The Gamma Knife Center established in E-Da Hospital has the newest technology of the world in both software and hardware. The design of planning and treatment procedure of this center was modified from the design of the Department of Neurological Surgery of the University of Pittsburgh Medical Center as reference. The medical team is composed by the specialists from the Department of Neurosurgery, Radiation Oncology, Diagnostic Radiology, Neurology, Hematology & Oncology, Ophthalmology and Nursing. The goal of the center is to provide patient best quality of care using minimally invasive techniques that utilize stereotactic and radiosurgery technology, high resolution neuroimaging, and advanced computer systems. The center provides care to patients with brain tumors, vascular disorders, movement disorders, and pain problems.
Since establish in 2004, the Gamma Knife Center have treated over 700 cases with brain diseases in the 5 years. The results of long-term follow-up show that patients have high satisfaction with lower family’s care burden and good treatment results. The center will provide the best services by using excellent technique and offering friendly care for patients with brain diseases.

Brief Introduction
In the last years, the Gamma Knife Surgery has been more and more important in the field of neurosurgery. The treatment result of the Gamma Knife Surgery has been well accepted, and the most important characteristics are:

Non-invasive cerebral surgery
No bleeding, no operation scars
Low risk, no need for ICU, quick recovery
Save medical resources and lower the family’s care burden after operation
Only local anesthesia necessary, there is no need for a general anesthesia.
The children need a general anesthesia to coordinate the treatment.
After the gamma knife surgery, the patients can be discharged from the hospital on the next day and restore their normal daily life or go to work.
According to the long-term tracing report of the medical literatures, the treatment result is very good.

Principle of the Gamma Knife Operation
The development of the gamma knife equipment was from the Model U at the beginning, to the Model B and the newest automatic Model C and Model Perfexion. The gamma knife contains up to 201 cobalt-60 sources of approximately 30 curies each, placed in a circular array in a heavily shielded unit. The unit directs gamma radiation to a target point. Such target points selected in the brain can be placed at the center of the radiation focus, allowing a tumoricidal radiation dosage to be delivered in one treatment session. This special method can let the ill region to receive extremely high intensity of radiation energy to reach a better curable effect. Because it is divided in 201 radioactive beams, the radioactive energy received in the healthy brain tissue would be extremely low. Using the most modern computer system, we can protect efficiently the certain special important structures (for example, optic nerves and brainstem). It can reduce the post-operative sequelae.

Because the earlier types (Mode U and Mode B) were manually operated, the treatment time of the patients was long. The most modern automatic Mode C gamma knife is equipped with the automatic positioning system (APS), thus the operation time has been reduced dramatically. Because the treatment time of Model C gamma knife is shorter than the old model, of course the treatment comfortableness would increase very much.

The treatment planning of the Gamma Knife Radiosurgery is based on the precise imaging examinations (MRI, CT, Angiogram). Using the advanced computer program to determine precisely the radiology treatment area, it would not injure the surrounded normal brain tissue and could effectively treat the pathological area (such as brain tumor, vascular abnormality, etc). With the above mentioned high technical equipments, the gamma knife surgery is a very highly secure treatment method. It can avoid the danger and unwell of the traditional brain operations, therefore, it stands on a very important position in the modern neurosurgery.

Treatment procedures of the patients

Examination stage of outpatients
The patients come to our hospital as outpatients. They will receive a physiological examination of the nerve system by the neurosurgeons, and also the related imaging examinations (for example, MRI, CT, Angiogram, etc.)
The examination result will be analyzed by the gamma knife evaluation team and discussed whether the patients are suitable to receive the gamma knife surgery.
The patients who are decided to be suitable for the gamma knife surgery, our hospital will apply for treatment to the Bureau of National Health Insurance. Those who are not suitable for a gamma knife surgery; then the neurosurgeon will suggest the other kind of treatment. After the approval of the Bureau of National Health Insurance, we will notify the patients for hospitalization to receive the treatment.
Some cases do not get approval from the Bureau of National Health Insurance, and then we can apply for a revision. After the approval of the revision, we will notify the patients for hospitalization to receive the treatment. If the patients do not want to wait for the revision procedure and if the patients wish, we can provide the gamma knife operation on the patients’ own cost.
If the revision is still not approved, if the patients wish, we can provide the gamma knife surgery on the patients’ own cost, or our hospital can apply for an advanced approval again to the Bureau of National Health Insurance.

Hospitalization operation stage
In the afternoon of the day before operation, the patients finish the hospitalization process and receive the routine examinations before operation (such as physical examinations, blood examination, chest X-ray, electrocardiogram, etc).
In the morning of the operation day, the patient will be sent to the Gamma Knife Center. They will be placed with the head navigational positioning frame, and receive the imaging examinations (MRI, CT, angiogram, etc). After the examination, they will be sent back to the Gamma Knife Center.

From the imaging study, the gamma knife team uses the precise computer program of the Gamma Plan to design a complete treatment plan including the target and delivery dose. After well explanation to the patient and family, the patients receive the gamma knife surgery. After the treatment, the physician removes the patient’s head navigational positioning frame, and then the patient is sent back to the ward for further observation.
The next day of the operation, after the physician’s visit to ensure that there is no more problem, the patient can be discharged.

Follow up stage of the outpatients
After receiving the gamma knife surgery, the doctors will arrange the outpatient service for further follow-up.
The determined outpatient follow up is to examine and understand the changes of diseases after the treatment by the imaging study.

Indications of the gamma knife surgery

Arteriovenous Malformation (AVM)
Because the bleeding incidence of the Arteriovenous Malformation (AVM) is approximately 3% each year, it is ideal to remove the simple Arteriovenous Malformations (AVM) by the traditional operation. For the difficult and complex cases, the brain operations have high risk and could cause easily sequelae, even death. The gamma knife surgery is the minimally invasive operation. After the gamma knife surgery, it could cause obliteration of the malformed blood vessels (about 1-2 years). There is no more risk for more bleedings after total obliteration of AVM, and the symptoms (for example, headache, epilepsy, etc) will improve gradually.

Arteriovenous Fistula
When the arteriovenous fistula causes acute symptoms, it is recommended to treat with endovascular embolization and/or the tranditional operation. The methods can treat parts of the patients, but those patients with defeated surgery treatment or endovascular embolization should be considered to be treated with the gamma knife surgery. According to the literature, for the patients with complex Arteriovenous Fistula, the gamma knife surgery is a modern and very effective treatment method. After the gamma knife surgery, the Arteriovenous Fistula will be obliterated little by little, and the presented symptoms will be improved.

Acoustic neuroma or trigeminal tumor
The acoustic neuromas or trigeminal neuromas of less than 3 cm, according to the treatment experiences of the University of Pittsburgh Medical Center, treated with the gamma knife surgery, the control rate of the tumor will be over 95%. It will cause very less facial nerve paralysis (This is the most common sequela after the brain operation). And in some patients who had originally auditory nerve damage, there is an improvement after gamma knife surgery.

Meningioma
The meningiomas located in posterior fossa, skull base and in the orbit, or the meningiomas remained after operation which are not easy to remove, and the meningiomas which would cause anticipated nerve function damage after operation (for example the meningiomas located near the brainstem), these patients have satisfactory results after the gamma knife surgery. The overall control rate of the meningiomas treated with gamma knife surgery is over 90%. However, the average diameter tumor should be less than 3cm.

Pituitary adenoma
The patients with pituitary adenoma after operation or the patients unsuitable for operations due to poor general conditions are recommended to receive gamma knife surgery. According to the reports of the University of Pittsburgh Medical Center, many of these patients with pituitary adenoma undergone the gamma knife surgery have showed a very good tumor control.

Craniopharyngioma
The patients with craniopharyngioma who cannot be cured by operations or have recurrent tumors after operation, or unsuitable for operations due to poor general conditions, showed very good tumor control rate after receiving the gamma knife surgery.

Astrocytomas
Patients with astrocytomas (from the benign astrocytomas to the malignant Glioblastoma Multiforme(GBM)), besides of the traditional brain operation or whole brain radiation therapy, received additional gamma knife surgery can help the patients to extend the life time and improve the life quality.

Metastatic brain tumor
For the patients with metastatic brain tumor, besides of the traditional brain operation or whole brain radiation therapy, the patients who have a stable systemic condition are recommended to receive gamma knife surgery. After gamma knife surgery, the patients can extend the life time and improve the life quality. The local tumor control rate can reach more than 80%.

Trigeminal neuralgia
In some patients with trigeminal neuralgia, when the medicine control is ineffective, and who do not want to receive brain operation (microvascular decompression), or the post-operative relapse patients can receive gamma knife surgery. In many reports, about 80% of the patients treated with gamma knife surgery have very good results. Even with long-term follow-up, 60-70% of the patients kept on a good pain control. It has the advantage of low vulnerability, low side effect, there is no need of general anesthesia, no risk of traditional operations. The aged patients or patients with severe cardiopulmonary diseases that cannot receive any operation can receive the gamma knife surgery instead of the brain operation.

Functional nerve disease patients with Parkinson Disease
The functional disease patients (for example trembling of Parkinson and other extremities trembling caused by other reasons), treated with gamma knife radiosurgery, is a new indication of gamma knife surgery. The preliminary results are quiet satisfactory. The clinical trial for larger number of patients is still in process. The patients who do not have any results after the medication control or the aged patients or patients with severe cardiopulmonary diseases who cannot receive any operation, are recommended for receiving the gamma knife surgery.

Epilepsy
The patient with epilepsy treated with the gamma knife surgery is a new indication. The preliminary results are satisfactory for the patients who have no response to medical control and who cannot receive any brain operation, and who have clear focus of epilepsy (for example, brain temporal-lobe vascular malformation) underwent the gamma knife surgery.

Orbital tumor and severe glaucoma
To treat the orbital tumor with the gamma knife surgery is quiet common in treating the benign and malignant tumors which cannot be excised with traditional eye operations. The results are satisfactory. Treating the severe glaucoma with gamma knife radiosurgery is a new indication. The preliminary results are quiet satisfactory for the patients who cannot be treated with traditional operations and medication underwent the gamma knife surgery.

Gamma knife team
Chief, Gamma Knife Center: Cheng-Loong Liang, M.D.

Benign brain tumors / Cerebral vascular diseases
Acoustic neuroma, trigeminal neuroma, meningioma, pituitary adenoma, craniopharyngioma, arteriovenous malformation (AVM), dural arteriovenous fistula
Neurosurgery: Han-Jung Chen, M.D., Kang Lu, M.D., Cheng-Loong Liang, M.D., Po-Chou Liliang, M.D., Yu-Duan Tsai, M.D., Kuo-Wei Wang, M.D.
Radiation Oncology: Shyh-An Yeh, M.D., Kuan-Yin Hsiao, M.D.
Diagnostic Radiology: Po-Lin Sun, M.D., Yu-Chang Lee, M.D., Chang-Hsien Ou, M.D.
Medical Physicist: Jia-Ming Wu
Nurse Practitioner: Mei-Chin Chung, Chia-Yi Kao, Chun-Mei Chen, Li-Chu Wu, Pei-Chun Tsai, Ching-Hui Kung

Cerebral malign tumor and metastatic tumors
Astrocytomas, metastatic brain tumors
Hematology & Oncology: Hung-Bo Wu, M.D.
Neurosurgery: Han-Jung Chen, M.D., Kang Lu, M.D. Cheng-Loong Liang, M.D., Po-Chou Liliang, M.D., Yu-Duan Tsai, M.D., Kuo-Wei Wang, M.D.
Radiation Oncology: Shyh-An Yeh, M.D., Kuan-Yin Hsiao, M.D.
Diagnostic Radiology: Po-Lin Sun, M.D., Yu-Chang Lee, M.D., Chang-Hsien Ou, M.D.
Medical Physicist: Jia-Ming Wu
Nurse Practitioner: Mei-Chin Chung, Chia-Yi Kao, Chun-Mei Chen, Li-Chu Wu, Pei-Chun Tsai, Ching-Hui Kung

Cerebral functional diseases
Trigeminal neuralgia, epilepsy, functional nerve disease patients with Parkinson Disease
Neurology: Shih-Pin Hsu, M.D., Chen-Sheng Chang, M.D.
Neurosurgery: Han-Jung Chen, M.D., Kang Lu, M.D. Cheng-Loong Liang, M.D., Po-Chou Liliang, M.D., Yu-Duan Tsai, M.D., Kuo-Wei Wang, M.D.
Radiation Oncology: Shyh-An Yeh, M.D., Kuan-Yin Hsiao, M.D.
Diagnostic Radiology: Po-Lin Sun, M.D., Yu-Chang Lee, M.D., Chang-Hsien Ou, M.D.
Medical Physicist: Jia-Ming Wu
Nurse Practitioner: Mei-Chin Chung, Chia-Yi Kao, Chun-Mei Chen, Li-Chu Wu, Pei-Chun Tsai, Ching-Hui Kung

Eye diseases
Orbital tumors
Ophthalmology: Huan-Chen Hsu, M.D., Shih-Hao Tsai, M.D.
Neurosurgery: Han-Jung Chen, M.D., Kang Lu, M.D. Cheng-Loong Liang, M.D., Po-Chou Liliang, M.D., Yu-Duan Tsai, M.D., Kuo-Wei Wang, M.D.
Radiation Oncology: Shyh-An Yeh, M.D., Kuan-Yin Hsiao, M.D.
Diagnostic Radiology: Po-Lin Sun, M.D., Yu-Chang Lee, M.D., Chang-Hsien Ou, M.D.
Medical Physicist: Jia-Ming Wu
Nurse Practitioner: Mei-Chin Chung, Chia-Yi Kao, Chun-Mei Chen, Li-Chu Wu, Pei-Chun Tsai, Ching-Hui Kung

How to contact us?
There are three different methods for inquiring whether the patients are suitable to receive the gamma knife operation treatment:

Service of outpatients
Go to the Service of Outpatients of Neurosurgery of our hospital

Mail
Please describe the detailed clinical condition and attach the related information and imaging examination, send to Cheng-Loong Liang, M.D., Gamma Knife Center, Department of Neurosurgery, E-Da Hospital

E-Mail
Please describe the detailed clinical condition and attach the related information and imaging examination, send to the e-mail address of Cheng-Loong Liang, M.D. by e-mail.
E-Mail address: ed100183@edah.org.tw

After we have received related information, we would reply your questions as soon as possible, and provide proper suggestions in order to facilitate the treatment of the patients.