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Articles and Columns

Celebrating LSUHSC Uniqueness: Gamma Knife Radiosurgery
The Forum News
Published Wednesday, June 27, 2007
by Anil Nanda, MD, FACS

Imagine having a brain tumor that is so deep that it would be too dangerous to operate on. Or imagine having a blood vessel abnormality with so many other medical problems that it is not be safe to put the individual under general anesthesia. These are scenarios that can be easily solved with Gamma Knife Radiosurgery. It allows scalpel-like precision to cure brain tumors with laser beams that were previously unresectable or cancers that are in multiple spots that would require multiple open procedures. Fortunately this treatment has been available in Shreveport since 2002 at LSU Health Sciences Center . We were the first to have Gamma Knife technology, and remain one of only two in the state.

Years ago when Christopher Columbus first came to the U.S. , he used a system called “Dead Reckoning.” It was mainly a form of celestial navigation. Today, most of us have GPS systems and can pinpoint directions to get to where we need to go. The difference between the Gamma Knife and conventional surgery is that the Gamma Knife is like a GPS system that pinpoints exactly where we need to go in the brain.

The first step in Gamma Knife radiosurgery is to determine what the indications are. These include brain tumors, metastatic cancers, skull base tumors, and other small tumors that have been operated on in the past or are too deep to operate. Other indications include trigeminal neuralgia, facial pain, atervienous malformations, and a host of other disorders. On the morning of the procedure, local anesthesia is given to the patient and a stereotactic head frame is attached to the patient's head.

The location and size of the lesion are logged, and the Gamma Knife computer calculates and displays a three-dimensional image of the proper angle, duration, and size of the radiation beams. The patient is then placed on a table that guides the head into the Gamma Knife, which resembles a large helmet with 201 openings that focus the narrow beams of radiation onto the target. The head frame is locked into place, and the neurosurgeon gives the signal to begin radiation.

The Gamma Knife was a joint creation of Swedish physician Lars Leksell and bio-physicist Borje Larsson. Professor Leksell wanted to develop a tool to treat deep-seated intracranial abnormalities without opening the skull. In 1949, he developed the Leksell MicroStereotactic System, which allowed the placement of needles or electrodes without visual guidance. By 1951, the system was used to perform the first radiosurgical procedure by coupling a radiation source with a stereotactic guiding device. Leksell discovered that a single dose of radiation could successfully destroy brain abnormailites deep within the brain. In Shreveport , we have accomplished more than 760 procedures have been done in the Gamma Knife Suite. These include a variety of procedures such as acoustic neuromas, meningiomas, pituitary adenomas, astrocytomas, brain metastases, malignant skull base tumors, and trigeminal neuralgia. LSUHSC-S is the only hospital in the Ark-La-Tex offering Gamma Knife procedures.

The Gamma Knife provides not only great benefits to the area and LSU Medical School by attracting faculty and students, but also provides an even greater benefit to those patients who might otherwise have an inoperable condition. For most patients, it is now done as a purely outpatient procedure.

Gamma Knife is representative of a paradigm in brain surgery with no open cutting required.  The speed in which a patient recovers is often astonishing. In fact, one patient ran a marathon the day after the procedure. This quick recovery makes the procedure cost effective since its expense is less than half of conventional neurosurgery. Because the procedure is non-invasive, patient hospitalizations are significantly shorter, and complications usually associated with conventional surgery are greatly reduced. The procedure has now been done for more than 100,000 patients worldwide. It is now the standard of care, and is in fact the gold standard for certain disorders. The numbers at LSUHSC continue to grow and it’s a tribute to the multipdisiplinary team that exist for cancer and other neurological diseases at LSU that enable us to use this procedure so effectively.

We are very fortunate that we are able to offer this option to our patients with select neurological conditions. It is a complement to the Feist-Weiller Cancer Center , which extends beyond the local area.

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