What Was The First Ever Condition Treated Using Gamma Knife?

There are a lot of essential treatments and techniques found at a radiotherapy centre, but one of the most transformative and most important in the century-long history of modern radiation therapy is the Gamma Knife.

Developed by the inventor and neurosurgeon Lars Leksell, the Gamma Knife’s intention was to act as a form of bloodless surgery, allowing for pinpoint precision when dispensing radiation to treat a wide range of conditions up to and including brain cancer.

Its versatility was the result of a lifetime of perfectionism, with Dr Leksell himself insisting that there was no tool too precise for use on the human brain.

He strived for decades up until close to the end of his life to design a versatile frame and radiation tool that could be used to treat brain conditions more accurately and more safely than a scalpel could.

His first major test of this new form of minimally invasive neurosurgery could not have been more critical.

Fothergill Disease

Often presenting as waves of sudden, sharp facial pains, trigeminal neuralgia is one of the most difficult neurological conditions to treat.

This is in part because its symptoms can be mistaken for other conditions such as temporomandibular disorder (TMD).

First described by John Fothergill, it is considered to be one of the most painful conditions known to the medical world.

Whilst it is not inherently fatal, it can result in serious depression as the result of the unpredictable and agonising waves of pain that could be caused by any facial sensation, however light.

It has led to the condition being given the rather stark alternative name of “suicide disease” because without pain management it can make everyday existence extremely difficult.

There are multiple treatment options for trigeminal neuralgia, which include epilepsy medications such as carbamazepine, as well as destructive and non-destructive forms of surgery.

As trigeminal neuralgia can present in so many different ways, all of these options are required in order to treat the widest range of people with the condition.

Surgery includes decompressing the trigeminal nerve that is the cause of the facial pain or using a heated needle, glycerol or a catheter to intentionally damage the nerve to stop pain signals, although some of these treatments have the side effect of causing facial numbness.

All of these previous options required brain surgery, which inspired Mr Leksell to devise an alternative.

Having developed a stereotactic frame that proved an effective brain atlas for undertaking neurosurgery, he wondered if it would be possible to use the same approach and apply it to brain surgery.

Before developing a system using cobalt-60, the first experimental version of what became the gamma knife used X-rays, firing narrow beams of them in precise locations to meet at a central point, where they would collectively have the power to destroy whatever they needed to.

In this case, they would be aimed at the part of the trigeminal nerve that was causing issues and destroy it, in whole or in part. This would in turn relieve the constant flashes of pain and help give people their lives back.

Whilst it is not always the first line treatment for trigeminal neuralgia now given that modern surgery has a focus on preservation wherever possible, the Gamma Knife is still used for this purpose to this day, and the first step of this process was seen in 1953.

After some experiments to prove that the system worked safely, two people walked into his clinic with Fothergill’s disease and would agree to try the experimental treatment, given that many front-line treatments today were not widely available at the time.

It was astonishingly effective, and 18 years later at a follow-up session, the two patients were still free of pain, something that was seen as exceptionally remarkable.

It offered a lot of options for people who were suffering from trigeminal neuralgia but for whom other treatments had not provided long-term relief or could not be carried out due to medical concerns.

In particular, since trigeminal neuralgia typically (albeit not exclusively) affects people over the age of 50, older patients may not be able to handle the surgical process without putting them at risk of complications, meaning that the shorter, minimally invasive Gamma Knife was a preferable alternative.

However, beyond this specific condition, the successful treatment proved that the Gamma Knife could be an alternative to other forms of neurosurgery, one that would be less risky and completely bloodless, both huge priorities for Mr Leksell throughout his life and career.