Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Neuroanesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Neurol India. 2023 Mar-Apr;71(Supplement):S74-S81. doi: 10.4103/0028-3886.373626.
Gamma-knife radiosurgery (GKRS) has emerged as one of the mainstream modalities in the treatment of many neurosurgical conditions. The indications for Gamma knife are ever-increasing and presently more than 1.2 million patients have been treated with Gamma knife worldwide.
A neurosurgeon usually leads the team of radiation oncologists, medical physicists, nursing staff, and radiation technologists. Seldom, help from anesthetist colleagues is required in managing patients, who either require sedation or anesthesia.
In this article, we try to elucidate anesthetic considerations in Gamma-knife treatment for different age groups. With the collective experience of authors involved in Gamma-Knife Radiosurgery of 2526 patients in 11 years with a frame-based technique, authors have tried to elucidate an effective and operational management strategy.
For pediatric patient (n = 76) population and mentally challenged adult patients (n = 12), GKRS merits special attention given its noninvasive nature but problems of frame fixation, imaging, and claustrophobia during radiation delivery become an issue. Even among adults, many patients have anxiety, fear, or claustrophobia, who require medications either to sedate or anesthetize during the procedure.
A major goal in treatment would be a painless frame fixation, avoid inadvertent movement during dose delivery, and a fully wake, painless, and smooth course after frame removal. The role of anesthesia is to ensure patient immobilization during image acquisition and radiation delivery while ensuring an awake, neurologically accessible patient at the end of the radiosurgery.
伽玛刀放射外科（GKRS）已成为治疗许多神经外科疾病的主流方法之一。伽玛刀的适应证不断增加，目前全球已有超过 120 万名患者接受了伽玛刀治疗。
神经外科医生通常领导放射肿瘤学家、医学物理学家、护理人员和放射技术员团队。在管理需要镇静或麻醉的患者时，很少需要麻醉师同事的帮助。
在本文中，我们试图阐明伽玛刀治疗不同年龄组患者的麻醉注意事项。作者在使用框架技术对 2526 名患者进行伽玛刀放射外科治疗的 11 年的集体经验基础上，试图阐明一种有效的、可操作的管理策略。
对于儿科患者（n=76）和精神障碍的成年患者（n=12），GKRS 需要特别注意，因为它具有非侵入性，但在辐射输送过程中存在框架固定、成像和幽闭恐惧症的问题。即使在成年人中，许多患者也有焦虑、恐惧或幽闭恐惧症，他们在手术过程中需要药物镇静或麻醉。
治疗的主要目标是无痛的框架固定，避免在剂量输送过程中发生意外移动，并在框架移除后实现完全清醒、无痛和顺利的过程。麻醉的作用是确保在图像采集和辐射输送过程中患者保持不动，同时确保在放射外科治疗结束时患者保持清醒和神经可及。
