![Page 1: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/1.jpg)
![Page 2: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/2.jpg)
Γ-Knife Hypothalamotomy forRefractory Aggressiveness
Centro Medico ImbanacoCali
![Page 3: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/3.jpg)
No Disclosures
![Page 4: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/4.jpg)
The Truth• Patient:
– Threat, fatigue and distress– Poor response to treatment
• Caregiver:– Threat, fatigue and distress– Difficult healthcare access
• Health– Lack of therapeutic options– Safety of implanted devices
• System– Excessive cost of treatment
![Page 5: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/5.jpg)
DBS, we have a problem…
![Page 6: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/6.jpg)
Eyes Widely Shut
![Page 7: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/7.jpg)
Rules of Engagement
• We want pHyp• We don’t want infections• We want to help the family• We want to help the system• We hope one right lesion is enough• We think we should start with 120Gy @ 100%• We think we should wait 12mo. for second GK
![Page 8: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/8.jpg)
![Page 9: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/9.jpg)
Scales
• Psychiatry– Overt Aggression Scale– Global Assesemet of Function scale (GAF)– CGI/SI
• Neuropsychology– Wechsler adult intelligence scale– Mental retardations criteria – DSM V– Rey Auditory Verbal Learning Test (RAVTL)
• Social Work– Zarit Burden Interview
![Page 10: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/10.jpg)
The Oracle
• Kondziolka/Flickinger– VIM: 120Gy vs. 140Gy
• Duma– VIM: 140Gy vs. 150Gy
• Keep– STn: 120Gy
• Phone call; Kondziolka:– 120Gy @ 100%; 120° Gamma-angle (Franzini)
![Page 11: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/11.jpg)
![Page 12: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/12.jpg)
![Page 13: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/13.jpg)
![Page 14: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/14.jpg)
![Page 15: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/15.jpg)
COHORT
13 Patients
3 women, 10 men
7 (26) 49 y.o.
7 HPPN3 Autism2 Skizophreina1 Encephalitis
Targets
6 bilateral pHyp
5 unilateral pHyp
2 n.acc + pHyp
![Page 16: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/16.jpg)
Planning
• ½ (AC-PC)– X lateral 2mm-3mm– Y posterior 2mm-3mm– Z Inferior 5mm-6mm
• 4mm• 120° gamma angle• 120Gy @ 100%
![Page 17: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/17.jpg)
![Page 18: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/18.jpg)
![Page 19: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/19.jpg)
![Page 20: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/20.jpg)
![Page 21: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/21.jpg)
2 (26) 36mo.
![Page 22: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/22.jpg)
OVERT
![Page 23: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/23.jpg)
![Page 24: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/24.jpg)
![Page 25: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/25.jpg)
![Page 26: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/26.jpg)
Transforming lives
![Page 27: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/27.jpg)
Transforming lives
![Page 28: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/28.jpg)
Transforming lives
![Page 29: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/29.jpg)
Conclusions
• Right pHyp 120Gy @ 100%• Left pHyp 6mo. POP• No cognitive impairment• No infections• Easy follow-up• <20% cost
![Page 30: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/30.jpg)
Conclusions
• Decrease of caregiver burden• Higher expectations of family• Changes in patient’s needs
![Page 31: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/31.jpg)
Medical Ethics Commitee• Neurosurgery
– Bernardo Perez– Adriana Serrano
• Psychiatry– Andrea Otero– Cesar Gonzalez
• Neuropsychiatry– Angela Maria Perez
• Radiation Oncology– Ilse Vasquez
• Nursing– Johanna Gomez
• Medical Physics– Johnny Burbano– Oscar Garzon
• Anesthesia– Claudia Elena Osorio
• Neurology– Adriana Caballero– Paula Andrea Millan
• Social Work– Anabolena Mesa
• Administration– Gloria Florez
![Page 32: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/32.jpg)
Always present
• L. Dade Lunsford• Douglas S. Kondziolka• John C. Flickinger• Ann Maitz
![Page 33: Γ-Knife Hypothalamotomy for Refractory Aggressiveness€¦ · – Ilse Vasquez • Nursing – Johanna Gomez • Medical Physics – Johnny Burbano – Oscar Garzon • Anesthesia](https://reader035.vdocuments.site/reader035/viewer/2022081611/5f06ba807e708231d4197045/html5/thumbnails/33.jpg)