A Case of Carcinoma Breast with Brain Metastasis for Gamma Knife Radiosurgery

Breast cancer is the most common cancer in women which may metastasize to other parts of the body. The most common sites for metastasis are the lungs, bones, brain, and liver. Brain metastasis occurs in 10–25% of patients. The treatment for brain metastasis involves local or systemic therapy or both along with measures to control intracranial pressure and its complications. Local therapy includes surgical removal of lesions, whole brain radiotherapy, or stereotactic radiosurgery either alone or in combination. The procedure may either be performed under local anesthesia, monitored anesthesia care, or general anesthesia depending on patient factors. The gamma knife stereotactic radiosurgery involves application of head frame under local infiltration anesthesia and precise delivery of radiation to the lesion in a gamma knife suite. The patient should undergo a thorough preoperative evaluation before the procedure. The anesthesiologist should anticipate and be prepared for management of complications particularly airway-related complications in emergency. Being at a remote location, additional help may not always be available. Post procedure, the patients are closely monitored before discharge. The patients are discharged the same day and followed up every 3 months with MRI for recurrence of lesion.