Why Was Gamma Knife Stereotactic Radiosurgery Invented?
The ultimate goal of the surgeon is to do no harm, and in the field of cancer care and treatment, this means using the most precise, minimally invasive procedures and tools necessary to preserve and prolong life.
One of the greatest oncological innovations that abides by this principle is Gamma Knife, a highly advanced radiosurgical treatment that allows for tumours, lesions and malformations to be ablated and destroyed without the need for any incisions.
It differs from conventional radiotherapy because the precise nature of the system allows for suitable treatments to be completed in just one day, from consultation and planning to the computer-guided process itself.
The system was developed in the 1940s and 1950s by Lars Leksell (1907-1986), an innovative Swedish neurosurgeon who dedicated his life to making brain surgery more precise, more advanced and more effective.
The Aesthetics Of Healing
Interestingly, Professor Leksell did not intend to become a doctor, let alone one of the most important medical innovators of the 20th century. His desire to help people came about in part due to an unfortunate accident.
When he was a teenager, he was admitted to hospital following a car accident and his experiences with his doctors proved to be deeply inspirational to him that he signed up for medical school in 1927, becoming a neurosurgeon in the 1930s.
However, as his son would later note, Professor Leksell struggled with the operating theatre as it existed in the 1930s and wondered if a different form of surgery might be possible.
In part, this desire came from a general belief that less invasive procedures are typically safer, but it also came from a place of aesthetics.
Such surgeries were cleaner, more intricate and involved far fewer scars and lingering aftereffects; the only marks that are found after Gamma Knife treatment are from the bolts used to secure the frame in place.
By 1935, this became his driving force, and for the next 20 years, he would develop, refine and start to perfect the next step in brain cancer surgery.
3 Steps To Radiosurgery
Aside from radiotherapy itself, there were two other major innovations that helped Professor Leksell in this ambition to treat brain conditions.
The first was the Horsley-Clarke Frame, initially developed as a tool used to help create atlases of animal brains by allowing for precise measuring for incisions.
Invented in 1908 by Victor Horsley and Robert Clarke, the stereotactic frame would be adapted for use on the human brain a decade later, but it would take until 1933 for the stereotactic method to be used in neurosurgery.
This second innovation was thanks to surgical pioneer Martin Kirschner, who used a type of stereotactic frame to perform a procedure to treat the pain syndrome trigeminal neuralgia.
Before precise radiation application at the precision required for use in the brain was available, Dr Kirschner used a minimally invasive surgical procedure to insert an electrode to a precise location in the trigeminal nerve and burn it. This procedure is now typically undertaken using radiosurgery.
Both of these technologies would be more widely recognised and adapted in the late 1940s, when an adaptation of the Horsley-Clarke frame was used to map the human brain for the first time, thanks to the work of Ernest Spiegel and Henry Wycis.
Their innovative human brain atlas would inspire a lot of researchers in the field of stereotaxy, including Lars Leksell.
He first adapted the frame to use a polar coordinates system rather than the Cartesian measurements that had been used since 1908, which made it much easier to use in an era before CT scans were common.
He then found a way to use it to make radiotherapy more precise.
No Tool Is Too Refined
The idea behind stereotactic radiosurgery is that if you know exactly where to focus a point of radiation, it is safer and more effective to target multiple beams of radiation onto a single point rather than one.
This ultimately proved to be very effective, with successful trigeminal neuralgia cases treated as early as 1953. However, from its invention up until Professor Leksell’s retirement in 1974, he continued to adapt, refine and upgrade the frame.
His guiding principle for this, and one of his most famous quotes, was the idea that any tools that a surgeon uses have to be adapted to suit the task, and there is no tool that is too refined when it comes to treating the brain.
