Setting Up A Pediatric Gamma Knife Program: The Experience Of Two Canadian Centres

Abhaya Kulkarni1, Michael Ellis1, Normand Laparriere2, Elaine Ng1, Michael Schwartz3, Michael West4, Gary Schroeder4, Patrick McDonald3

1Hospital for Sick Children 2 Princess Maragaret Hospital 3University Health Network 3Winnipeg Childrens Hospital 4Health Sciences Centre

Keywords: gamma knife, pediatrics, children, radiosurgery, anesthesia

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     Within the last 6 years, two Canadian Gamma Knife centres started pediatric programs and each faced unique challenges.
     Our experience in confronting these challenges was evaluated.
     The early experiences of the University of Manitoba and University of Toronto Pediatric Gamma Knife Programs, started in 2003 and 2006, respectively, are reviewed.
     We evaluated the different pediatric case logistics.
     The two programs had the following features in common: the Gamma Knife unit was located in an adult facility, a pediatric neurosurgeon with special training in Gamma Knife led the program, there was support from the adult Gamma Knife program, and pediatric anesthesia teams were involved in treating the young patients who required anesthesia during treatment. There were, however, some differences. In Manitoba the children’s hospital was physically connected to the adult hospital and Gamma Knife unit and was under the same administrative umbrella. In Toronto the children’s hospital was 2 km away and was a separate administrative entity. In Manitoba, unlike Toronto, the children’s physicians already had routine administrative privileges to work at the adult facility. Specific issues that presented challenges included: obtaining privileges for the pediatric health care team to work at the adult facility, ensuring that enough pediatric-sized anesthesia equipment was available, transporting the pediatric patient, and determining how a rare catastrophic event with a pediatric patient might be handled in an adult facility. Because of the remote physical nature of the children’s hospital in Toronto, all these issues provided a bigger obstacle to initiating the pediatric program. To date, 32 children have been treated at both programs (27 under general anesthesia). The first pediatric case in Manitoba was performed in December 2003 (1 month after the first adult case) and in Toronto in September 2006 (12 months after the first adult case). Median age at treatment was 12.2 years (range 4-17). Average follow-up duration was 16.1 months. Complications included transient peri-lesional edema (4 asymptomatic, 1 symptomatic), hypopituitarism (1 patient), and vascular line complication while under anesthesia (1 patient).
     This was a retrospective review.
     Starting a pediatric Gamma Knife program can provide logistical challenges. 
Effective treatment can be performed with co-operation between a dedicated pediatric team and the Gamma Knife facility.


Project Roles:

A. Kulkarni (), M. Ellis (), N. Laparriere (), E. Ng (), M. Schwartz (), M. West (), G. Schroeder (), P. McDonald ()