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Gamma Knife High Cervical Lesions

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The development of neurosurgical methods has completely changed how we treat intricate brain and spinal lesions. The Gamma Knife radiosurgery, a highly accurate, non-invasive technique used to treat a range of neurological disorders, is one example of this invention. Although it is most frequently linked to vascular malformations and brain tumours, its use in high cervical spinal lesions has led to significant developments in targeted treatment with low morbidity.

Gamma Knife High Cervical Lesions
Gamma Knife High Cervical Lesions

For patients, carers, and medical professionals looking for clarification on this innovative therapeutic alternative, this page provides a thorough description of the Gamma Knife’s function in treating high cervical lesions.

High Cervical Lesions: What Are They?

High Cervical Lesions What Are They (1)
High Cervical Lesions What Are They (1)

Abnormalities (such as tumours, arteriovenous malformations, or other pathological disorders) found in the topmost section of the cervical spine, especially including vertebral levels C1 to C3, are referred to as high cervical lesions. The spinal cord, vertebral bodies, or other neuronal and vascular systems may be affected by these injuries.

High cervical lesions that are common:

  • Benign tumours (such as schwannomas and meningiomas)
  • Malignant tumours, such as chordomas and metastases
  • AVMs, or arteriovenous malformations
  • Paragangliomas or glomus tumours
  • Hemangioblastomas
  • Recurrent or postoperative persistent lesions

High cervical lesions pose a considerable danger during open procedures and are difficult to access surgically due to their close proximity to the brainstem, cranial nerves, spinal cord, and vertebral arteries.

Why Treat High Cervical Lesions with Gamma Knife?

The anatomical complexity and surgical risk of the high cervical area are caused by:

Why Treat High Cervical Lesions with Gamma Knife
  • Closeness to the spinal cord and brainstem
  • Important neurovascular structures are involved.
  • Due to the deep placement, there is limited surgical exposure.
  • Open surgery carries a high risk of neurological morbidity.

In certain situations, the Gamma Knife presents an alluring substitute, especially when:

  • The size of the lesion is small to medium.
  • Because of their age and comorbidities, the patient is not a good candidate for surgery.
  • Previous radiation or surgery has not worked.
  • Surgical access is thought to be excessively complicated or dangerous.

How Do You Use a Gamma Knife?

How Do You Use a Gamma Knife
How Do You Use a Gamma Knife
  1. Planning Before the Procedure

To precisely determine the size, location, and features of the lesion, the patient is subjected to high-resolution imaging, typically MRI, CT, and/or angiography.

  1. Positioning of the Stereotactic Frame or Mask

The patient’s head and upper cervical spine are immobilised using a stereotactic frame (or thermoplastic mask in frameless systems) to guarantee sub-millimeter accuracy.

  1. Planning for Treatment

Using specialised software, a multidisciplinary team of medical physicists, radiation oncologists, and neurosurgeons creates a personalised radiation plan that maximises the dose while safeguarding adjacent vital structures.

  1. Delivery of Radiation

The Gamma Knife equipment applies concentrated radiation to the target area while the patient is lying on the treatment couch. Depending on the complexity, the treatment usually takes between thirty minutes and two hours.

  1. Recovery After Treatment

Most patients are able to return home the same day and return to their regular activities in a day or two.

Gamma Knife Advantages for Severe Cervical Lesions

Gamma Knife Advantages for Severe Cervical Lesions
Gamma Knife Advantages for Severe Cervical Lesions
  • Non-invasive: No general anaesthesia or incision
  • Accurate targeting: Reduces harm to nearby spinal cord or brainstem
  • Lower risk: Particularly in regions that are unreachable for surgery
  • Outpatient process: Quick recuperation
  • Repeatable: Useful in the event that the lesion returns
  • Cost-effective: In contrast to lengthy hospital stays and open surgery

Restrictions and Things to Think About

Despite its strength, the Gamma Knife is not always appropriate. Among the limitations are:

  • Size restriction: Less effective for tumours larger than 3–4 cm
  • Response time delay: The effects of radiation might last for weeks or months.
  • Not always effective: Particularly for tumours that are aggressive or developing quickly
  • Possible radiation hazards: Oedema, radiation necrosis, or delayed neurological signs are uncommon but potential side effects.

The optimum course of treatment must be determined by evaluating each situation separately.

Clinical Results and Supporting Data

The Gamma Knife has demonstrated encouraging results in treating upper cervical lesions in a number of clinical investigations and case series, specifically:

  • Over 80–90% of benign tumours, such as meningiomas and schwannomas, have tumour control rates.
  • Notable decrease in neurological symptoms and pain
  • Few problems in patients who were carefully chosen

Particularly when used as a supplement or substitute for surgery for high-risk lesions, the Gamma Knife has proven to be a safe and efficient technique.

 In conclusion

Combining accuracy, safety, and effectiveness, Gamma Knife radiosurgery is a revolutionary method for treating lesions in the upper cervical spine. By providing a targeted, minimally intrusive solution, Gamma Knife gives hope to patients with anatomically complex lesions or those who face surgical risks.

Multidisciplinary examination is still crucial, as always. To ascertain whether Gamma Knife is the best course of action for their illness, patients should speak with a radiation oncology team and a specialist neurosurgeon.

Source:

  1. https://pmc.ncbi.nlm.nih.gov/articles/PMC9486226/
  2. https://pubmed.ncbi.nlm.nih.gov/27663880/
  3. https://www.jkns.or.kr/upload/pdf/0042004144.pdf
  4. https://link.springer.com/article/10.1007/s00701-016-2964-4
  5. https://spinesummit25.eventscribe.net/fsPopup.asp?PosterID=721856&mode=posterInfo
  6. https://www.researchgate.net/publication/326174467_Gamma_Knife_Radiosurgery_For_Upper_Cervical_Spine_Lesions_Frame_Fixation_at_Maxilla
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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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