Ganz The History of the Gamma Knife

1. Auflage 2014
ISBN: 978-0-444-63526-6
Verlag: Elsevier Science & Techn.
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, Band Volume 215, 152 Seiten

Reihe: Progress in Brain Research

The History of the Gamma Knife presents the evolution of concepts and technology which ended in the production of the modern Gamma Knife. The story starts before the Second World War and links pioneers in Berkeley and Sweden. To the best of the author's belief it is the first detailed, factually accurate account of the development of this important therapeutic method. - The author has been involved in Gamma Knife surgery since the early days and has written 3 books and many papers on the topic - The author is fluent in Scandinavian languages and knows the original pioneers in the field and has consulted with them to ensure the story is accurate - The book is written in an informal easy to read style - The book fills a vacuum in the literature. There are many short accounts of a few pages but no hopefully definitive account of the story of the Gamma Knife. Also these short accounts all too often contain errors which hopefully are absent from the current text

Jeremy Ganz was trained in neurosurgery at Queen Square London, Frenchay Hospital Bristol and Manchester Royal Infirmary. He emigrated to Norway in 1976 and was appointed staff surgeon in Bergen in 1979. In 1989 he was appointed chief of the Gamma Knife Center in Bergen, the fifth such center in the world. Since then he has travelled the world teaching Gamma Knife practice finishing in Cairo where he helped establish a Gamma Knife Center, where he worked for six years. Since retirement he has published three books on Gamma Knife neurosurgery and one on epidural bleeding. Subsequently he has been interested in neurosurgical history, in particular the history of cranial surgery from Hippocrates to the present with two books and several papers on these topics.

Autoren/Hrsg.

Ganz, Jeremy C.

Inhaltsverzeichnis

1;Front Cover;1
2;The History of the Gamma Knife;4
3;Copyright;5
4;Preface;6
5;Contents;10
6;Acknowledgments;16
7;Chapter 1: Background knowledge in the early days;18
7.1;1. Introduction;18
7.2;2. Clinical Neurology;19
7.3;3. Investigations;20
7.3.1;3.1. Electrical;20
7.3.2;3.2. Imaging;20
7.3.2.1;3.2.1. Plain Skull X-Rays;20
7.3.2.2;3.2.2. Brain and CSF Anatomy;21
7.3.2.3;3.2.3. Contrast Studies: CSF Replacement Studies;21
7.3.2.4;3.2.4. Contrast Studies: Contrast in Blood Vessels;25
7.4;4. Operating Theater Limitations;27
7.5;5. Introduction of Specialized Clinical Neurosciences Departments;27
7.6;6. Conclusion;28
7.7;References;28
8;Chapter 2: Some physics from 550 BC to AD 1948;30
8.1;1. Introduction;30
8.2;2. Before Accelerators;30
8.2.1;2.1. Ancient World;30
8.2.2;2.2. Newton to the Nineteenth Century;32
8.2.3;2.3. The Development and Application of Vacuum Tubes with Electrodes at Each End;33
8.2.4;2.4. Subatomic Structure;34
8.2.5;2.5. Experiments Using Spontaneously Radioactive Materials (Asimov, 1991);35
8.3;3. The Need for New Instruments;37
8.4;4. A Digression;38
8.5;5. Units;38
8.6;References;40
9;Chapter 3: Medical physics - particle accelerators - the beginning;42
9.1;1. The Age of Particle Accelerators;42
9.2;2. The Advent of the Cyclotron;42
9.3;3. Ernest Orlando Lawrence (1901-1958): An Outline;45
9.4;4. John Hundale Lawrence (1903-1991): An Outline;46
9.5;5. Artificial Radiation;48
9.6;6. First Cyclotron-related Patient Treatment;48
9.7;7. Principles of Early Medical Applications of the Cyclotron: Neutrons;49
9.8;8. Principles of Early Medical Applications of the Cyclotron: Protons;50
9.9;References;52
10;Chapter 4: From particle accelerator to radiosurgery;54
10.1;1. Introduction;54
10.2;2. Required Physical Characteristics;55
10.3;3. Indications;55
10.4;4. Design Characteristics of a Particle Beam for Radiosurgery;56
10.5;5. Practical Early Medical Applications of the Cyclotron: Physical and Animal Experiments;57
10.5.1;5.1. Beam Margin Definition;57
10.5.2;5.2. Beam Energy and Relative Biological Effect;57
10.5.3;5.3. Animal Experiments to Test Usefulness in Clinical Work;59
10.6;6. Practical Early Medical Applications of the Cyclotron: Crossover Technique;60
10.6.1;6.1. Narrow Beams with Crossover Technique;61
10.7;References;62
11;Chapter 5: Stereotactic and radiosurgery concepts in sweden;64
11.1;1. Introduction;64
11.2;2. Lars Leksell;65
11.3;3. Three-Dimensional Reference System Common to Imaging, Treatment Planning, and Treatment;66
11.4;4. The First Paper on Radiosurgery;70
11.5;5. The First Radiosurgery Cases;71
11.6;References;73
12;Chapter 6: Stereotactic and radiosurgery research in sweden;74
12.1;Abstract;74
12.2;Keywords;74
12.3;1. Introduction;74
12.4;2. Börje Larsson (1933-1998);75
12.5;3. Uppsala Research;77
12.5.1;3.1. Defining Basic Radiation Parameters in the Spinal Cord;77
12.5.2;3.2. Defining Basic Radiation Parameters in the Brain for Localized Necrotic Lesions;77
12.5.3;3.3. Brain Blood Vessel Changes Following Local Irradiation with High-Energy Protons;78
12.5.4;3.4. Further Characterization of the Localized Necrotic Lesions;79
12.5.5;3.5. Characterizing the Radiation Beam;79
12.5.6;3.6. First Human Patients in the Cyclotron;80
12.5.7;3.7. Late Papers;80
12.5.7.1;3.7.1. Histology of Late Local Radiolesions in the Brain;80
12.5.7.2;3.7.2. Radiological Properties of High-Energy Protons;81
12.6;4. Summary;81
12.6.1;4.1. Achievements with Protons in Uppsala;81
12.6.2;4.2. Philosophical Reflections;82
12.6.3;4.3. Sources of Dissatisfaction with the Proton Beam Method;82
12.7;References;82
13;Chapter 7: The journey from proton to gamma knife;84
13.1;1. Introduction;84
13.2;2. How Could Proton Beams Be Replaced?;85
13.3;3. Larsson and Lidén Principles;85
13.3.1;3.1. Dose;85
13.3.2;3.2. Localization and Precision;86
13.3.3;3.3. Relative Biological Efficiency;87
13.3.4;3.4. Radiation Volume Shaping;87
13.4;4. Gamma Knife Preparation;87
13.4.1;4.1. Building the First Gamma Unit;88
13.4.2;4.2. Gamma Unit Design;89
13.5;5. Sophiahemmet;91
13.6;References;91
14;Chapter 8: The earliest gamma unit patients;94
14.1;1. Introduction;94
14.2;2. A Little About Scandinavian Culture;94
14.3;3. The Early Patients;96
14.3.1;3.1. The First Patient;96
14.3.2;3.2. A Short but Relevant Digression;97
14.3.3;3.3. The First Patient Again;97
14.3.4;3.4. The Next Eight Patients;99
14.3.5;3.5. Gamma-Thalamotomy for Intractable Pain;99
14.3.6;3.6. The Next Steps;99
14.4;4. Names;99
14.5;References;100
15;Chapter 9: Stockholm radiosurgery developing 1968-1982;102
15.1;1. Introduction;102
15.2;2. Early Limitations of Imaging and Dose Planning;103
15.3;3. The Introduction of Computerized Imaging;107
15.4;4. Gamma Unit Number 2;107
15.5;5. Status with Specific Diseases;108
15.5.1;5.1. Functional Diseases;108
15.5.2;5.2. Pituitary Adenomas;109
15.5.3;5.3. Arteriovenous Malformations;110
15.5.4;5.4. Vestibular Schwannomas;110
15.6;References;111
16;Chapter 10: From stockholm to pittsburgh;112
16.1;1. Introduction;112
16.2;2. Need for a Gamma Knife Manufacturer;112
16.3;3. Hernan Bunge from Buenos Aires and David Forster from Sheffield;113
16.4;4. Elekta, Scanditronix, and Investment;116
16.5;5. The First Gamma Knife in the United States;117
16.6;References;118
17;Chapter 11: Changing times and early debates;120
17.1;1. Introduction;120
17.2;2. AVMs;121
17.3;3. Pituitary Region Tumors;122
17.4;4. Meningiomas;123
17.5;5. Metastases;124
17.6;6. Vestibular Schwannomas;124
17.6.1;6.1. Background;124
17.6.2;6.2. Smaller Vestibular Schwannomas;125
17.6.3;6.3. Larger Vestibular Schwannomas;125
17.7;References;126
18;Chapter 12: The development of dose planning;128
18.1;1. Introduction;128
18.2;2. Imaging Modalities;129
18.3;3. KULA;131
18.4;4. GammaPlan;132
18.5;Reference;133
19;Chapter 13: Changing the gamma knife;134
19.1;1. Introduction;134
19.2;2. Changing the Helmets;134
19.3;3. The B Model;136
19.4;4. Introducing the APS: The C Model;138
19.5;5. Plugging;139
19.6;6. Perfexion;140
19.6.1;6.1. Design Differences;141
20;Chapter 14: Conclusion and possible future trends;144
20.1;1. Final Thoughts;144
20.2;2. Quo Vadis?;145
20.3;3. Principles;146
20.3.1;3.1. The Therapeutic Team;146
20.3.2;3.2. Functions of the Team;147
20.4;4. Avoidance of Controversy;147
20.5;5. Concluding Remarks;147
21;Index;148
22;Volume in Series;152

Leseproben

Chapter 1 Background knowledge in the early days
Jeremy C. Ganz Abstract
The purpose of this chapter is to outline the medical facilities that were available to the inventors of radiosurgery at the time when the technique was being developed. This is achieved by describing in brief the timeline of discoveries relevant to clinical neurology and the investigation of neurological diseases. This provides a background understanding for the limitations inherent in the early days when investigations and imaging in particular were fairly primitive. It also helps to explain the choices that were made by the pioneers in those early days. The limitations of operative procedures and institutions designed to treat neurological diseases are also mentioned. Keywords clinical neurology radiology contrast studies operating theaters neurological hospitals 1 Introduction
Radiosurgery was first defined by Lars Leksell in the following terms: “Stereotactic radiosurgery is a technique for the non-invasive destruction of intracranial tissues or lesions that may be inaccessible to or unsuitable for open surgery” (Leksell, 1983). As stated in this section, no human activity occurs in a vacuum including the development of medical technology. Radiosurgery was developed out of the perceptions and efforts of a small group of men who passionately believed that such a method was urgently needed in the battle against a large number of contemporaneously untreatable diseases. The possibility of developing radiosurgery was a spin-off of the developing field of nuclear physics, which was such a characteristic development of the first half of the twentieth century. What was required would not be clear at the start, but would become so. There were five essential elements. The first chapters of this book concern the journey toward understanding and eventually the implementation of these elements; and it was a long journey: 1. Images that enable the visualization of the lesion to be treated are an essential part of the method. 2. A three-dimensional reference system common for imaging, treatment planning, and treatment. 3. A treatment planning system by means of which the irradiation of each case can be optimized. 4. A means of producing well-defined narrow beams of radiation that selectively and safely deliver the radiation dose under clinical conditions. 5. Adequate radiation protection. 2 Clinical Neurology
This book concerns neurosurgery and neuroradiosurgery and surgery of the central nervous system (CNS). At the time when the processes that would lead to neuroradiosurgery were beginning—around 1930—neurosurgery's contribution to patient welfare, while more rational and scientifically based than any at the time in its previous history, had relatively little to offer. Certainly, cell theory had permitted the analysis of the cellular components of the CNS and their architecture and interrelationships. Based on this new knowledge, clinical neurology had made great strides with the development of the examination of the CNS based on the understanding of how its different components were interconnected (Compston, 2009). John Madison Taylor had introduced the reflex hammer in 1888 (Lanska, 1989). Gradual understanding of how to examine the CNS was propounded by Joseph Babinski (1857–1932) in 1896 (Koehler, 2007). Ernst Weber (1795–1878) and Heinrich Adolf Rinne (1819–1868) had introduced means of distinguishing between conductive and neurogenic hearing loss although the precise date of their tests has proved impossible to determine. These tests require tuning forks that had been originally invented by John Shure (ca. 1662–1752) reaching the advanced age for the time of 90 years. He was distinguished enough that parts were written for him by both Händel and Purcell (Shaw, 2004). It was applied to neurological testing first in 1903 (Freeman and Okun, 2002). The ophthalmoscope was invented by Helmholtz in 1851 (Pearce, 2009). It was developed and its source of illumination was improved over succeeding decades. During my time at the National Hospital for Nervous Diseases, Queen Square, London, I was told that such was the value given to ophthalmoscopy that there was a time when junior doctors at Queen Square were required to examine the fundus of patients suspected of raised intracranial pressure (ICP) every 15 min. In 1841, Friedrich Hofmann invented the otoscope (Feldmann, 1995, 1997). In the 1930s, the examination of the CNS was becoming fairly precise and this precision would improve over the decades to come until the arrival of computerized imaging in the 1970s and 1980s. Until then, clinical examination was the most accurate method for localizing pathological processes. However, not all clinical symptoms arise from identifiable foci of diseases. Thus, subacute combined degeneration of the cord gives a complex picture with some tracts affected more than others. Again, in multiple sclerosis, with intermittent lesions varying in time and space, a simple localization from clinical information would be difficult. However, this is not that important for the performance of a surgical technique of which radiosurgery is one because surgical conditions are single and focal in the vast majority of cases. The advances described in the previous paragraphs greatly increased the accuracy with which a skillful clinician could localize the position of a pathological process within the CNS. Even so, the first systematic monograph on clinical neurological localization was published as late as 1921 by a Norwegian, Georg Herman Monrad-Krohn (1884–1964), writing in English (Monrad-Krohn, 1954). In 1945, the more or less definitive text by Sir Gordon Holmes (1876–1975) was published (McDonald, 2007). 3 Investigations
3.1 Electrical
As far as functional investigations were concerned, electroencephalogram (EEG) became commercial in 1935 and electromyography (EMG) arrived in 1950. 3.2 Imaging
In terms of further radiological investigations, the first visualization of the CNS came with the use of contrast-enhanced X-ray studies introduced by Cushing's student Walter Dandy (1886–1946), specifically pneumoencephalography (1918) (Dandy, 1918) and pneumocisternography (1919) (Dandy, 1919). While these examinations were undoubtedly an improvement, yet to modern eyes, they still look primitive. Then, in 1927, came carotid angiography that while a further improvement was still limited and not without risk. Vertebral angiography became routine in the early 1950s. A brief description of the way these methods works follows. Since the first radiosurgery information was published in the early 1950s, it is necessary to see how the necessary imaging for radiosurgery could be achieved at that time. If we bear in mind that the technique was solely used for intracranial targets, there were basically three imaging techniques. 3.2.1 Plain Skull X-Rays Plain skull X-rays existed but were of little value in showing targets suitable for radiosurgery. The right side of Fig. 4 shows an X-ray of the skull, taken from the side, and indicates that the only reliable location of an intracranial soft tissue is the position of the pituitary gland (see Figure 4). Following 1918, it became clear that parts of the brain could be demonstrated using what are called contrast media. These are fluid substances (liquid or gas) that affect the passage of X-rays through the skull. Either they let the rays pass more easily, in which case they will darken the part of the image where they are, or they will stop them passing so easily, in which case the portion of the image-containing medium will appear lighter. The most frequently used medium in this context was air and how it worked requires some explanation. 3.2.2 Brain and CSF Anatomy It is necessary to digress a little and explain some facts about intracranial anatomy. The brain sits tightly enclosed within the skull but it is floating in a bath of fluid called cerebrospinal fluid (CSF). This is created at roughly 0.32 ml/min. Figure 1 is a diagram of the anatomy of the brain and the fluid-filled spaces (called ventricles) that it contains. Figure 2 illustrates how the CSF is made in the ventricles and flows through the brain. It leaves the ventricles and flows over the brain between two membranes, the pia mater and the arachnoid. The pia mater means soft mother and is called that because it embraces the brain as a mother embraces her child. The arachnoid is so called after some imaginative anatomists looking through the microscope considered that the membrane and the space under it looked like a spider's web. In Greek mythology, a skillful but arrogant young lady called Arachne challenged Athena, the goddess of among other things weaving, to a weaving contest. The girl inevitably lost and was turned into the world's first spider. Thus, spiders are called arachnids and this explains the use of the term arachnoid in the current context. It should be remembered that at any one time, there is about 150 ml of CSF in the system and two-thirds of it is outside the brain in the subarachnoid space. Figure 1 This diagram illustrates the shape of the ventricles within the brain....