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New Treatment for Depression
Non-invasive
Stereotactic Treatment of Functional Intracranial lesions planned using stereotactic imaging and Leskell GammaPlan software are created non-invasively with the high precision Leskell Gamma Knife. This non-invasive technique offers significant advantages to the patient and provides ideal study conditions for correlating lesion specifications and clinical assessment. The Gamma Knife contains 201 fixed cobalt gamma beams which intersect at a single immovable point within the unit. The beam size can be collimated to 4, 8, 14 and 18 mm's corresponding to beam intersection volumes in which > 50% of the maximum dose is contained within 0.09, 0.57, 2.7 and 5.5 cm3 respectively. A Leskell stereotactic frame is used to establish an MRI based coordinate system within the brain which is used to align each target position with the fixed point of beam intersection. Gamma Knife functional neurosurgery is most commonly performed for patients with trigeminal neuralgia (85% success rate at Miami Neuroscience Center). The trigeminal nerve is targeted using a single 4 mm shot with a maximum dose of 70 to 80 Gy where as Gamma Knife cingulotomies were performed using four 4-mm shots with a maximum dose of 180 Gy (see Figures below). Two successful outpatient Gamma Knife cingulotomies performed for treatment of intractable depression and for intractable lumbar back pain are presented. Case number one suffered from intractable depression. The patient had undergone over 300 electroshock therapies and 52 different inpatient drug regimes without relief of her obsessive compulsive disease. She was referred for Gamma Knife treatment as an intractable patient. Initially the patient received a Gamma Knife subcaudate tractotomy with no response at four months follow up (i.e., the patient's psychiatrist of 10 years jubilantly reported that the patient was playing golf).
Case number two suffered from intractable lumbar back pain and was using a morphine pump for pain management. The patient had been subjected to numerous surgical procedures including a spinal cord stimulator without relief. At one month follow up of the Gamma Knife cingulotomy the patient experienced enough relief to be off of all medications and enjoy normal activities.
According to the 1997 Leskell Gamma Knife society survey, Gamma Knife treatment of functional disorders has been increasing rapidly: 750, 1799 and 3073 treatments as of 1995, 1996 and 1997. Since October of 93, the Miami Neuroscience Center (MNC) has performed 143 outpatient treatments on 103 patients with functional disorder (7.3% of the MNC Gamma Knife radiosurgery case load). The overall mean time required for stereotactic frame placement, imaging, planning, treatment, and sterertactic frame removal at MNC was 3 hours and 21 minutes. For more
information contact: Copyright © 1999 Miami NeuroScience Center |
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