Three women suffering from different cranial conditions were among the first to undergo treatment with the highly advanced Gamma Knife Icon, the international gold standard for this specialised branch of radiosurgery, made available in South Africa for the first time at Netcare Milpark Hospital recently. As they eagerly wait for this ‘surgery without a scalpel’ to take effect, they share the journeys that brought them to this point.
Essential tremor stands between a nurse and the work she loves
“I started suffering from essential tremor two or so years ago. It only affects my hands, which shudder severely when I try to do any task,” says 49-year-old Sr Daleen Meissenheimer, who hails from the Free State.
“I was placed on long term incapacity leave from my work as a nurse at a public sector clinic a year ago as a result of this condition.”
Pic ‘Gamma Knife Icon patient.jpg’: (left to right) Neurosurgeon and radiation oncologist, Dr Dheerendra Prasad of the Roswell Park Cancer Institute in New York; radiation oncologist, Dr Sylvia Rodrigue; patient, Mrs Melanie Thomson; and neurosurgeon Dr Frans Swart. Mrs Thomson, who suffers from trigeminal neuralgia, was one of the first patients to receive Gamma Knife Icon treatment at Netcare Milpark Hospital.
Essential tremor is the most common movement disorder in the world. It is a neurological condition that causes involuntary trembling in a part of the body, most often the hands and arms.
“As you can imagine, I was not able to do my nursing work properly with hands that shook so badly that I could not take a patient’s blood or even hold a pen properly to fill out a patient file or write a report. This has been one of the hardest aspects of this condition for me to bear, as I love nursing and miss it very much. I have a young son and need to be able to work in order to support us.”
When Meissenheimer was first diagnosed with essential tremor she was prescribed medication, which initially helped to control the tremors, but a month later the symptoms returned. While deep brain stimulation is usually used to treat severe essential tremor nowadays, Meissenheimer was not a suitable candidate for that procedure.
“My neurosurgeon advised that the Gamma Knife was the best and safest treatment option available to me,” she adds.
The Gamma Knife Icon is the sixth generation of the Leksell Gamma Knife system, and introduces a number of new innovations, such as integrated imaging and software, and an advanced patient motion management system to continuously control dose delivery. The system is used in the treatment of selected brain tumours, head and neck tumours, vascular malformations in the brain, as well as functional disorders, such as essential tremor.
“The Gamma Knife Icon procedure itself was completely painless, no sedation was necessary and I wasn’t even aware that it was taking place. I was able to go home directly afterwards. My doctors anticipate that the Gamma Knife Icon procedure will take between three to six months to show benefit, and I will also need a further procedure in a year’s time on the other side of my brain in order to complete the treatment process,” Meissenheimer explains.
She expressed her gratitude to the Gamma Knife South Africa team who conducted her treatment, adding that she wished this technology had been available years ago as it would also have benefitted her father. “My father suffered from very bad essential tremor, so much so that he needed full time care including having to be fed during the last years of his life.”
Acoustic neuroma patient’s long wait is over
“One morning, I woke up and I couldn’t hear in my right ear anymore. I went to the GP, and then to an ear, nose and throat specialist, and at first they couldn’t diagnose what was wrong. Eventually, I was sent for an MRI, and the scan identified a tumour growing on a nerve that connects the inner ear to the brain. I was diagnosed with acoustic neuroma,” says 49-year-old Renet Kotze of Johannesburg, who was the first patient to receive Gamma Knife Icon treatment in South Africa.
Acoustic neuromas, also known as vestibular schwannomas, acoustic schwannomas or neurinomas, occur in about 9.4 people per million globally. Although the tumour is usually benign, it grows in the confines of the ear canal and may eventually press on the brainstem, which controls many essential functions, such as breathing and heart rate.
Mrs Kotze relates how traditional surgery, which failed to eliminate the tumour, impacted her life as Gamma Knife Icon treatment was not yet available at that time.
“In 2008 I had a 17-hour long operation to remove the tumour. When I woke up from the operation I had lost my hearing, I couldn’t talk, walk, drive or eat solid food. I had to have extensive rehabilitation to regain these functions. I experienced temporary relief from the headaches, but the recovery from the operation took two years because there are so many interconnected nerves in the area where they had to operate.
“Unfortunately, the tumour grew back after the operation. I started exploring options with my doctor, and that’s when I first heard of Gamma Knife treatment. At that time, I would have had to travel to the Unites States at my own expense to receive the treatment.
“I have been eagerly waiting for the technology to become available here in South Africa, because the tumour was growing quite slowly, at a rate of approximately 3mm per year. I was so grateful to receive a telephone call several weeks ago to say that now the most advanced version, the Gamma Knife Icon, has arrived.”
Kotze says that she was initially somewhat anxious when she heard that she would not be anaesthetised for the Gamma Knife treatment. “It is very quiet in the Gamma Knife Icon equipment, and I really did not feel anything. The Gamma Knife SA team were brilliant; they played classical music for me during the treatment and they kept me updated on how much longer it would take – the treatment itself lasted only 56 minutes,” she recalls.
“I have been told that this treatment has shown an exceptional success rate internationally in terms of reducing or preventing further growth of acoustic neuroma. I feel very positive, although we will only be able to assess how successful it has been in a year’s time.
“I did not know what to expect in the Gamma Knife Icon treatment, but now that I have had it, I can tell you that I would rather go through 300 Gamma Knife treatments than have that 17-hour operation again,” Kotze says.
Non-invasive radiosurgery precision offers new hope for trigeminal neuralgia patient
“I have had trigeminal neuralgia for about eight years now. The condition causes headaches and ‘spikes’ of severe pain through the jaw, cheek, and head, although each individual experiences it differently,” explains Melanie Thomson of Johannesburg.
“The pain can come on suddenly, for example when I brush my teeth, or when talking or laughing. My mouth goes numb, and I cannot eat properly. The pain comes and goes, and even at times when I am not in pain, I live in dread of the next attack.”
In April last year, Thomson had a microvascular decompression operation, which she describes as “quite a hectic operation”. “They had to cut my hair and the incision they made on my head was quite big, about as long as my hand. I spent two days in ICU, then two more days in hospital and was out of action for four to six weeks after the operation. I had a few months of relief after the microvascular decompression surgery, but unfortunately the symptoms came back.”
A year later, Thomson’s doctors gave her the news that the latest in non-invasive cranial radiosurgery, the Gamma Knife Icon, would soon be introduced for the first time in Southern Africa at Johannesburg’s Netcare Milpark Hospital, and that she was a candidate for this type of treatment.
“Before commencing the treatment, I had to have an MRI scan and that equipment makes lots of weird noises. I believe they use the MRI to pinpoint the nerve that the Gamma Knife will target,” says Thomson.
“At first it seemed a bit scary because the doctors said that I would be awake during the treatment,” she relates. “First, the Gamma Knife SA team put a frame on my head, and explained that this is to ensure that your head doesn’t move during the treatment. The team put me at ease, and told me what was happening every step of the way. All I had to do was lay still for 25 minutes, it was painless and there was no sound,” she remembers.
“We arrived at Netcare Milpark Hospital at 9am and we left at noon. I felt a little nauseous afterwards, but compared to the operation I had previously, Gamma Knife Icon treatment was a walk in the park. Time will tell whether the treatment has been successful, but my doctors and I are hopeful of a positive outcome,” she concluded.
Issued by: Martina Nicholson Associates (MNA) on behalf of Gamma Knife South Africa at Netcare Milpark Hospital
Contact : Martina Nicholson, Graeme Swinney, Meggan Saville or Pieter Rossouw
Telephone: (011) 469 3016
Email: [email protected], [email protected], [email protected] or [email protected]