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Neurosurgical Radiosurgery – Gamma Knife

  1. Department of Neurosurgery
  2. Information for patients
  3. Disease patterns and therapies in an interdisciplinary context
  4. Neurosurgical therapy procedures and clinical working groups
  5. Neurosurgical Radiosurgery – Gamma Knife

Gamma Knife Radiochirurgie: das Schneiden mit dem Strahlenmesser am Gehirn

The modern era of radiosurgery at the University Department of Neurosurgery began with the establishment of the Gamma Knife Perfexion® in June 2012. Gamma Knife radiosurgery is a high-dose irradiation of cerebral lesions performed under stereotactic conditions.

In the Gamma Knife Perfexion®, 192 cobalt sources are arranged in a ring, divided into eight sectors, and focused with extremely high precision on the target center. With the help of collimators of different sizes, the irradiation field is adapted to the lesion being treated.

As a tool of modern neurosurgery, Gamma Knife radiosurgery can be used both as a primary therapy and in combination with other treatment options.

The most common indications include brain metastases, cerebral vascular malformations (AVM, dAVF, cavernomas), as well as benign tumors such as meningiomas and vestibular schwannomas, in addition to functional radiosurgery. Due to the high, precisely delivered dose and the steep dose fall-off, even multiple lesions—such as multiple brain metastases—can be treated in a single procedure.

The indication, a detailed patient consultation and informed consent discussion—including the explanation of the treatment process and the required planning examinations—as well as appointment scheduling take place at the Gamma Knife outpatient clinic of the Department of Neurosurgery at the Medical University of Vienna and Vienna General Hospital (AKH Vienna).

Procedure:

The day before the Gamma Knife treatment:

  • Inpatient admission of the patients.

On the day of treatment:

  • Placement of the stereotactic frame on the patient’s head.
  • Local anesthesia of the fixation points of the stereotactic frame using subcutaneous local anesthetic.
  • Fixation of the stereotactic frame with four screws.
  • The stereotactic frame remains in place until the procedure is completed.
  • After frame fixation, a planning examination is performed—most commonly a magnetic resonance imaging (MRI) scan with contrast agent and specially adjusted sequences.
    For some treatments, an additional planning CT scan or planning angiography is required.
  • The actual radiosurgical irradiation, which is silent and painless, is carried out after the planning examinations and treatment planning by the Gamma Knife physicians together with the medical physicists.

End of the treatment:

  • Removal of the stereotactic frame
  • Application of a dressing

Patients are usually able to go home two hours after the treatment is finished.

Exceptions include children, who must undergo the procedure under general anesthesia, and vascular patients who require planning angiography. These patients are usually discharged the day after the Gamma Knife treatment.