Posted by - J. Rand Baggesen, M.D.

Last month’s High-Tech Health column focused on the early detection of cancer through the use of new blood tests to find the earliest sign of disease. Interestingly, just last week it was announced that a new blood tests for prostate cancer may commercially available in 2008. The test, ECPA-2, which detects a chemical made principally by cancerous prostate tissue may refine our search for prostate cancer and eliminate many unnecessary biopsies for patients. In patient’s who suffer cancer, as many as 20-40% experience growth to the brain. Here in the United States, 130,000 patients will unfortunately experience metastatic brain cancer annually.

Cancer remains both difficult to diagnose and often progressive despite our best treatments. This month our focus will shift from early diagnosis to treatment. You may be surprised to learn that Richmond has one of the most advanced medical technologies available anywhere in the world called the Gamma Knife. The Gamma knife is not a knife at all. This highly sophisticated piece of equipment focuses 201 beams of radiation to a single focal point enabling physicians to perform brain surgery without an incision. The Gamma knife can be used to treat a variety of medical conditions affecting the brain.

In addition to cancer treatment, the Gamma knife can be used for other brain conditions. Meningiomas are growths of the lining that covers the brain tissue. These can sometimes become large and push on sensitive structures inside the head. Tumors of the pituitary gland can enlarge causing the pituitary to shrink abnormally. Acoustic neuromas are tumors inside the middle ear that can affect hearing and other brain tissue. Arteries and veins can sometimes grow into sponge like structures called arteriovenous malformations. These malformations can occupy areas inside the head where normal brain tissue is displaced. Trigeminal neuralgia is another condition that can be treated with the Gamma knife. One of the nerves providing sensory innervation of the face can become inflamed causing unrelenting face pain.

The Gamma knife uses 201 beams of radiation focused on a single point allowing doctors to precisely target disease tissue without damaging surrounding healthy tissue. Doctors can perform intracranial surgery without a scalpel. Additional conditions that can be treated using the Gamma knife include epilepsy, Parkinson’s disease and chronic pain. Because there is no incision, the risks of infection, bleeding and other adverse reactions to anesthesia are minimal.

The Gamma knife procedure is a four step process. First, a head frame is attached to the patient to ensure stability and accuracy. Patients are given medicine to keep them calm and local anesthetics are used for this essentially painless step. Second, patients undergo imaging to determine the exact size and shape of the target tissue. Using very sophisticated software models, doctors develop a detailed treatment plan during the third step. The fourth and final step is the actual Gamma knife treatment. It usually lasts from 30 minutes to an hour. Most patients are monitored for one hour then go home and returned to their normal routines in one to two days.

As one of only two gamma knife centers in the state of Virginia, CJW’s Gamma Knife Surgery Center utilizes fourth-generation technology from Leksell, the manufacture of the Gamma knife. CJW is designated as a Gamma knife host site by the manufacturer serving as a facility where other medical centers learn and train on the Gamma knife. The Neuroscience Center combines the most advanced technology with exceptionally skilled neurosurgeons, interventional neuroradiologist and state-of-the-art facilities including private suites designed for patient comfort.

As new technologies accelerate in the field of medicine, it becomes more important and more difficult for doctors to maintain knowledge and awareness of these changes. The ability to interact with subspecialists in the hospital setting is an important way to continue the lifelong learning that is being a physician. At the Executive Health Evaluation program, our physicians become intimately involved with health problems of our clients. We provide our patients the time necessary to navigate the complex world of medical care. It is satisfying to have world-class resources at our disposal for our patients when we provide care using the core tenants of the Executive Health program: The right test, for the right reason, with the right medical follow-up.

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