Image-Guided Radiosurgery Using the Gamma Knife

Abstract

Image guided brain surgery became a reality in the mid-1970s after the introduction of the first methods to obtain axial imaging using computed tomography (CT) [9]. The recognition of cranial disease much earlier in its clinical course prompted the need for concomitant minimally invasive technologies to both diagnose and to treat the newly recognized brain tumors and vascular malformations. Subsequently, the development of magnetic resonance imaging (MRI) spurred further interest in accurate, safe, and effective guided brain surgery. Stereotactic radiosurgery (SRS) was the brains child of the pioneering brain surgeons, Lars Leksell and Erik-Olof Backlund at the Karolinska Institute [4, 5]. Stereotactic guiding devices were adapted to newly evolving imaging techniques, ranging from encephalography to angiography, CT, and MRI. These new techniques prompted further evaluation of stereotactic radiosurgery, a field envisioned by Leksell in 1951. His concept that ionizing radiation could be cross fired to destroy or inactivate deep brain targets without a surgical opening proved to be an enormous step forward in minimally invasive surgery. Under the watchful eye of Leksell, Gamma knife technologies gradually expanded in their role and their usage exploded across the field of neurosurgery [1–3, 6–13].