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Gamma
Knife Treatment for Pediatric Patients
Indications
The principles
for Gamma Knife radiosurgery treatment in children are generally the same
as those for adults. The common conditions requiring treatment include
brain tumors and vascular malformations. Specific tumors that are treated
include ependymoma, medulloblastoma, germinoma, and astrocytoma. All of
these tumors are generally treated by surgery first. If residual tumor
remains, a combination of other treatment, including radiosurgery and/or
chemotherapy may be recommended. One advantage offered by radiosurgery
over conventional external beam radiation in children is that the remainder
of the brain only receives a very small dose of radiation. This reduces
the late effects of radiation to the brain. For vascular malformations,
if part of the lesion remains after surgery, or if the lesion is very
deep in the brain, then radiosurgery can in most patients cause obliteration
of the lesion.
Anesthesia
Gamma Knife treatment
involves three steps that often make it very difficult for children to
undergo the procedure awake. The first portion of the procedure is the
placement of a metal frame on the head. This frame is actually attached
to the skull with four sharp pins. Although adults are usually able to
tolerate the placement of the frame with local anesthesia, most children
cannot. The second step is a detailed MRI scan. Again, since the patient
must lie completely still, anesthesia is often required for children.
(For vascular malformations, an angiogram is also done immediately after
the MRI scan). The actual radiation treatment, the last step, involves
moving the patient into a small enclosed space for several minutes at
a time. Although not painful at all, the experience can be frightening
for a small child. Depending upon the age of the child, general anesthesia
may be required for the first two steps or all three. For all children,
the Gamma Knife treatment is arranged in conjunction with a pediatric
anesthesiologist who is in attendance during the entire procedure. Anesthesia
is tailored to the requirement of the child. At the end of the radiation
treatment, the frame is removed and the patient is transferred to the
pediatric recovery room where the anesthesia is allowed to gradually wear
off. Most patients are discharged at the end of the day.
Preparation
Before the day
of treatment, all children and their parents will meet the pediatric neurosurgeon
and radiation oncologist to discuss the nature of the procedure and any
special considerations. An additional evaluation is done in the Prepare
Clinic by the Anesthesia department to ensure that the patient is ready
for the procedure.
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