Who Was The First Person To Be Treated With The Gamma Knife?

Precision is key when it comes to any treatment related to the brain, and part of the reason why people are often prescribed a trip to a radiotherapy centre for stereotactic radiosurgery is precisely because of this precision.

Lars Leksell once noted that no tool can be too refined for the human brain, and this became the motivation for him, alongside a desire for bloodless neurosurgery, to develop what became the Gamma Knife, the first-ever stereotactic radiosurgery technique and still one of the most widely used in the world.

It is a critical piece of equipment that has helped to ease the suffering of countless people and help treat many different types of brain cancer. However, who was the first to receive treatment using this pioneering technique? 

It depends somewhat on the definition of stereotactic radiosurgery.

Stereotactic Surgery With Radiation

In 1947, Mr Leksell started to develop the stereotactic frame, the critical part of the Gamma Knife technique.

However, the infamous perfectionist was initially wary about exactly what type of surgical system he would use. Radiotherapy was widely used by the end of the Second World War to treat other forms of cancer, but in the absence of MRI or CT scanners, the techniques involved were far less precise.

Mr Leksell would never have allowed that regardless, but he also was acutely aware that the distribution technologies for radiation therapy that existed at the time were perhaps not precise enough for the systems he had devised, meaning that the first radiation surgery using the stereotactic technique was not technically radiosurgery.

In 1948, a patient came to see him with a craniopharyngioma, a pea-sized benign tumour that does not spread and grows incredibly slowly. Because it does not move, it was the perfect test for the polar stereotactic method Mr Leksell used.

However, instead of using narrow beams of radiation, as would be standard with the Gamma Knife, the treatment instead consisted of phosphorus, which punctured the cyst and destroyed it from the inside.

His solution was a diagrammatic coordinate system that consisted of a complex series of concentric circles that compensated for X-ray divergence by calculating the difference between the tube and the developing material.

In a career filled with remarkable innovation and success, this system was one of Lars Leksell’s few failures. First of all, it relied on pneumoencephalography, itself a somewhat archaic imaging method that was not universally used, and the unintuitive coordinates system confused a lot of surgeons, making it difficult to actually apply to neurosurgery.

Regardless, the success of this procedure inspired him to look for an accurate alternative in the field of radiotherapy. It would not take him long to find success.

X-Ray Stereotactic Radiosurgery

With the frame system already a proven success, the next step was to find an alternative treatment system to probes and radioactive injections, both of which required invasive surgery to achieve.

In 1951, Mr Leksell figured out the centre-of-arc radiation principle that proved that multiple small doses of radiation could be focused onto a central point and be highly accurate without damaging healthy tissue surrounding it.

Whilst the principle was effective, exactly which form of radiation could be used at the time was still a point of contention. Gamma rays and ultrasound were considered, but ultimately X-rays were the first radiation outlet to be used.

After some initial experimentation, the first two cases that were successfully treated were both for trigeminal neuralgia, an extremely painful nerve disorder known as the “suicide disease” due to its reputation as being one of the most painful conditions in medicine.

A common treatment for the condition is to intentionally damage the trigeminal nerve that causes the pain, usually undertaken by using a probe or needle to damage the point where the nerve splits into three.

Using the stereotactic frame with a 280-kilovolt X-ray tube, the two people he treated were free of pain for at least two decades, highlighting the potential for the technique, even if an alternative source of radiation was required.

Initially, he tried to use a synchrocyclotron to use proton beams to destroy lesions in the brain, but the system proved to be too complicated and soon abandoned the idea after its introduction in 1958.

By 1960, however, Mr Leksell had found out about cobalt-60, a form of gamma radiation that was more accessible for clinical use and could be integrated into the stereotactic system he already had in place.

This ultimately enabled him to realise his dream of creating a bloodless neurosurgery that could be used as an alternative to conventional neurosurgery in a wide variety of cases in spite of initial scepticism.