Send Parkinson’s patients home in hours, not days
Send Parkinson’s patients home in hours, not days
Gamma Knife moves surgeries to outpatient arena
Stereotactic neurosurgery has been used to treat the symptoms of Parkinson’s disease for years, but use of the Gamma Knife, manufactured by Elekta of Norcross, GA, has moved the surgeries for Parkinson’s from the inpatient to the outpatient arena.
Traditional surgical treatments for the tremors or rigidity of Parkinson’s are a thalamotomy for tremors and pallidotomy for rigidity. In each of these operations, a small hole is made in the thalamus or globus pallidus to reduce the signals that trigger those symptoms.
Tremors and rigidity are common with Parkinson’s disease because the patient’s brain lacks dopamine, a neurotransmitter that suppresses irregular messages that cause the afflictions. Usually the surgery requires a 48- to 72-hour stay.
Patients who undergo either of these surgeries with the Gamma Knife go home four to six hours after surgery, says Michael L. Goodman, MD, director of The Georgia Gamma Knife Center at Piedmont Hospital in Atlanta. Because the procedure is non-invasive and there is no general anesthesia used, side effects and complications are uncommon, he adds. More than 90% of patients report excellent results, he says.
The Gamma Knife uses radiation as a surgical tool by enabling the surgeon to target 201 individual beams of gamma radiation on one point of the brain. Other areas receive a trivial dose of radiation, says Goodman.
The targeted area is destroyed, with the effect of the radiation taking up to one month to create the hole, says Deane "Skip" Jacques, MD, medical director of the Neurosciences Institute at Good Samaritan Hospital, Los Angeles.
Patients receive IV sedation and a local anesthetic to block the discomfort of the stereotactic frame placement. This frame is attached to the head to help the surgeon target the beams of radiation, says Goodman. "The most common side effect of the procedure is nausea that is related to the sedation and anxiety, but antiemetics such as Zofran help control the nausea," he adds.
Patients coming into the Georgia Gamma Knife Center are admitted through outpatient admissions, then go to the center’s work area to receive a mild sedative and have their hair and scalp washed. There is no need for hair to be shaved, points out Goodman. A stereotactic frame is attached, and an MRI scan is performed to ensure the frame is positioned correctly.
After the radiation treatment, patients get a bandage, but it is primarily for sympathy, says Goodman. After a few hours in recovery to make sure the nausea is under control or not a problem, the patient goes home and resumes normal activities the following day.
Parkinson’s typically affects people between 40 and 70 years of age with the peak age of onset in the 50s. The average age of patients seen at the Georgia Gamma Knife Center is between 70 and 75, says Goodman. For this reason, most treated for Parkinson’s are Medicare patients, but there has been no problem with reimbursement for the treatment, he adds.
It is important to ask your payers how the procedure is reimbursed, says Jacques. Although his center performs the same procedure for Parkinson’s as the Georgia center, his payers require Gamma Knife patients to stay overnight. "Parkinson’s patients could go home the same day because they are not sick, but it is not recognized by our payers as an outpatient procedure," he explains.
Approximately $100 of the cost of the procedure is related to disposable items, such as gloves and sponges, says Goodman. Salaries, the equipment, and the building are the biggest overhead costs, and the per-case cost differs from facility to facility. "A Gamma Knife costs about $2.2 million, and construction of the room in which to place it runs about $1 million," says Goodman. The room must be constructed to hold the equipment, which weighs approximately 40,000 pounds, and the walls must be solid concrete with lead shielding.
The advantage of making this type of investment is that the Gamma Knife is used for more than treatment of Parkinson’s. It can be used to treat malignant and benign brain tumors, vascular malformation, and other neurological disorders, says Jacques.
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