Gamma knife radiosurgery

Abstract

Over the last 25 years we have witnessed a dramatic evolution of Gamma Knife radiosurgery. From its humble beginnings in Sweden at the hands of Lars Leksell, it is now in 45 countries worldwide. This chapter aims to outline the historical background of Gamma Knife Radiosurgery and provides an understanding of the steps involved in treating a patient. Furthermore, it imparts technical information gleaned from years of experience to aid in setup and planning. The stepwise progression of treatment flows from stereotactic frame placement to imagine acquisition, then to planning, all before treatment is provided. Each step requires attention to detail and an understanding of the potential pitfalls in order to provide quality patient care and to assure that the treatment can be completed. There have been multiple iterations of Gamma Knife models for which we will focus on the models PERFEXION and 4C. These updates have led to almost real-time calculations, automated repositioning, and in regard to the PERFEXION unit, extended cranial reach. In excess of 675,000 Gamma Knife radiosurgery procedures have been performed worldwide, primarily but not limited to tumors, vascular malformations, and functional brain disorders. This volume has led to an exponential increase in research that will undoubtedly be illustrated throughout this book. In the future, as our understanding improves and the Gamma Knife modifications become more utilized, it should provide better treatments, resulting in better patient outcomes.