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The Leksell Gamma Knife installation was a risk that paid off, not only for the institution making the investment, but for more than 15,000 patients treated over 30 years. The patients have come from all over the world. The experience evolved early on to capitalize on the emerging and then clear role of radiosurgery in the management of malignant brain disease, a role Leksell himself never envisaged. At our center, where in 5 hospitals we treat more than 10,000 patients per year, radiosurgery – including Gamma Knife and spine cases – now accounts for 10% of our annual neurosurgery volume. It became a critical part of the armamentarium that patients need, an option often used in conjunction with other image-guided surgical procedures, including endoscopic techniques. Our annual volume ranges from 650 to 700 patients per year, with two current gamma knife units. Efficient and compassionate care characterizes the efforts of our team, including physics providers and 5 outstanding nurses. As envisioned by Leksell, patients are in and out the same day, no operating rooms, no intensive care units. In addition to our care providers, we have wonderful connections with our imaging teams from MRI, CT, and angiography. The radiologists and technologists have been fantastic collaborators, often suggesting new imaging protocols to enhance target recognition with or without a frame. In 30 years, no patient has not been treated on the day of their scheduled procedure. This testifies to the robust nature of the technology, the problem-solving abilities of our medical physicists, and the willing availability of the Gamma Knife service team to bail out any urgent situation.

When we started to do Gamma Knife radiosurgery we realized that much effort had to be directed at maintaining a patient database and all patient records were sequestered in our administrative center. This has allowed more than 50 fellows and observers to collaborate on more than 500 publications (Fig. 4) related to the outcomes, risks, and benefits of brain radiosurgery [21].

Fig. 4. Publications from our center have continued at a rapid pace related to our experience in more than 15,000 patients and our continually updated database.