Gamma Knife: A healthy dose of awareness means earlier treatment, better outcomes

"Where's the MRI?" Gregory House of TV's House, MD, might scream at his team of diagnostic sleuths. 

On another night, Neurosurgeon Derek Shepherd treats complex disorders of the brain and nervous system on Grey's Anatomy. 

And one of the most popular storylines of the long-running E.R. was the one about beloved character Dr. Mark Green succumbing to brain cancer. 

The intricacies of the human brain, and the advanced tools available to treat its injuries and diseases, have become part of our collective consciousness thanks to shows like these as well as the forensic drama, CSI, where technology gets top billing. 

We marvel at hi-tech tools that seem like science fiction, but in truth Lancaster County has long been on the cutting edge of medical advances. Neurosurgeon Bill Monacci, fellowship-trained in cranial base and micro-neurosurgery at George Washington Hospital in Washington, D.C., was drawn to practice in Lancaster because of the investment in medical technology here. As Former Neurosurgery Consultant to the Army Surgeon General, he has been on the front line of technology targeted to treating the brain. 

Dr. Monacci, of Lancaster Neuroscience and Spine Associates, applauds the public's heightened awareness of all things medical. He says that fear of the unknown very often kept people from seeing a doctor, which could mean that their pain increased, and the condition became inoperable.

"We see patients who have symptoms like loss of balance, blurred vision, hearing difficulties or stabbing pain," he said, "and they may have seen a show about it, or done a search on the Internet. They have a greater awareness of what the symptoms might mean, and they are more likely to seek medical attention." 

Among the most prominent tools in the arsenal of brain surgeons is Gamma Knife surgery, also called Stereotactic Radiosurgery. You may not have heard these words in any fast- paced TV dialogue, but you probably will. The increasing role of Gamma Knife in treating tumors and facial pain and other brain-related problems is a story worth telling. 

"When patients learn that we can often treat them without an incision in a single half-day outpatient session resulting in very rapid recovery and minimized side effects, they are relieved and encouraged," he said.

Gamma Knife is not a knife at all. It is a non-surgical device that delivers low intensity, highly concentrated radiation – to stop a growth, eliminate an abnormality, or relieve symptoms. It sends 201 targeted beams of gamma radiation to the exact location of the tumor. Each beam is too weak to harm the healthy part of the brain, but converged on their target, the gamma radiation beams are strong enough to destroy tumor cells. An alternative to conventional brain surgery and whole brain radiation, the treatment is performed in an outpatient session. Patients typically get back into their normal activities the same day. Today it is one of the most important tools for treating brain problems. 

Dr. Monacci described two patients he treated very recently at the Lancaster General Gamma Knife Center. One was a Lancaster woman in her fifties, a wife and mother who was suffering unrelenting facial pain. She had gone to see her dentist, and an E.N.T. specialist, and underwent appropriate tests. "This was searing pain," he explained, "around her nose and mouth. It prevented her from sleeping, and the simple act of chewing would bring on the

pain, so she couldn't eat." When her MRI scan ruled out other possible causes, she was evaluated and underwent treatment by the Gamma Knife team for what they discovered was trigeminal neuralgia, a chronic and disabling pain syndrome that strikes a nerve that supplies sensation to the face. "I never saw a happier patient," Dr. Monacci recalled after her procedure. "Her quality of life was markedly improved." In her case, the radiation beams were focused on the problem nerve to eliminate the pain while leaving normal function of the nerve. 

Another patient, a 53-year old Lancaster man was starting to lose his hearing, and tests revealed a benign brain tumor that typically causes hearing loss in adults. Before the availability of Gamma Knife radiosurgery, he would have needed open brain surgery, faced two to three months recovery, and still had the potential for further hearing loss and loss of facial motion. But with Gamma Knife treatment, his hearing loss was minimized. He was in and out in one morning and able to return to full work activity the next day. 

Lancaster General has offered Gamma Knife technology since1999, one of the first community hospitals in the country to do so. Two of Dr. Monacci's partners, Dr. Eddy Garrido and Dr. John Gastaldo, were the first neurosurgeons to perform Gamma Knife radiosurgery, teaming with radiation oncologists, radiation physicists, and specially trained nurses at Lancaster General's Gamma Center. As a result, and with advances in MRI technology that more precisely target tumors, area residents have benefited greatly from the level of technology and skill here - on a par with or above that of leading medical centers. 

It's a "one-two-three", the three surgeons concur -- patient awareness, advanced technology, and teamwork by physicians and hospitals -- that leads to early testing and treatment. "That can make a big difference in the prognosis and in what choices we have to treat each patient," Dr. Monacci concluded.