Читать книгу Leksell Radiosurgery - Группа авторов - Страница 11

It all started in the early 1930s when a young Lars Leksell witnessed the hardships that his mentor, and much later predecessor, Herbert Olivecrona had to cope with in his operating room (Fig. 1). Olivecrona, the grand old man of European neurosurgery, had succeeded in reducing surgical mortality from 70 to 40%, but it was still blood, sweat and tears that reigned in the operating room. Early on, Leksell became convinced that there must be ways to minimize surgical trauma to the patients, while still achieving acceptable outcomes.

Fig. 1. Herbert Olivecrona’s operating room at the Serafimerlasarettet in Stockholm. What Leksell experienced here set everything in motion.

In 1908, Sir Victor Horsley and Robert Clark published a paper in which they described their “stereotach.” The system was conceived in order to study cerebellar function in monkeys [1]. The paper was soon forgotten but its importance would later be recognized.

In 1946, at the first meeting of the Scandinavian Neurosurgical Society, Leksell met Sir Hugh Cairns, a British pioneer from the Nuffield Infirmary in Oxford. He asked Cairns for his views on a new kind of neurosurgery in which you inserted electrodes in the brain, guiding them mechanically and with the help of the brain’s own electrical activity. In some cases, he suggested to Sir Hugh, you could even replace the scalpel or the electrodes with some sort of narrow beam, perhaps X-rays or maybe ultrasound. Cairns became interested, almost enthusiastic, and Leksell felt strengthened in his beliefs [2].

Various authors had described mechanical guidance into the brain in the 1920s and 1930s, but modern stereotaxy really came to life in the late 1940s when several surgeons, more or less contemporaneously, described their own versions of the Horsley and Clark stereotach. There were the stereotactic instruments of Spiegel and Wycis in the USA, Jean Talairach in France, Traugott Riechert in Germany, and others. Leksell published his own instrument in 1949 and it differed from the others in that it used the so-called center-of-arc principle to reach the surgical target (Fig. 2) [3]. The principle means that using an electrode or other instrument with a length corresponding to the radius of the arc, the target can be reached from any point of the convexity of the head. The tip of the instrument always ends up at the center of the arc. This made the Leksell instrument intuitive to use and it would become the fundamental principle of stereotactic radiosurgery (SRS) and the one upon which the Gamma Knife (GK) was designed.

Fig. 2. 1949 – the original Leksell stereotactic instrument (a) and the center-of-arc principle (b).