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Gamma Knife in Cavernous Hemangioma

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Cavernous Haemangioma: What is it?

Cavernous Haemangioma_ What is it
Cavernous Haemangioma_ What is it

Cavernous Haemangioma is a kind of vascular lesion that occurs in the brain or spinal cord. It is sometimes referred to as Cavernous Malformation or Cavernoma. It is composed of clusters of abnormally expanded blood vessels that resemble tiny raspberries or mulberries. These deformities are prone to bleeding (haemorrhage) because they are low-flow lesions that frequently contain slowly flowing blood.

Some cavernomas are asymptomatic and are found by chance during MRI scans for other reasons, while others can produce neurological impairments, seizures, migraines, or symptoms similar to a stroke, particularly if bleeding happens.

Important Cavernous Haemangioma Features

  1. Location: The retina, spinal cord, brainstem, or even the brain (cerebral).
  2. Size: Usually falls between a few millimetres and a few centimetres.
 

Signs and symptoms

The most prevalent symptom is seizures.

  • A headache
  • Weakness or numbness
  • Having trouble speaking or seeing
  • Issues with balance (whether in the cerebellum or brainstem)

Reasons/Causes:

  1. Sporadic cases: Take place when there is no family history.
  2. Familial form: Usually linked to several lesions, this kind is inherited due to an autosomal dominant genetic mutation.

Diagnosis

MRI (Magnetic Resonance Imaging) is the most accurate method for diagnosing a cavernous haemangioma. Because of their slow blood flow, cavernomas are typically invisible on conventional angiography, in contrast to arteriovenous malformations (AVMs). These lesions can be detected with great sensitivity using advanced imaging techniques like gradient echo MRI or susceptibility weighted imaging (SWI).

Options for Treatment

The location, size, symptoms, and bleeding risk of cavernous haemangiomas all affect how they are managed.

  • Observation:

Regular monitoring with recurring MRI scans may be recommended for patients who are asymptomatic or only mildly symptomatic, particularly those with tiny or stable lesions.

  • Medical Administration:
  • Drugs that prevent seizures in people who have epilepsy.
  • Medications to treat headache pain.
  • Close monitoring and lifestyle modifications to reduce stress or trauma.
  • Removal by Surgery (Craniotomy):

Microsurgical removal may be an option for symptomatic patients with accessible lesions, particularly those that are causing neurological impairments or recurrent bleeding.

Gamma Knife Radiosurgery: A Less invasive Alternative

Chhabra shunt
Chhabra shunt

A sophisticated, non-invasive procedure called Gamma Knife Radiosurgery uses concentrated radiation beams to precisely target the cavernous haemangioma, particularly in hard-to-reach places like the brainstem or deep-seated brain structures.

Gamma Knife In Cavernous Haemangioma

Gamma Knife Radiosurgery is a secure and efficient alternative, especially for:

  • Lesions in deep or eloquent parts of the brain (such as the brainstem, thalamus, or basal ganglia)
  • Individuals who would not benefit from open surgery
  • After partial surgical resection, residual lesions
  • Recurrent bleeding from lesions that have already been treated

How it Operates:

The cavernoma’s blood arteries are harmed by the Gamma Knife’s many concentrated radiation beams that converge at the target lesion. This reduces the chance of more bleeding without harming the surrounding brain tissue over time by eliminating or reducing the area of injury.

Gamma Knife benefits include:

  • No hospitalisation or incision
  • Painless and with little or no adverse effects
  • High accuracy with millimetre precision
  • Patients who undergo an outpatient procedure return home the same day.
  • Even individuals with high surgical risk or comorbidities can benefit from it.

Restrictions:

  • It could take months for effectiveness to become visible.
  • It is not advised for cavernomas that have resulted in significant bleeding.
  • Rare chance of adverse effects from radiation

In conclusion

A different and frequently unexpected vascular lesion, cavernous haemangioma necessitates thorough assessment and specialised care. Gamma Knife Radiosurgery has become a ground-breaking technique, providing a safe, efficient, and non-invasive alternative for deep or dangerous lesions, even though surgery is still the gold standard in some situations.

It’s important to speak with a neurosurgeon skilled in both standard and radiosurgical methods if you or a loved one has been diagnosed with a cavernous haemangioma in order to choose the best course of action for your situation.

Source:

  1. https://pmc.ncbi.nlm.nih.gov/articles/PMC4600992/
  2. https://en.wikipedia.org/wiki/Cavernous_hemangioma
  3. https://radiopaedia.org/articles/cerebral-cavernous-venous-malformation
  4. https://www.nhs.uk/conditions/cavernoma/
  5. https://my.clevelandclinic.org/health/diseases/21594-cavernous-hemangioma
  6. https://www.aurorahealthcare.org/services/aurora-spine-services/cavernous-hemangioma
  7. https://www.healthline.com/health/cavernous-hemangioma
  8. https://pubmed.ncbi.nlm.nih.gov/15662812/
  9. https://pubmed.ncbi.nlm.nih.gov/27341049/
  10. https://www.nature.com/articles/s41598-019-56119-1
  11. https://ro-journal.biomedcentral.com/articles/10.1186/s13014-021-01885-4
  12. https://karger.com/ced/article/54/2/196/906781/Gamma-Knife-Stereotactic-Radiosurgery-for-Cerebral
  13. https://journals.lww.com/neurosurgery/abstract/2010/09000/gamma_knife_surgery_for_cavernous_hemangiomas_in.7.aspx
  14. https://www.sciencedirect.com/science/article/abs/pii/S1878875018328699
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You May Also Know Related to Gamma Knife
FAQ’s

Gamma Knife uses 192–201 precisely focused beams of gamma rays that converge at a single target point in the brain. This high dose of radiation damages the DNA of abnormal cells, stopping their growth or causing them to shrink, while minimizing exposure to nearby healthy tissue.

No, Gamma Knife is not a traditional surgery. It is a non-invasive outpatient procedure performed without any incision, stitches, or general anesthesia in most cases.

Gamma Knife is commonly used for:

Brain tumors (benign and malignant)
Metastatic brain lesions
Arteriovenous malformations (AVMs)
Trigeminal neuralgia
Acoustic neuromas (vestibular schwannomas)
Pituitary tumors
Certain functional disorders (like tremors)

The procedure is generally painless. Patients may feel mild pressure while the head frame (if used) is applied or may experience slight discomfort from anesthesia injections, but the treatment itself is not painful.

Depending on the condition and treatment plan, Gamma Knife may take 30 minutes to 3 hours. Most patients go home the same day.

Common side effects are usually mild and temporary, including:

Headache
Nausea
Fatigue
Mild scalp swelling or tenderness at the frame site
Rarely, some patients may experience delayed radiation effects such as brain swelling or radiation necrosis.

Most patients can return to their normal routine within 24–48 hours after the procedure.
You may feel mild fatigue for a few days.
Follow-up imaging is usually required after 1 year.

Gamma Knife has a high success rate and has been used worldwide for decades. Its effectiveness depends on the condition treated, size and location of the lesion, and overall patient health. In many cases, it offers results comparable to open surgery with fewer risks.

Yes, in some cases Gamma Knife treatment can be repeated if the disease recurs or if new lesions develop.

Yes. Gamma Knife is considered one of the safest and most precise forms of radiosurgery, with millions of patients treated globally and extensive clinical data supporting its use.

Eligibility depends on factors such as:

Size and location of the lesion
Overall health and age
Whether open surgery is too risky
A neurosurgeon and radiation oncologist will decide if Gamma Knife is the best option for you.

A detailed MRI or CT scan is performed to map the brain.
A lightweight head frame or mask is used for accuracy.
Your doctors plan the radiation dose and target areas using specialized software.

Local anesthesia is given if a head frame is used.
General anesthesia is usually not required, except for children or patients unable to remain still.

Costs vary depending on hospital, city, and condition treated. On average, Gamma Knife in India ranges from ₹1.5 lakh to ₹4.5 lakh. It is usually more affordable compared to treatment in Western countries. At AIIMS Delhi, it is much more affordable around ₹75,000 which makes it affordable for the patients in need.

AIIMS Delhi is one of the leading centres for Gamma Knife in India.

AIIMS uses the latest Gamma Knife Perfexion system.

It has successfully treated thousands of patients for brain tumors, blood vessel problems, and even eye cancers.

The treatment is done by expert neurosurgeons such as Dr. Deepak Agrawal and team.

Clinic timings for Gamma Knife OPD at AIIMS Delhi: Monday & Friday, 8:00 AM – 9:00 AM.

Cost is around ₹75,000 and is subsidized compared to private hospitals.

The whole procedure is usually done in one day:

  • Consultation & Planning – Doctors review your scans and decide the treatment.
  • Head Frame/Mask – A lightweight frame or mask is placed to keep your head still.
  • Imaging – MRI/CT scans are done to locate the exact target.
  • Treatment Planning – Specialists plan the dose and direction of radiation.
  • Gamma Knife Treatment – You lie on the machine; painless radiation beams treat the target (30 mins–3 hrs).
  • Recovery & Discharge – The frame is removed, and most patients go home the same day.
  • Follow-up – MRI after a few months to check results.

Before you get a treatment date, you need to complete a few steps:

  • OPD Registration – Visit the Neurosurgery OPD (Gamma Knife clinic at AIIMS, Mon & Fri 8–9 AM) and register.
  • Consultation with Doctor – Meet the neurosurgeon who will check your reports, MRI/CT scans, and medical history.
  • Investigations – Sometimes fresh MRI/CT or blood tests are needed for treatment planning.
  • Medical Fitness – Basic checks like blood pressure, sugar, heart condition, etc.

Financial/Insurance Approval –

  1. If using Ayushman Bharat or government schemes, you need approval papers.
  2. If self-paying, you will be given the estimated cost (~₹75,000 at AIIMS).
  • Consent & Admission Slip – Once doctors confirm you are fit and formalities are done, you sign the consent form.
  • Treatment Date Allotment – A date is given for your Gamma Knife procedure.

Once you receive your Gamma Knife date, you’ll need to do a few simple things before the procedure:

  • Admission Process – Report to AIIMS on the morning of your procedure and complete admission at the Neurosurgery ward/Daycare.
  • Paperwork – Carry your OPD slip, MRI/CT films, blood test reports, admission slip, and ID proof. If you are covered under Ayushman Bharat/insurance, keep those approval papers ready.
  • Consent Forms – You (or a family member) will sign consent for the procedure and anesthesia.
  • Medical Check-up – Doctors will check your BP, sugar, heart rate, and do a quick physical exam.
  • Fasting – Usually, you will be asked to not eat or drink for 6 hours before the procedure.
  • Pre-Procedure Prep – An IV line may be put, and medicines (sedation/antibiotics if needed) are given.
  • Treatment – You are then taken to the Gamma Knife room for frame/mask placement, imaging, and treatment.

After the procedure, you’ll be observed for a few hours and most patients are discharged the same day or next morning.

Urea & creatinine

No, You can have light breakfast.

Yes, you can take the medicine and then come for the treatment.

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