Kraus Back and Neck Institute in Houston, TX spinehealth.com

Relief from Lower Back and Neck Pain

 
surgery optionsavoid surgery
      At the Kraus Back and Neck Institute (KBNI), we specialize
                 in non-surgical as well as surgical treatments
                                of Back and Neck  Pain
     Conservative to Surgical Options: MINIMALLY INVASIVE SPINE SUGERY 
              
 "Applying Science to the Art of Medicine"                                                  
                              .....................................................................
  
                       
                 Dr. Kraus is available for Neurosurgery consultation (surgical and non-surgical) in Houston.
                      Offices:  1) West Houston Medical Center
                                    2) Memorial Hermann Memorial City Hospital
                                    3) Katy
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      To arrange  an appointment, call 281-870-9292,  visit  neurosurgerypa.com
or   send an e mail
              For national and international patients, we can help with  travel arrangements
                                
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                                            Dr. Kraus is honored to be listed in
                                            "Best Doctors in America" (2001-2008) and
                                             "Top Doctors of Houston, Texas" (2007, 2008, 2009)     

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   last updated
  June 19, 2009

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Gamma Knifegamma knife houston, texas united states

 



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       Gamma Knife
Houston, Texas (TX), USA

Gamma Knife stereotactic radiosurgery is an alternative to open brain surgery, in many cases.  It is very useful at treating certain benign and malignant tumors of the brain (acoustic neuromas, meningiomas, metastatic brain tumors), facial pain (trigeminal neuralgia), blood vessel malformations of the brain (AVM, or arteriovenous malformations).  The Gamma Knife consists of 201 beams of radiation, emitted by radioactive cobalt, focusing on one area of the brain.  Generally, patients go home the same day.  The name Gamma Knife radiosurgery is derived as follows.  The gamma rays are the energy beams which focus upon the lesion, and are derived from radioactive cobalt.  The term radiosurgery comes from the fact that the reaction of the targeted tissue is more similar to the reaction the tissue would undergo from a surgery (where brain tumor is removed) than from traditional radiation therapy.  Stereotactic means that the beams of radiation all focus upon one point.

My experience with Gamma Knife radiosurgery began in June, 1999, when I started the Gamma Knife program at the Wallace Kettering Neuroscience Institute, at Kettering Medical Center, in Kettering Ohio.  I trained at the Gamma Knife Center under Dr. Bengt Karlsson at the Karolinska Insttitue in Stockholm, Sweden.  I also trained at the Gamma Knife Center at the Cleveland Clinic under Dr. Gene Barnett.  While I was medical director of the Gamma Knife facility at Kettering (Wallace Kettering Neuroscience Institute), the center had performed over 500 Gamma Knife procedures.  I have always been very impressed with this incredibly accurate machine, which I feel gives patients with certain lesions and disorders of the brain, a good chance for success, with relatively low risk. 

In November, 2004, I moved to Houston , Texas, to develop and become Medical Director of  the Neuroscience Center, and Medical Director of the Gamma Knife Center, at West Houston Medical Center.  The Gamma Knife Center has the Model C Gamma Knife, which one of the  most sophisticated Gamma Knife units, allowing for the incredible precision and accuracy of the Gamma Knife Models U and B (earlier models of the Gamma Knife), with the addition of an Automated Positioning System, which reduces the time the patient is in the Gamma Knife room during treatment.

The number of patients treated worldwide, with the Gamma Knife, is increasing on an exponential basis. 

Here in Houston, we treat patients from the Houston area, as well as from other states and abroad.

If you would like more information about Gamma Knife, and whether it may be of benefit to you, please contact the office of

Gary E. Kraus, M.D.
neurosurgeon
Neurosurgery, P.A.
Medical Director, Neuroscience Center
Medical Director, Gamma Knife Center
West Houston Medical Center
Houston, Texas

Clinical Assistant Professor
Department of Neurosurgery
University of Texas Medical School at Houston
Houston, Texas, USA


tel:  281-870-9292
fax:  281-870-8493
website: 
neurosurgerypa.com

The Gamma Knife Team in Houston Texas supports the treatment of patients within the greater Houston area, Texas, many regions of the United States, as well as Mexico and Puerto Rico.  There is easy access for international patients from Saudi Arabia and Dubai.  If there are any questions, please contact us.  We would be happy to help with the arrangement of hotel and transportation accomodations.  For patients from Mexico or Puerto Rico, we are very capable of handing any language barriers, to make the treatment and stay as easy and pleasant as possible.

 

Below is a description of the benefits and merits of the Gamma Knife.    Many of the pictures were supplied by Elekta, the company headquartered in Sweden, which manufactures the Gamma Knife.  Credit for the pictures goes to Elekta, and these pictures are used with their permission.

 

Gamma Knife Radiosurgery

gamma knife review, Houston, Texas, TX, USA

 

Dr. Gary Kraus practices Gamma Knife Surgery at the West Houston Gamma Knife Center, in Houston, Texas.  He is part of the Gamma Knife Team.

The Gamma Knife is useful in the treatment of patients with the following:
            malignant brain tumor (metastatic brain tumor, primary brain tumor)
            benign brain tumor ( acoustic neuroma, meningioma )
            trigeminal neuralgia (facial pain)
            arteriovenous malformation (AVM)
            other lesions of the brain. 

 

Center of Arc Principle

stereotactic leksell frame targets center of arc, Houston, Texas, TX, USA

The Gamma Knife principles of operation are based upon the "center of arc" principle, in which the center of the target is at the center of the circular arc of rotation.  This allows a "3 dimensional" approach, otherwise known as a stereotactic approach to the brain.  If a biopsy needle is placed on the are, and passed into the brain, this is then known as stereotactic neurosurgery.  If, instead of a biopsy needle, a beam of radiation is passed, this is then known as stereotactic radiosurgery. 

 

 

First stereotactic radiosurgery procedure

linear accelerator radiosurgery frame based

The performance of the first stereotactic radiosurgery procedure, before the invention of the Gamma Knife.  This was done by Dr. Lars Leksell, the neurosurgeon who invented the Gamma Knife.  The procedure was done at the University of Upsala, which had a strong physics department, which was necessary to support the cyclotron used in stereotactic radiosurgery. 

 

Proton Beam Radiosurgery

 

proton beam radiosurgery

Dr. Lars Leksell had performed stereotactic proton beam radiosurgery before developing the Gamma Knife.  Proton beam radiosurgery has significant uses today for certain tumors within the body.

 

Professor Lars Leksekk with the first Gamma Knife Unit, Stockholm, Sweden, 1968

gamma knife pioneer dr lars leksell in stockholm sweden

Dr. Lars Leksell is seen with the first Gamma Knife patient, in 1968, at the Karolinska Institute, Stockholm, Sweden.  Since Dr. Leksell didn't have the benefit of a cyclotron at the Karolinska Institute in Stockholm, Sweden, he designed a device which became known as the Gamma Knife, and which held fixed sources of gamma rays (cobalt) around the patient's head.

 

First Installation of Gamma Knife Model U 1987 / University of Pittsburgh

first gamma knife in united states in pittsburgh; model u: university of pittsburgh, pittsburgh, pennsylvania

The first Gamma Knife was located at the University of Pittsburgh, in 1987.  This was the Model U.   The use of the Gamma Knife at the University of Pittsburgh was responsible for dramatically increasing its use in the United States, and worldwide.  Initial research at the University of Pittsburgh lead the an exponential increase in the acceptance of the Gamma Knife throughout the world.

 

Gamma Knife, Model B

gamma knife model b, University of Pittsburgh, Pittsbugrh

The Model B Gamma Knife differs in design from the Model U.

 

Gamma Knife, Model C

gamma knife model c, west houston medical center, houston, texas, tx, usa

The Gamma Knife Model C has made the delivery of stereotactic radiosurgery more efficient, by the addition of APS (automatic positioning system).  For most of the "shots" of radiation delivered, the patient does not have the need for the Gamma Knife team to manually change the position within the Gamma Knife Unit, but this is done instead, automatically, by the machine itself.

 

 

 

 

Gamma Knife C, side view

sectional view of gamma knife model c, houston, texas

A cross section of the Gamma Knife shows the large shielding ball, which contains the radioactive cobalt pellets, which provide the radiation delivered by the Gamma Knife.  The total weight of the Gamma Knife ball is approximately 44,000 pounds. 

 

Cobalt 60 radiation sources for Gamma Knife

radioactive cobalt pellets emit the gamma radiation

It is remarkable, that the total weight of the radioactive pellets used within the Gamma Knife (for which 44,000 pounds of steel are required for adequate shielding) is only 5 ounces.  The half life of the cobalt pellets is about 5.2 years, meaning that in this time, they will lose half of their radioactivity.

 

Loading the Gamma Knife with cobalt pellets

loading the radioactive cobalt pellets in the gamma knife

The loading process, during which the radioactive pellets of cobalt are placed within the Gamma Knife Unit, is quite an involved process, and may take several days.  Here, the loading device is seen.  This device, seen next to the Gamma Knife, weights 16,000 pounds, and the Gamma Knife itself weights 44,000 pounds.

 

Radiosurgery Principle

the gamma rays are collinear, converging on the target, brain tumor

 

 

 

 

 

 

 

 

 

 

 

 

In the above schematic diagram, the beams of radiation of the Gamma Knife are seen converging upon the target, which may be a brain tumor, blood vessel disorder, or nerve.  This is the principle of stereotactic radiosurgery.  This principle is also used by the neurosurgeon when open neurosurgery is performed on the brain.

To better understand the principle of stereotactic radiosurgery, consider the following example.  Sunlight is not strong enough to burn a hole in paper, but when we take a magnifying glass, and focus the beams sunlight onto a single spot, now the focused energy can burn a hole in paper.  The same principle holds true for the Gamma Knife.  Each individual gamma ray of energy is, by itself, too weak to cause harm to a brain tumor, or to the normal brain.  But, when we focus 201 beams of radiation energy together (on a brain tumor, or nerve (as in trigeminal neuralgia), this area receives an enormous amount of radiation, with the surrounding area of normal brain tissue receiving only a minimal dosage from the several beams which pass through that area.

 

Steep Dose Profile

dose profile of gamma knife, showing steep dose dropoff

 

The accuracy of the Gamma Knife is demonstrated, by showing the beam profile.  Here we see, that even millimeters away from the center of the target (which receives a great deal of radiation), the brain tissue receives minimal amounts of radiation.  This is very important for protection of the normal brain tissue which may surround a brain tumor. 

 

Collimator Helmets for Gamma Knife

machine to change the helmets on the model c gamma knife unit

Above, the one of the helmets used in the Gamma Knife is seen.  This hold the collimators, which shape the beams of radiation.  The radiation passes through these ports, into the brain, and converge on the brain tumor, blood vessel disorder, or trigeminal nerve (as in the treatment of trigeminal neuralgia).

 

Collimators

4 mm collimators for the gamma knife

 

Above, the collimators are seem, which will shape the beams, blocking all but a small portion of the individual beams of the Gamma Knife, which allows for the accuracy of the Gamma Knife. 

Lesion produced by gamma knife

focal lesion created by gamma knife; specimen

A cross section through a portion of the brain treated with Gamma Knife, shows what appears to be a very focal lesion.  This is possible because of the accuracy of the Gamma Knife. 

 

gamma knife radiosurgery / minimally invasive surgery on the brain

isodose lines of gamma knife plan, brain tumor

Above is a Gamma Knife collage, demonstrating the focusing of beams, as well as a dose profile curve around a brain tumor.

 

teamwork for treatment

teamwork required for gamma treatment

The Gamma Team consists of a team of whose team members are an expert in their own field.  The traditional Gamma Knife Team will have an expert in Neurosurgery (neurosurgeon), Radiation Oncology, Physics, Neuroradiology and Nursing.   The added expertise of each individual helps to assure the patient of an accurate treatment, benefiting from the input of an expert in each of the various specialties.

 

leksell stereotactic frame

leksell g frame for stereotactic treatment

Here, the Leksell stereotactic frame is seen on a patient's head.  Placement of the frame takes several minutes, and, depending upon the anesthetic used, many patients are not at all bothered by it, and in fact, they often don't even remember it.

The rest of the day is "just boring" for the patient, but it will not be painful.

 

diagnostic imaging: mri, ct, pet, angiography

mri diagnostic scanning and imaging

The patient undergoes imaging studies.  Above, and MRI is being performed prior to the Gamma Knife procedure. The expert team is looking for the brain tumor or blood vessel malformation, or trigeminal nerve, upon which the radiation will be focused.

 

diagnostic testing

diagnostic modalities ct mri angiography

Imaging studies may consist of CT or MRI scans, and may include angiography.  In some cases, PET scanning may be added.  A brain tumor generally shows up better on an MRI scan that on a CT scan.  In particular, a metastatic tumor may show on an MRI scan, even when it is extremely small in size.  A CT scan is a good modality to see bone, and may be used when a patient cannot undergo an MRI scan, such as is the case if the patient has a pacemaker.  An MRI is also valuable in visualizing the trigeminal nerve, which is the target of the gamma knife for patients suffering from trigeminal neuralgia. 

 

 

finding the target / brain tumor

images of tumor, ct, brain tumor

Above, a CT of the head is seen, with a Gamma Knife Leksell frame already affixed to the patients head.  The cross hairs are focused on an acoustic neuroma, which is a benign brain tumor which affects the hearing and balance nerve.

 

the gamma plan

gamma knife planning station, tumor

The Gamma Knife planning station software, which is very sophisticated, allows modeling and simulation of the treatment outcome, providing for the safety of treatment.  This allows the delivery of radiation to the target, but the minimization of radiation delivery to critical  structures, such as the optic nerves (nerves to the eyes).  Here, again, is seen a treatment plan targeting an acoustic neuroma.  An acoustic neuroma often presents when the patient notices a decrease in hearing out of one ear.  While hearing preservation is often difficult with either open neurosurgery or gamma knife radiosurgery for an acoustic neuroma, facial nerve function (which allows the face to move, smile, raise the eyebrows, etc) is usually preserved with the Gamma Knife, while it is often at risk with open neurosurgery.

 

patient ready for gamma knife treatment

patient on table, about to begin treatment

Above, a patient is seen about to enter the Gamma Knife.  There is actually quite a bit of room, and the "closed in feeling" which some patients experience with MRI scanners is not felt with the Gamma Knife.

 

advantages of gamma knife radiosurgery

minimally invasive brain surgery has decreased morbidity and length of stay

The Gamma Knife is becoming increasingly accepted as the treatment for a number of disorders within the brain.  There are several reasons for this.  The main reason is that it works, and it provides for a good chance of success, with relatively low risk.  The other reasons include the cost advantage.  There are no long hospitalizations as is often the case with open brain surgery, and patients often return home the same day.  The risks of complications are relatively low, especially compared with open brain surgery.

Essentially, Gamma Knife can be considered minimally invasive brain surgery.  Because it is minimally invasive, it is sometimes referred to as "brain surgery without a scalpel."

 

indications for gamma knife

indications for gamma knife treatment

The Gamma Knife may make certain lesions, which otherwise seem "inoperable" with conventional open surgery, now "operable" with Gamma Knife Radiosurgery.  Elderly patients, who want to avoid the risks of a major open surgical procedure, may opt for Gamma Knife. 

Gamma Knife may also be used to treat portions of tumors or arteriovenous malformations (AVM's) which were not removed at the time of an open surgical procedure.

The Gamma Knife is useful in the treatment of patients with the following:
            malignant brain tumor (metastatic brain tumor, primary brain tumor)
            benign brain tumor ( acoustic neuroma, meningioma )
            trigeminal neuralgia (facial pain)
            arteriovenous malformation (AVM)
            other lesions.

 

Metastatic Brain Tumor : Houston, Texas

A metastatic brain tumor is a tumor which has spread from another portion of the body.  It may have come from the lung, breast, colon, skin, or kidney, as well as other areas.  When the metastatic tumor spreads to the brain, it may grow there as a single lesion, or may develop in different areas of the brain, as multiple tumors.  The greater the number of tumors, the more difficult it will be to treat.  On the other hand, the likelihood that a metastatic tumor will arrest its growth, due to Gamma Knife radiosurgery, is roughly 90%.  Even if the tumors are on different portions of the brain,  the brain tumors can be addressed.  There are many different protocols which are used to treat metastatic tumors to the brain.  Depending upon the nature of the tumor, and its cells of origin, different treatments may be used.  Gamma Knife radiosurgery does play a mojor role in the treatment of brain metastasis.

 

Trigeminal Neuralgia: Houston, Texas (TX), USA

Trigeminal neuralgia is a debilitating condition, in which a patient suffers lancinating, shock like pains, to a side of the face.  This affects only one side of the face, and may involve the forehead, eye, cheek, maxillary or mandibular area.  Often, chewing, touching, brushing the teeth, and even the wind, may precipitate severe spasms of facial pain, which will subsequently resolve.  Patients with trigeminal neuralgia typically have pain free intervals between the episodes of extreme pain.  Treatment options available for trigeminal neuralgia include:  1) medications such as tegretol or dilantin, 2) lesioning of the trigeminal nerve with a needle, as in a trigeminal rhizotomy, 3) an open neurosurgery procedure on the back of the brain, to move an offending artery away from the base of the trigeminal nerve (this procedure is known as a microvascular decompression (MVD) ), and 4) Gamma Knife radiosurgery.  While an open surgery as the highest chance for success (90%), it also has the highest risk of complications.  Gamma Knife radiosurgery has an 80% - 85% of giving patients with trigeminal neuralgia  a good to excellent result, with a good result being reduced pain while still on medications, and an excellent result being no pain off of medications. 

With Gamma Knife radiosugery, the improvement in the facial pain of trigeminal neuralgia is not immediate, but may take from days to weeks.  If the patient does not experience any pain relief after three months, the procedure was not considered to be a success.

 

Acoustic Neuroma

An acoustic neuroma is a benign tumor which usually grows from one of the nerve roots which travel to the vestibular apparatus in the skull base, which is responsible for balance.  The other nerves which are in contact with this nerve are the facial nerve, which allows movement of the face (as in smiling, frowning, etc), and the hearing nerve.  As the acoustic neuroma grows, hearing is often affected.  There are several different neurosurgery approaches which may be used in the treatment of an acoustic neuroma, but, for appropriately sized tumors,  the Gamma Knife offers an excellent combination of a high chance of success, with a low risk.  The Gamma Knife has a 90% - 95% chance of arresting growth of an acoustic neuroma.  Occasionally, the tumor may appear on MRI scans to be larger 6 months after gamma knife radiosurgery than it was before gamma knife, but this is often swelling of the tumor from radiation injury, and in most of these patients, as the tumor is followed one, two and three years down the road, the tumor will begin to shrink.

 

gamma knife is often the treatment of choice

acoustic neuroma treatment with gamma knife

Gamma Knife is becoming the treatment of choice for acoustic neuromas, which are slow growing benign tumors growing at the base of the skull. 

 

 

cost comparison gamma knife vs craniotomy

cost analysis of gamma knife

length of stay gamma knife vs craniotomy

length of stay analysis of gamma knife

 

Another nice advantage of the gamma knife for the treatment of a brain tumor, or trigeminal neuralgia, is that the patient will generally return home the same day.  When the neurosurgeon performs an open neurosurgery, the patient may be in the hospital for days.

 

 

For questions or additional information about Gamma Knife, or if you would like to determine whether this treatment may be appropriate for you or someone you know, please contact the office of

Gary E. Kraus, M.D.
neurosurgeon
Neurosurgery, P.A.
Medical Director, Neuroscience Center
Medical Director, Gamma Knife Center
West Houston Medical Center
Houston, Texas

Clinical Assistant Professor
Department of Neurosurgery
University of Texas Medical School at Houston
Houston, Texas, USA

Neurosurgeon: 
West Houston Medical Center
Memorial Hermann Memorial City Medical Center


tel:  281-870-9292
fax:  281-870-8493
website: 
neurosurgerypa.com

 

The Gamma Knife Team supports the treatment of patients within the greater Houston area, Texas, many regions of the United States, as well as Mexico and Puerto Rico.  There is easy access for international patients from Saudi Arabia and Dubai.  If there are any questions, please contact us.  We would be happy to help with the arrangement of hotel and transportation accomodations.  For patients from Mexico or Puerto Rico, we are very capable of handing any language barriers, to make the treatment and stay as easy and pleasant as possible. 

Dr. Kraus has 10 years of experience with Gamma Knife Radiosurgery.  He is medical director of the Gamma Knife Center at West Houston Medical Center.  There are three offices in Houston Texas which are conveniently located on the medical campuses of West Houston Medical Center, and Memorial Hermann Memorial City Hospital, as well as in Katy, Texas.  His offices serve  patients in the Houston area, surrounding areas in Texas, as well as other states in the United States, and abroad.  Please contact us at 281-870-9292, to help with your travel and hotel arrangements.

 

 

 

 

 

 

 

 

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