Gamma-Knife Radiosurgery in Juvenile Nasopharyngeal Angiofibroma

Q: What conditions can be treated with Gamma Knife?

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)

Topics

A rare, benign, but locally aggressive vascular tumor that develops in the nasopharynx, juvenile nasopharyngeal angiofibroma (JNA) mostly affects teenage boys. By destroying nearby tissues and structures, it can act aggressively even though it is histologically benign (non-cancerous). It is essential for patients and physicians to comprehend the nature of JNA, its presentation, diagnosis, and available treatments, including cutting-edge methods like Gamma Knife Radiosurgery.

What is it?

The fibrovascular tumor known as JNA typically begins close to the sphenopalatine foramen, which is situated at the rear of the nasal cavity. Despite being benign, the tumor is well-known for its propensity to bleed heavily, both naturally and during surgery, because of its abundant blood supply.

The study of epidemiology

Age group: Boys between the ages of 10 and 25 are most frequently observed.
Gender: It almost primarily impacts men.
Less than 0.05% of all head and neck tumors are caused by this tumor.

Causes and Symptoms

Early signs and symptoms include:

Nosebleeds that are severe or frequent
Congestion of the nose
Runny nose

As the tumor grows, the symptoms worsen. More severe symptoms may include:

Swelling in your face, particularly in your cheeks
Pain
Eyes that are watery
Eyes that bulge and eyelids that droop
Headaches
Vision loss
Double vision
Loss of hearing
Problems with speech
Apnoea during sleep
Numbness in the face

It is caused by what?

The reasons for JNA are not entirely understood by experts. Hormones are probably involved because these tumors almost exclusively affect men. According to experts, JNA tumors are not inherited.

Risk factors for juvenile nasopharyngeal angiofibroma

For JNA, there aren’t many distinct risk factors. Although JNA is not inherited, you are at a higher risk of developing it if any members of your biological family have familial adenomatous polyposis (FAP), a rare disorder in which precancerous polyps develop in your large intestine. This relationship is still being investigated by experts.

What side effects might juvenile nasopharyngeal angiofibroma cause?

If untreated, can result in:

Having trouble breathing
Speech, hearing, and vision problems
Deformities of the face, such drooping eyelids or protruding eyes
Anosmia is the loss of smell
Severe blood loss and nosebleeds
Shift in mental condition

How is angiofibroma of the juvenile nasopharynx diagnosed?

During an examination, a medical professional can make the diagnosis of JNA. They will examine your nose and then enquire about your symptoms. For additional testing, they can also recommend that you see an otolaryngologist (ENT).

Which diagnostic procedures can be used to identify juvenile nasopharyngeal angiofibroma?

Your doctor will want to perform imaging testing if they suspect JNA. These could consist of:

Computed tomography, or CT, scans.
Magnetic resonance imaging, or MRI.
Scans using PET (positron emission tomography).

To examine the tumor, they might also undertake a nasal endoscopy. A light and camera are attached at the end of an endoscope, which is a long, flexible tube. To view within your nasal cavity, a healthcare professional will carefully insert an endoscope into your nose. You should not experience discomfort since they will apply a numbing spray, which will cause pressure.

What is the course of treatment for juvenile nasopharyngeal angiofibroma?

The recommended treatment for juvenile nasopharyngeal angiofibroma is surgery. Radiation therapy is also necessary for some people.
The location and size of the JNA tumor determine the course of treatment.

Surgery for nasopharyngeal angiofibroma in children

The entire JNA tumor is intended to be removed during surgery. A surgeon may be able to remove the tumor through your nose (endoscopic surgery), depending on its size and location. This procedure will be carried out in a hospital by an otolaryngologist.

Radiation treatment for JNA

Because of its placement, surgeons may not be able to remove the entire tumor in some circumstances. Your doctor might suggest radiation treatment or additional surgery if the tumor cannot be removed or if it returns after surgery. High-energy X-ray beams are used in this treatment to reduce the tumor’s size.

For prevention, there is no known way to prevent JNA tumors.

Gamma-Knife Radiosurgery for Nasopharyngeal Angiofibroma in Children

A non-invasive, extremely accurate type of radiation therapy called Gamma Knife Radiosurgery (GKRS) targets the tumor with concentrated radiation while preserving nearby healthy tissues. It is a promising complement or substitute for surgery in the treatment of JNA, especially when the tumor has intracranial extension or surgery is not practical.

Gamma Knife Indications in JNA:

Remaining tumor after surgery
Recurrence following surgery
Tumors involving the deep base of the skull or the brain
Individuals who are not good candidates for surgery

Gamma Knife Radiosurgery Benefits:

Minimally invasive—no incision during surgery is necessary
Targeting the tumor with high precision while preserving important surrounding structures
Reduced likelihood of problems
An outpatient surgery that requires little recovery time
Outstanding rates of tumor control in long-term monitoring studies

Results:

Research shows tumor control rates of between 85 and 90 percent, with tumors gradually regressing over several months. When surgery is not enough to treat symptoms like nasal blockage and epistaxis, GKRS has been proven successful.

Diagnosis and Monitoring

The majority of patients have outstanding long-term results when they receive the right care. Monitoring for recurrence requires routine imaging follow-up, particularly in the initial years after therapy. MRI scans are advised periodically for patients receiving Gamma Knife treatment in order to evaluate tumor regression.

In conclusion

A difficult but treatable disorder is juvenile nasopharyngeal angiofibroma. Although surgical resection is still the mainstay of treatment, Gamma Knife Radiosurgery has become a useful method for treating inoperable or residual tumors because it provides great control with little morbidity.

To create the optimal treatment plan for every patient, a multidisciplinary team of radiation oncologists, neurosurgeons, ENT specialists, and interventional radiologists is required.

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FAQ’s

How does Gamma Knife work?

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.

Is Gamma Knife a surgery?

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.

What conditions can be treated with Gamma Knife?

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)

Is Gamma Knife painful?

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.

How long does the procedure take?

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

What are the possible side effects?

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.

When can the patient return to normal activities after Gamma Knife?

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.

How effective is Gamma Knife?

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.

Can Gamma Knife be repeated if needed?

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

Is Gamma Knife safe?

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.

Who is eligible for Gamma Knife treatment?

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.

What happens before the procedure?

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.

Will I need anesthesia?

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.

What is the cost of Gamma Knife in India?

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.

Where can I get Gamma Knife treatment in Delhi?

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.

What is the complete process of the Gamma Knife?

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.

What formalities do I have to complete prior to getting the date of GK?

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 –

If using Ayushman Bharat or government schemes, you need approval papers.
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.

What formalities do I have to complete after getting the date of GK?

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.