Not too long ago, bloodless brain surgery was shrugged off as science fiction. Only five years ago, 21-year-old Jessica Adams, who suffers from a brain disorder called arteriovenous malformation (AVM), would have had to choose between doing nothing and undergoing invasive brain surgery. Both carry risks.
Doing nothing would have increased Jessica''s chance of suffering hemorrhagic stroke, or bleeding in the brain, by 50 percent by the time she is 35. Undergoing open-skull surgery at 21 was not much of an alternative, either.
Last week, Jessica went under the knife--the gamma knife that is-- at Barnes-Jewish Hospital, which took care of her problem in about 22 minutes. That same day, Jessica went home.
The gamma knife is a device that delivers beams of radiation to diseased sections in the brain, while sparing healthy tissue around them. The term "knife" is somewhat misleading. There are no incisions, no blood, no post-operative recovery.
The knife is a 25-ton machine that takes up about a third of a small operating room. The patient''s head is positioned in a helmet, the brain carefully mapped out before the procedure. Then, like the blades of a knife, beams of radiation are focused at the abnormal part of the brain.
The gamma knife is used in AVM patients like Jessica, as well as to treat certain brain tumors, alleviate Parkinson''s disease, or to kill metastatic tumors that have traveled to the brain from another organ. The treatment can take anywhere between one and six hours. The patient is awake and alert throughout the entire procedure.
Not everyone is a good candidate for the gamma knife. People with tumors or lesions larger than 3.5 centimeters are not treated as are patients whose tumors are too close to vital areas in the brain, such as the optical nerve.
"It beats surgery," says Eric Filiput, a nurse at the Gamma Knife Center. "This is a non-invasive way to be very aggressive."
The center sees about 20 patients a month. Barnes-Jewish shares the gamma knife with many physicians from other hospitals who come to treat their own patients.
"You need a certain volume of patients to make it economical," Filiput explains. The device and its installation cost about $4 million.
Jessica, a physics major at the University of Missouri-Columbia, was diagnosed with AVM by pure chance. Jessica hit her head while fixing a chair in her home in Nevada, Mo. Because of the intense pain, she decided to see her family physician. The doctor ordered a CT scan-just to rule out a concussion. That night, the doctor called Jessica''s parents to tell them the CT scan had shown a spot in their daughter''s brain. "We were so scared because we thought it was a tumor," says Jessica''s mom, Rama Adams.
An MRI test later revealed the true nature of Jessica''s problem- an AVM, a tangle of dilated blood vessels that disrupts normal blood flow in the brain and which can lead to stroke.
"We feel pretty relieved now because we know there is a 90-percent cure rate with (the gamma knife)," says Jessica''s father, Jim Adams.
On the day of her treatment, Jessica is accompanied by a cheering crowd of six-her parents, her boyfriend, Donovan Weber, and her two best friends, Sarah Scherder and Angela Suppasansathoren.
As physicians and nurses trickle into the OR, Jessica''s entourage is asked to leave. Her two friends high-five Jessica and wish her luck. Her boyfriend whispers, "Love you baby-girl." The Adams'' hug their daughter.
Jessica lies down on the bed, obediently places her head in the metal helmet that will funnel the right amount of radiation to her brain. As doctors strap her down, and check her IV, Jessica flashes a dazzling smile--she knows that in less than an hour she will be at the Cheesecake Factory with the people whom she loves the most, and her brain abnormality will be a thing of the past.