Abstract
PURPOSE
We sought to describe our experience regarding anesthetic indications, techniques and complications with Gamma Knife radiosurgery (GKRS).
METHODS
We retrospectively evaluated the use of anesthesia for both adult and pediatric patients at a high-volume center.
RESULTS
Twenty-two adult cases and 10 pediatric cases were identified. For adult patients, the median age was 55.5 years. Pediatric patient ages ranged from 3 to 16 years. For adult patients, indications for sedation were claustrophobia (n=16), anxiety (n=4), chronic pain (n=1), and severe comorbidity (n=1). Twenty-five patients received general anesthesia with a secure airway (GA). Seven patients received total intravenous anesthesia with spontaneous ventilation (TIVA). One of these patients required placement of an airway after initial TIVA. The median sedation to treatment ratios for pediatric patients (3.76) and adult patients (4.06) did not significantly differ (P=0.49). However, the median sedation to treatment ratios for patients who received GA (4.08) was significantly higher than patients who received TIVA (1.88, P=0.0005). Anesthetic complications included cutaneous flushing, excessive secretions and airway obstruction that required unplanned placement of an airway, wheezing attributed to propofol sedation, and unspecified anesthetic issues that resulted in a MRI scan with a suboptimal time interval. All complications occurred in adult patients.
CONCLUSIONS
Gamma Knife radiosurgery with GA was associated with a longer sedation to treatment ratio compared to TIVA. However, despite the prolonged sedation time, use of GA was associated with few complications, none of which were severe and observed only in adult patients. Practitioners should consider the need for anesthesia in adult and pediatric patients who are intolerant to GKRS due to severe claustrophobia, anxiety, or pain when evaluating patients prior to GKRS. Due to the increased risk of respiratory complications in these patients, we recommend the use of general anesthesia with a secure airway despite the prolonged sedation time.
Gamma Knife Radiosurgery With Mask Fixation Under General Anesthesia for Pediatric Patients
