Just last week neurosurgeons at the Cleveland Clinic got their hands on some brand new technology. The Perfexion is the latest version of the GammaKnife and it isn't really a knife at all, but a machine that targets and destroys brain tumors with radiation. Compared to the old version, manufacturers claim the new machine is safer, easier to use, and treats a larger area of the head and neck. The recent upgrade is part of the Clinic's attempt to stay on the leading edge of ever-evolving biomedical technology. Dr. Gene Barnett, associate director of the Clinic's GammaKnife Center feels this goal is in-step with offering the highest quality patient care.
Gene Barnett: It's clear that this is a very powerful device and that there's an increasing need, in terms of our patients, for radiosurgery of the brain and other parts of the body as well.
Radiosurgery devices like the GammaKnife obliterate the cells they target with hundreds of highly focused beams of intense radiation, and the surgeon never even raises a scalpel. Gamma rays, like x-rays, are not impeded by bones or flesh - the beams travel right through the skull and converge in a single, tiny spot. Dr. Barnett explains that alone the beams are harmless - but combined they are lethal.
Gene Barnett: If you take a magnifying glass out on a bright sunny day and you focus it down to a point, at that point it's really hot and you can even burn a piece of paper with it, but anyplace else underneath that magnifying glass is nice and cool. It's the same for radiosurgery - it's where all the beams of radiation converge or come together, that's what gets treated while the rest of the head or brain gets none from the beams that go in or out.
Patrick Baron spent 8 days in the hospital after brain surgery, and took medication that made his skin turn green all before he had GammaKnife treatment. The difference he said, was like night and day.
Patrick Baron: The gamma knife was absolutely painless; the only discomfort throughout the whole procedure was the screws going in to hold the brace.
The Cleveland Clinic where Baron had his GammaKnife treatment has been performing radiosurgery in some form for more than a decade, and the GammaKnife is now the standard of care for treating brain cancers that have spread from other parts of the body. For some patients it's one of several treatment options, and for others it might be the only option- like in the case of certain breast cancers that don't respond to drugs.
Gene Barnett: With the new treatments that help control body breast cancer like Herceptin, many patients unfortunately fail with tumors that have gone to the brain because Herceptin does not get into the brain, so they need treatments that can control those tumors and yet doesn't harm the rest of the brain and the GammaKnife Perfexion is a good unit for that.
But radiosurgery can be used to treat more than tumors. It's being successfully used to treat a painful condition of the facial nerves known as trigeminal neuralgia and to correct malformations of blood vessels in the brain and even abnormal rhythms of the heart. And that may be just the tip of the iceberg. Researchers say that depression, drug addiction and back pain may one day also be candidates for radiosurgery.
The cost of these devices is expensive - the Cleveland clinic spent nearly $3 million upgrading its existing gamma knife, and a new one costs five million dollars. But Dr. Barnett insists that dollar for dollar, radiosurgery is a better value
Gene Barnett: There is no hospital stay there's no anesthesiologist, their's no nursing team there's no or time which cost's hundreds of dollars per minute, it's really a relatively low-cost procedure compared to many of the alternatives and what's even better is that it often is, as effective if not better.
And while the many promises of radiosurgery remain to be seen, the long term value may not be in the cost savings of single surgeries, but in creating en environment of leading-edge research. Gretchen Cuda, 90.3.