Stereotactic radiosurgery (SRS) is a non-invasive, highly precise therapeutic modality in neurosurgery. Radiosurgical medicine employs radioactive beams to treat specific pathological targets within the brain. A remarkable example of stereotactic radiosurgery is the Gamma Knife, which unlike conventional open cranial surgery, offers a non-invasive alternative for the management of deep-seated or traditionally inoperable brain tumors and malformations. Moreover, its application extends beyond neurosurgical oncology and vascular pathology; it is also effectively utilized within the field of psychiatry for the treatment of conditions such as depression, obsessive-compulsive disorder, and anorexia nervosa.
The concept of the Gamma Knife was conceived in 1940th by the Swedish neurosurgeon Lars Leksell. Over the years, radiosurgery has undergone significant refinement, and in 2023 the Swedish company Elekta introduced the ESPRIT model, which incorporates low-dose cone beam computed tomography (CBCT). This innovation reduced overall procedure time and further enhanced the precision of stereotactic radiosurgery. The Gamma Knife ESPRIT is now available at Aversi Clinic, where it is actively utilized for patient treatment.
Stereotactic radiosurgery exerts its therapeutic effect by inducing DNA damage within targeted cells. The injured cells lose their ability to reproduce, leading to tumor regression. The Gamma Knife harnesses the body’s intrinsic capacity to initiate apoptosis in pathological cells, engaging both immune and vascular mechanisms. High-dose gamma irradiation promotes the generation of tumor-specific antigens, resulting in increased T-lymphocyte activity and strengthening of the body’s immunologic defense. Treatment outcomes depend on the patient’s overall systemic status and on the response of CD8 cytotoxic T cells, which are particularly sensitive to radiation.
More than two million patients with various oncological, psychiatric, neurological, and vascular disorders have already been treated with the Gamma Knife. As for the Gamma Knife ESPRIT, the innovation of this technology lies in its capability to treat virtually all newly developing intracranial lesions, regardless of their size.
Gamma Knife is used to treat:
- Benign brain tumors (vestibular schwannoma, meningioma, craniopharyngioma, pituitary adenoma, hemangioblastoma, glomus tumors);
- Malignant brain tumors (glioblastoma, brain metastases, gliomas, hemangiopericytoma, chondrosarcoma, nasopharyngeal carcinoma, pediatric brain tumors, and other malignant neoplasms);
- Trigeminal neuralgia;
- Cavernomas;
- Cerebral arteriovenous malformations (AVMs);
- Any intracranial tumor affecting vital brain functions;
- Certain forms of epilepsy;
- Essential tremor;
At the Gamma Knife Radiosurgery Symposium organized by Aversi Clinic, Medscriptum interviewed Professor Jean Régis, a French academician and neurosurgeon at Timone University Hospital. He currently heads the Department of Stereotactic and Functional Neurosurgery and Radiosurgery. In the interview, Professor Régis discusses the significant role of the Gamma Knife in modern medicine and presents a real clinical example in which Gamma Knife treatment transformed a patient’s life.
How does Gamma Knife radiosurgery improve patients’ quality of life beyond its primary goal of treating disease?
Gamma Knife radiosurgery significantly improves patients’ quality of life. Many individuals with severe neurological disorders suffer from tremor, refractory epileptic seizures, or psychiatric disturbances that substantially limit their functional and cognitive abilities. By precisely targeting the pathological area with gamma irradiation while maximally protecting the surrounding healthy tissue, the Gamma Knife reduces symptoms and enhances overall patient well-being. From a physical standpoint, the reduction in tremor amplitude and the decreased frequency of epileptic seizures improve motor stability, safety, and independence in daily activities. From a functional perspective, symptom regression enables patients to re-engage in family life and, in many cases, return to professional activity.
How common is disease recurrence after Gamma Knife radiosurgery, and how essential is post-treatment monitoring?
The frequency of recurrence after Gamma Knife radiosurgery varies significantly depending on the pathology of the disease. The treatment target whether trigeminal neuralgia, epilepsy, psychiatric syndromes, tumors, or movement disorders determines both clinical outcomes and the likelihood of recurrence. Consequently, each condition has its own specifically defined clinical and radiological monitoring protocol. Accurate assessment of recurrence and the appropriate monitoring schedule therefore depend directly on the type of pathology and individual risk factors. The primary objectives during treatment are effective disease control, minimal toxicity, and timely intervention when necessary.
What is the future of the Gamma Knife in functional neurosurgery, and based on your experience, which clinical case stands out most in which the Gamma Knife played a decisive role in improving a patient’s condition?
I believe that the Gamma Knife has a bright future in functional neurosurgery, given the many indications for its use. It provides positive clinical outcomes with minimal invasiveness and low toxicity. Among the cases I have encountered, one particularly stands out: a young girl from New Zealand who suffered from severe seizures and associated cognitive impairment due to a hypothalamic hamartoma. Following Gamma Knife radiosurgery, her life was completely transformed, and she regained normal cognitive function. She was able to speak freely, communicate effectively, and perform daily activities independently. This case clearly illustrates the significant role of the Gamma Knife in modern neurosurgery.
How frequently does radiation necrosis occur following Gamma Knife radiosurgery?
No cases of radiation necrosis have been reported during the treatment of epilepsy, trigeminal neuralgia, or psychiatric disorders. Overall, the incidence is very low, approximately 7%, and has been observed only during the treatment of tremor and proprioceptive ataxia, conditions that represent the primary functional limitations in patients with coordination and movement disorders.
What strategies are available to reduce the risk of radiation-induced necrosis?
Since necrotic lesions are a very rare occurrence in radiosurgery, we offer affected patients rehabilitation through hyperbaric oxygen therapy, which has demonstrated successful outcomes in studies.
What is the significance of Gamma Knife conferences in the field of stereotactic radiosurgery?
The exchange of information between countries promotes the deepening of knowledge and increases medical professionals’ awareness of ongoing achievements and innovations worldwide. Events of this kind facilitate the sharing of new technologies and clinical experiences, dissemination of documented outcomes, and familiarization with best practices, representing an indispensable approach for continuous advancement in the medical field.
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