It seems like an oxymoron. After all, how can one perform brain surgery without a knife? The answer is by using radiosurgery; high-dose radiation that treats brain tumors without cutting. In 1951 Swedish neurosurgeon Dr. Lars Leksell first coined the term “radiosurgery” to describe the use of radiation to destroy target tissue such as a brain tumor with the precision and finesse of a surgeon’s scalpel. Though the process is not actually surgery in the traditional sense, the radiation beams can be directed to a target within one millimeter of accuracy. Radiosurgery does not enable the physical removal of tumors from the body, but instead, causes damage to tumor cells that ultimately leads to the death of the tumor. The body’s immune system then removes the tumor debris over time.

Dr. Leksell introduced the first radiosurgery device with the invention of the Gamma Knife in 1968. The targeting strategy of Gamma Knife uses a rigid head frame fixed to the skull for precise radiation targeting of brain tumors. The traditional head frame limits the use of Gamma Knife to treatment of intracranial tumors and therefore does not allow for spinal or body radiosurgery. The Gamma Knife was later introduced in the US in 1987 by Leksell protege, Dr. L. Dade Lunsford, a neurosurgeon at the University of Pittsburgh Medical Center. The Gamma Knife has since been used successfully and reliably for treatment of targets confined within the skull.

With advances in technology, in 1994 Stanford neurosurgeon Dr. John Adler introduced the Cyberknife, which uses a radiation source mounted on a versatile robotic arm. Having also been a student under Dr. Leksell, Dr. Adler sought to create a radiosurgery device that can be used in other areas of the body in a more comfortable manner without a rigid head frame. With the invention of Cyberknife, radiosurgery can now be used to treat tumors virtually anywhere.

Different radiosurgery treatment tools often require unique treatment strategies. Further, intracranial vs. extracranial radiosurgery (e.g., spinal radiosurgery) require distinct levels of skill and training. Defining the target, determining dose, and limiting radiation exposure to healthy tissue are all important factors that can significantly affect treatment outcome. As a neurosurgeon specializing in brain and spine radiosurgery and former student of John Adler and Dade Lunsford, I founded the Brain and Spine Radiosurgery Institute, a division of Princeton Neurological Surgery, P.C., in an effort to offer the most advanced clinical expertise using the latest radiosurgery treatment tools to the greater Princeton area. Our radiosurgical team carefully reviews all treatment options with every patient to determine if radiosurgery or “knifeless” brain and spine surgery is right for them.

Brain and Spine Radiosurgery Institute, 3836 Quakerbridge Road, Suite 203, Hamilton. 609-890-3400. See display ads, pages 13 and 17.

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