Making a difference through excellent patient care

Official opening of the Parkway Gamma Knife Centre, Singapore:

By Samangie WETTIMUNY

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He who has health, has hope, And he who has hope has everything. An ancient proverb which I have often heard as a child comes to my mind incessantly. Anyway one need not necessarily know any proverb to feel the devastating emotional blow a family undergoes when a critical illness strikes a family member all of a sudden.

Should a person lose all hopes and becomes nobody just because his doctor diagnoses that he has a brain disorder- either a brain tumour or vascular malformation- or simply any other serious illness? Certainly No. Miracles of modern technology supported by sincere expression of caring and sharing can help him and his family turn the grief of futility and despair into grief of hope and release! I came face to face with yet another valiant fighter who did not lose his smile and his good spirits as a result of his illness, away in Singapore, at the Parkway Health Day Surgery and Medical Centre of Parkway Group Health care -Singapore’s first private health care provider to earn the prestigious Joint Commission International (JCI) accreditation for all its three hospitals-East Shore, Gleneagles and Mount Elizabeth.

Soon after undergoing Gamma Knife surgery, Chan Wahnam(56), was ready to speak to all of us, journalists from all around the globe who had gathered at Parkway Health Day Surgery and Medical Centre in Singapore to participate at the official opening of the Gamma Knife Centre of Parkway Health. Though the official opening ceremony was on October 9, 2008, the centre was in operation since June and more than 51 patients have been treated up to now, and at present Parkway Health’s Gamma Knife centre is the only provider of Gamma Knife surgery in Singapore.

Conventionally, brain tumours and other disorders have been extremely difficult to treat, often requiring delicate and invasive neurosurgery. However with the introduction of Gamma Knife radiosurgery, treating a brain tumour is no longer an arduous and time-consuming procedure, medical experts say.

Of course now I have evidence right in front of me. “I don’t feel any discomfort at all.” Mr. Wahnam tells us with a smile after taking the treatment in the Gamma Knife Suite for more than an hour. I could see “hope” in his eyes. “If you have hope, you have everything.”

“He can return home today or tomorrow morning.” says Dr. Yeo Tseng Tsai, Medical Director of the Gamma Knife Centre patting affectionately Wahnam’s shoulder as he leaves the room, of course well supported by the caring hands of the Parkway Health assistants.

No wonder why the Gamma Knife treatment was continuously referred to as the “gold” standard for radiosurgery by all the panellists who attended the press conference which was held to mark the official opening of the centre. Addressing the journalists a smiling Prof. Bengt Karlsson, the internationally renowned Swedish expert in Gamma Knife radio surgery who has been actively involved in setting up of the centre said that Gamma Knife is an excellent treatment for suitable patients. In fact Parkway Health’s Gamma knife Centre is a collaboration between Prof. Karlsson and the Parkway Health. He recalled how the Gamma Knife was introduced by Swedish neurosurgeon, Lars Leksell in 1967 and explained the evolution of Lexell Gamma Knife through out the centuries.

As the Vice President of Elekta, the world leader in image guided and stereotactic clinical solutions for radiosurgery and radiation therapy, Rolf Kjellstrom talked in great detail of the clinical challenges Elekta has to cope with, when providing clinically effective, cost efficient and safe treatment with minimal risk for complications while preserving quality of life. As the only company that could supply the whole range of necessary solutions, Elekta gives radiation oncologists and neurosurgeons an unmatched capability to aggressively treat tumours and functional targets with ultra-high precision while sparing health tissue. Elekta has introduced a complete product range of Lexell Gamma Knife Perfexion, Leksell Gamma Knife 4C and Lexsell Gamma Knife 4.

Out of his years of experience in the medical field,Medical Director of the Cancer Centre, Dr.Yeo Tseng Tsai said that most of the patients who have brain disorders (or any) prefer not to have their heads cut open. He further explained as to how radiosurgery is minimally invasive, patient friendly and can be broadly applied. The risk is low. “Technologies do matter. Technologies can be refined.” But he cautioned that there can be high risk if done inappropriately or incorrectly. Talking of indications for radiosurgery he dealt with two issues- type of lesion and size/volume of lesion. There are three categories of lesions:

Category A: is very strong evidence based, well accepted and non-controversial. Vestibular schwannoma/Acoustic neuroma, AVM, cerebral Metastasis or metastases and meningioma fall into this category.

Category B: Strong evidence based-gaining widespread acceptance. Pituitary tumours, Trigeminal Neuralgia can be given as examples.

Category C: Some evidence present although mostly anecdotal still. Glioma, Craniopharyngioma, pineal tumours, central Neurocytoma, Ependymoma, Medulloblastoma, cavernoma, thalamotomy, pallidotomy, epilepsy surgery-hippocampectomy and Epilepsy surgery-hypothalamic hamartoma are identified as lesions of this category.

Explaining the volume of lesion Dr. Yeo said that in general 20cc is the stated official cut-off. “But in reality it depends on the doses prescribed and the location of the lesion.” Speaking at the opening ceremony held in the evening of October 9, at the Gamma Knife Centre, Richard Seow, Chairman of Parkway Holdings Ltd once again emphasized the importance of Gamma Knife surgery in treating brain disorders.” It has been proven to be an effective and reliable surgical treatment for brain tumours; and with the talents leading our Gamma Knife Centre, patients will benefit from this gold standard treatment method.” As he emphasized the adoption of this proven technology complements the range of advanced neurological care at ParkwayHealth, enabling them to provide a comprehensive service for their patients.

Occupying 2,224 square metres area on the ground floor of the PDSMC, now the Parkway Health makes use of the latest technologies, such as Gamma Plan 8.2, the most up-to-date dose planning software available for the Gamma Knife machine. When it comes to dealing with the intricate nervous system, every second counts. In fact neuroscience is just one out of Parkway Health’s eight clinical programmes. The others are heart and vascular, musculoskeletal,oncology, primary care and chronic disease management, surgery, transplant and cellular therapy and women and children.

Parkway Cancer Centre which is attached to the Gleneagles hospital has a panel of efficient doctors to treat its patients with dignity and respect.

Not only Singaporeans are benefited by the latest health facilities. Parkway health operates more than 43 International Patient Assistance Centres (IPAC) located around the world.

We all know that Singapore is Asia’s leading medical hub. It has gone on record thar every year around 400,000 overseas patients visit Singapore for advanced medical treatment.

In 2000, the World Health Organization ranked Singapore’s health care system as the sixth best in the world and the best in Asia.

Anyway there is also a cross section of people who are sceptical of the private health care sectors as they view it solely as yet another lucrative money -making venture. “There are some who say that we build new hospitals to attract more patients. More patients mean making more money, and that is how they see it.” Shuvo Hridayesh, Parkway Health country Manager, International Patient Assistance Center, Sri Lanka tells me., explaining that it is very wrong to think in those lines.

We do not want people to fall sick. But certainly they need assistance when they fall sick.” Parkway Health’s mission is to make a difference in people’s lives through excellent patient care.” So is his wish.

Maladies will never give advance notices.

The stark truth is if you are a living being you fall ill and specially when a fatal illness hits you like a bolt from the blue you need a ‘trustworthy’ and a caring person to fall back on. Happiness is always relative and it depends on how you define it. But I am sure that you all would agree with me if I say happiness is nothing more than good health!

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Gamma Knife - Gold standard for radiosurgery

The Gamma Knife is recognised internationally as the most advanced radiosurgical treatment modality for deep-seated brain tumours and other lesions that cannot be removed safely using conventional brain surgery.

What is Gamma Knife?

Gamma Knife was invented by Swedish neurosurgeon Lars Leksell in 1967. It is a form of stereotactic radiosurgery used to treat some brain disorders( such as brain tumours and vascular malformations), without the need for open surgery. Although it was named Gamma Knife, it uses gamma rays instead of a surgical knife. Computer-planned finely collimated gamma -rays are precisely focused at the target in the brain without affecting the surrounding healthy tissues. It is performed as an outpatient surgery procedure and the patient can return home the same day or the next morning, depending on the advice of the neurosurgeon.

What can be treated by Gamma Knife?

1. Brain tumours

Both benign and malignant brain tumours, especially tumours originating elsewhere in the body that have metastasised to the brain.

2. Arteriovenous Malformations (AVMs)

AVMs are an abnormal collection of blood vessels. When located in the brain, these abnormalities can cause bleeding, headaches or seizures.

3. Acoustic Neuromas/Vestibular Schwannomas

These non-cancerous tumours develop on the nerve that affects balance and hearing, often causing gradual hearing loss, tinnitus and dizziness.

4. Trigeminal Neuralgia

This nerve disorder affects the trigeminial nerve, one of the largest nerves in the head that causes sudden disabling facial pain that feels like an electric shock-like or stabbing pain.

5. Pituitary Tumours

Pituitary tumours are abnormal growths that develop in the pituitary gland, a small organ about the size of a pea, located in the centre of the brain. These tumours can cause a variety of problems because the pituitary controls the thyroid, adrenal and reproductive glands.

Benefits of Gamma Knife Treatment

1. It is a non-invasive surgery. The gamma-rays are focused at the abnormal lesion without affecting the normal adjacent tissues.

2. The treatment gives very good results comparable or superior to conventional open-surgery with no risk of bleeding or infection. It also has a much lower risk of morbidity and morality compared to open surgery.

3.Treatment is usually done as a day surgery procedure. Hospital stay, if any, would be overnight at the most. By comparison conventional surgery would require 1-2 days of intensive care stay, with 7-14 days of hospitalisation (depending on the case.)

4.Patients undergoing Gamma Knife treatment can return to their pre-operative lifestyle almost immediately, compared to 4-6 weeks of convalescence required for those who undergo conventional surgery.

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Treatment procedure

Frame fixation

Before a Gamma Knife radiosurgery procedure is done, a light weight metal head frame (a stereotactic frame) which ensures that the radiation beams are exactly targeted, is attached to the patient’s head in the preparatory room.

Localising the target tissue

Magnetic Resonance Imaging (MRI), Computed Tomography (CT) or Cerebral Angiography is then carried out to determine the exact size, shape and position of the treatment area in the patient’s brain.

Computerised Treatment Planning

After the scan, patient will take a rest at the recovery area. From the MRI images, the neurosurgeon uses computerised treatment planning to decide on the dose and positioning of the rays. The treatment planning ensures that the dose delivered is accurate and just sufficient to neutralise the tumour target.

Gamma Knife treatment

As the treatment planning is completed, the patient undergoes the treatment in the Gamma Knife suite. The whole process takes about 1-3 hours(depending on the size and configuration of the lesion) and does not involve any surgical incision.

After the treatment procedure is completed, the frame will be removed. Patient will then have a few minutes of rest in the recovery area. Patient can return home the same day or the next morning..