to its cadre of treatment tools. The Leksell Gamma Knife® Perfexion™, the most accurate and advanced stereotactic radiosurgery technology available, is now available at the Comprehensive Cancer Center.

About the Perfexion

For the first time ever, Perfexion offers clinicians the advantage of being able to treat head and neck and cervical spine tumors in addition to the intracranial benign and malignant lesions and vascular malformations typically treated with Gamma Knife.

Gamma Knife stereotactic radiosurgery (SRS) is a method of delivering an ultra-precise, highly focused dose of radiation to the target.

“Gamma Knife is recognized as the gold standard against which other stereotactic radiosurgery technologies are measured,” said Michael Chan, MD, co-director of the Gamma Knife program. “No other technology offers the speed and precision of the Perfexion Gamma Knife and that means patients can return more quickly to their daily lives.”

Based on nearly 50 years of clinical experience, Gamma Knife SRS has become the treatment of choice for selected benign and malignant brain tumors and vascular malformations involving the brain as an alternative to conventional open surgery. Now it is also a treatment option for head and neck and cervical spine lesions.

The treatment plan is carefully designed by a team of neurosurgeons, radiation oncologists and radiation physicists who use high-tech computer planning to precisely conform the radiation dose to the size and shape of the lesion. The unit aims 192 narrow pencil-beams of radioactive cobalt-60 at the lesion. The beams focus precisely on the target tissue, thus minimizing radiation effects to surrounding healthy brain tissues. 

The Perfexion allows all patients to be treated as an outpatient in a single session. The dramatic increase by 300 percent of the treatable volume improves patient comfort and throughput and is expected to greatly expand radiosurgery’s role in the head and neck and cervical spine.

Benefits of Perfexion

  • Unparalleled accuracy
  • Improved normal tissue sparing
  • Improved ability to treat base of skull and upper neck tumors
  • Best-in-class radiation safety and protection

Indications for Gamma Knife:

  • Arteriovenous malformations
  • Benign brain tumors including:
    • acoustic neuromas
    • meningiomas
    • pituitary tumors
  • Malignant brain tumors including high-grade and selected low-grade astrocytomas
  • Brain metastases
  • Malignant skull base tumors
  • Functional disorders including:
    • Trigeminal neuralgia
    • Essential tremor
    • Parkinson ’s disease
  • Cervical, para nasal sinus and pharyngolaryngeal lesions

Who Are Appropriate Candidates for Gamma Knife?

Gamma Knife SRS is appropriate for patients with brain lesions 4 cm or less in maximum diameter, where open surgical options have been exhausted or are contraindicated because of patient age, concomitant medical illness, multiple lesions or location of the lesion.
Lesions that are otherwise considered inoperable or inaccessible often can be treated successfully.
Previous external beam radiation therapy is not a contraindication. In fact, Gamma Knife is an excellent treatment for recurrent, previously irradiated brain metastases and primary brain tumors and appears promising as a boost therapy in newly diagnosed metastases.
It is also an excellent option for patients with acoutstic neuromas in whom preservation of hearing and/or facial function is particularly desirable.
Patients with trigeminal neuralgia who do not respond to medical therapy, and for whom it is desirable to avoid invasive surgical procedures, are excellent candidates for Gamma Knife SRS. Similarly, patients with medically refractory tremor can benefit from radiosurgical thalamotomy.
The Perfexion was first used for radiosurgery of the head and neck in 2006 and is proving to represent a great improvement over other radiosurgical technologies. The dramatic increase of the treatable volume, along with advances in dose planning, are greatly expanding radiosurgery’s role in the treatment of head and neck and cervical spine tumors.

Consultations and Patient Convenience

A concerted effort is made to ensure that every eligible patient is efficiently evaluated and treated. To accomplish this goal patients are promptly seen in consultation. Alternatively, films, clinical history and, if appropriate, pathologic slides can be evaluated in a weekly Gamma Knife conference to determine if travel to Winston-Salem for a formal consultation is desirable or necessary.
The procedure is often conveniently scheduled for the day following initial consultation, eliminating the need for two trips to the Medical Center. On the morning of the treatment, patients undergo head frame placement, neuroimaging and then treatment, all within the span of 4-8 hours.
Clinical imaging follow-up after radiosurgery can be arranged either with the referring physician in their community or at Wake Forest Baptist Medical Center, whichever is more desirable and convenient for the patient.  

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Last Updated: 07-07-2014
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