[Neurosurgery using the Gamma Knife]

Abstract

Gamma Knife radiosurgery is a neurosurgical technique dedicated to treat a wide spectrum of intracranial pathologies. Radiosurgery is a method employing a single fraction of high dose ionizing radiation beams focused on the stereotactically defined intracranial target volume through the intact skull. This precise irradiation of intracranial volumes can necrotize the targeted cell mass--as in treatments of tumors and functional syndromes--or may induce certain biological effects in the target tissue-as in treatments of AVM's and epilepsy--without imposing a significant risk on the neighboring intact neural tissues. The clinical application of Gamma Knife includes a wide range of neurosurgical indications, such as treatments of arteriovenosus malformations, pituitary adenomas, craniopharyngiomas, meningiomas, vestibular schwannomas, gliomas, metastatic tumors, as well as functional neurosurgical syndromes, such as trigeminal neuralgia, extra-pyramidal dysfunctions, epilepsy, pain- and psychiatric syndromes. The clinical effect of irradiation is not immediate, it becomes detectable on follow up studies after a few months. The application of the technique is determined by the histological type, size and location of the pathology. Gamma Knife has evolved to become an established alternative to opened cranial surgery in certain cases with low morbidity and no mortality, offering a safe neurosurgical treatment for inoperable as well as operable lesions that carry significantly high surgical risk. In our review we present the technical and radiobiological principles, clinical indications, limitations and outcome results of this method. Our data are based on the practice and results of the Lars Leksell Center for Gamma Surgery, Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA (Director: Ladislau Steiner dr.).