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News Article
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Brain Surgery Without a Knife
By Sandy Kleffman
CONTRA COSTA TIMES
April 28, 2004
WALNUT CREEK - Just minutes after having major "surgery" on a small brain tumor, Patricia Larson joked with her doctor and felt no pain.
She would be home by midafternoon.
The 76-year-old Bethel Island resident took advantage of new state-of-the-art equipment at John Muir Medical Center, Walnut Creek Campus for stereotactic radiosurgery, a procedure that avoids cutting, blood and a lengthy recovery time.
Doctors gave her some numbing medication and she remained alert as specialists treated her meningioma, a noncancerous brain tumor.
"This is really tremendous, when you think I would have had to have open-scalp surgery," she said.
Stereotactic radiosurgery has grown in popularity in recent years, changing the definition of an "inoperable tumor."
It is not surgery in a traditional sense. Instead of cutting open the scalp, doctors deliver a dose of high-energy radiation to kill tumor cells or halt their growth.
It can be used on a variety of cancerous and noncancerous tumors.
For a brain tumor, a neurosurgeon first attaches a metal frame to a patient's head. The frame holds the head still and aligns reference markers in a fixed position.
Medical specialists then use computer tomography, magnetic resonance imaging or other imaging tests to produce three-dimensional views of the growth to determine its precise size, shape, location and relationship to other brain structures.
After specialists devise a treatment plan, the patient lies on a table with the head frame secured to prevent the patient from moving.
The machine then moves around the patient, aiming the radiation at precisely the correct angles.
The machine continuously reshapes the beam to match the size and shape of the tumor from different angles. This helps protect healthy tissue and reduces damage to delicate structures such as the brainstem and spinal cord.
"Because the radiation is so focused and so accurate, this really redefines the whole field of what is inoperable because we can do radiosurgery on many things we wouldn't want to do conventional surgery on," said Dr. Terence Chen, medical director of neurosurgery services at John Muir, Walnut Creek Campus.
It makes it easier to reach cancerous growths deep within the brain.
Doctors at the John Muir Health also plan to use the equipment to attack some spinal, eye, prostate, colon, liver, lung, breast, pituitary and other forms of cancers and growths.
Such machines can target radiation to an accuracy of half a millimeter, or about 1/50th of an inch. That's getting close to the accuracy of a surgeon's scalpel, Chen said.
The John Muir Health has performed such procedures since January with its Novalis Shaped Beam Surgery system, purchased with a donation from the John Muir Health Foundation. The cost, including installation and modification of rooms, came to $3.5 million.
John Muir Health became the only hospital in Northern California and the 21st in the nation to buy a Novalis system. The manufacturer, BrainLAB, has sold more than 30 systems worldwide.
Three other Northern California hospitals, all associated with universities, have equipment by other manufacturers for performing stereotactic radiosurgeries. UC San Francisco, Stanford and the UC Davis Cancer Center use machines known as a Gamma Knife or Cyber-Knife, Chen said.
This marks the first time such technology has been available in the East Bay.
"It's where medicine is going and has been going for the last couple of decades, which is using an interdisciplinary approach to solve a problem," said Dr. Vincent Massullo, chairman of radiation oncology at John Muir Health.
Not everyone is sold on the procedure. Critics say there have not been adequate studies to determine the long-term benefits of radiosurgery over traditional operations, including how effective it will be at preventing recurrences.
But while it isn't suited for everyone, John Muir Health doctors say they are excited with the option.
"I don't want to use the word revolutionary, but this really is akin to that," Chen said.
"You turn a hospital stay with maybe four to eight hours of general anesthesia, plus a week in the intensive care unit, maybe followed by another couple (of) weeks in rehab recovering from a brain surgery ... you turn that into a couple (of) outpatient visits where you drive home."
Even after a traditional operation, John Muir Health doctors sometimes use the new equipment to attack residual growths that have spread from a tumor to surrounding tissue. "It's basically used as a clean-up tool," Chen said.
Clayton resident Shirley Kaminski became one of the first patients treated with the new equipment at John Muir Health.
In May 2003, doctors diagnosed her with multiple myeloma, a rare but aggressive cancer that originates in bone marrow. The tumor damaged her spine, causing severe back pain and numbness in her legs.
Doctors first treated her with chemotherapy and traditional radiation. That left her tired and feeling sick. She lost weight.
A few months later, the tumor returned.
Doctors then decided to give Kaminski five outpatient treatments of radiation with the Novalis equipment. Today she is no longer on pain medication and has returned to full-time work and hobbies, including yoga.
"Rather than subject a patient to noxious therapy of some sort, this is a relatively innocuous treatment," Massullo said. "So it's heartening.
"The reason this technology came to the fore at this point in time is because of the vast improvements in energy technology. I liken it to having a guided missile."
(Posted April 30, 2004)