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The origins of this volume derived from the teaching course that our group provides at UPMC (University of Pittsburgh Medical Center) six times per year. The editors hope that it describes the evolution and current role of Leksell radiosurgery as it is applied to a wide variety of indications for cranial stereotactic radiosurgery. During the last 3 decades we have trained more than 900 neurological surgeons, 700 radiation oncologists, and almost 400 medical physicists. We are pleased that during the 31 years of our experience at the UPMC, Leksell radiosurgery has become a widely applied technique for the management of a diverse group of vascular, neoplastic, and functional disorders. The goal of the three editors of this volume of Progress in Neurological Surgery is to provide a topical summary of the current role of Leksell radiosurgery as we and other authors of this volume have applied it. It is hard to believe that Lars Leksell first coined the term stereotactic radiosurgery in 1951.

In this preface the editors would like to introduce the readership to many of the first or senior authors of chapters in this book. All have had significant roles in the development of stereotactic radiosurgery. Many authors have collaborated on more than 1 chapter.

L. Dade Lunsford

Co-editor L. Dade Lunsford, MD studied in Sweden in 1979 and again for 1 year between 1980 and 1981. He made the decision to help introduce stereotactic radiosurgery and the vision of Lars Leksell to North America. Lunsford has been in the academic ranks of the University of Pittsburgh since 1980, and currently serves as the Lars Leksell and Distinguished Professor at Pitt. He is also the director of the Center for Image-Guided Neurosurgery at UPMC. His chapters include the introduction of Leksell radiosurgery to North America, frame-based versus frameless Leksell radiosurgery, and, cavernous malformations. Lunsford has co-authored other chapters, including anesthesia needs, a patient preparation and nursing management, glioma, chordoma and chondrosarcoma and the 3H “tumors.”

Ajay Niranjan

Co-editor Ajay Niranjan is responsible for the overall organization of the volume as well as many chapters in this book. Dr. Niranjan was trained at the University of Lucknow and came to Pittsburgh to do a radiosurgery fellowship from 1997 to 1999. He received his MS (surgery) and M.Ch (neurosurgery) degrees at Lucknow, and his MBA at the University of Pittsburgh in 2009. Dr. Niranjan currently serves as Professor of Neurological Surgery at the University of Pittsburgh and co-director of the UPMC Center for Image-Guided Neurosurgery. He is managing director of our Brain Mapping Center which uses MEG and imaging to define the anatomy and function of the brain. He has been actively involved in almost all of our clinical and research activities and has been an important aspect of our clinical program designed to spread information about the outcomes related to radiosurgery for many indications. He is responsible for chapters on imaging, the creation and maintenance of a database registry, guidelines for multiple brain metastasis radiosurgery, craniopharyngioma radiosurgery, low-grade glioma, malignant gliomas, and targeted therapies. He is a coauthor on many other chapters. Finally, his outstanding work in movement disorders is covered in our functional radiosurgery section.

Hideyuki Kano

Co-editor Hideyuki Kano, MD, PhD received his MD degree at Shiga University in 1997 and his PhD at Kyoto University in 2004. His neurosurgical training was completed at both Kyoto and Osaka Universities in Japan. He came to Pittsburgh to do his radiosurgery fellowship in 2007–2008. He currently serves as Research Associate Professor of Neurosurgery at the University of Pittsburgh and director of radiosurgery research at the Center for Image Guided Neurosurgery at the University of Pittsburgh. In addition to co-editorship, his contributions include primary authorship of chapters on other gliomas, and chordoma and chondrosarcoma.

Dan Leksell

Dan Leksell is an otolaryngology trained physician who early in his life became an exponent for the Leksell Gamma Knife. One of five children of Professor Lars Leksell, Dan was one of two who went into the field of medicine. Throughout his career, he has been a medical spokesman for his father’s seminal contributions as well as for the AB Elekta company which manufactures the Leksell Gamma Knife. Over the last 20 years, Dan has been the head of the Leksell Gamma Knife Society, a professional organization dedicated to increasing the knowledge base related to Leksell radiosurgery.

Kevin Fallon

Jong Oh Kim

The chapter on medical physics is co-authored by two outstanding UPMC medical physicists, Kevin Fallon and Jong Oh Kim. The chapter provides a wonderful summary of the basic core knowledge that neurosurgeons, oncologists, and medical physicists need to know about the Leksell Gamma Knife.

Jonet Vacsulka

Jonet Vacsulka, BSN is our head nurse at the Center for Image-Guided Neurosurgery. In her chapter she provides an overview of the role of pre-, intra-, and postoperative care of patients. She oversees our outstanding nursing team who optimize the care of our patients. Most patients undergo Leksell radiosurgery on an outpatient basis. Our nurses are all experienced in the use of conscious sedation and help to ensure patient comfort during the entire procedure.

James Greenberg

The discussion on the use of sedation and, in selected patients, general anesthesia is co-authored by Dr. James Greenberg and covers many of the concerns related to anesthetic needs in both children and adults. Jim has been an important collaborator for more than 30 years and recently retired to hopefully lead a less stressful life in the future.

Michael Sheetz

The chapter on regulatory issues in the USA is authored by Michael Sheetz, PhD. He describes the unique regulatory requirements that were developed by the US Nuclear Regulatory Commission (NRC) and its agreement states. Michael Sheetz is Director of the University of Pittsburgh’s Radiation Safety Office and the Radiation Safety Officer for the University and affiliated University of Pittsburgh Medical Center (UPMC) Hospitals. He is also a Clinical Assistant Professor of Radiology in the University of Pittsburgh’s School of Medicine. Mike is certified in Comprehensive Health Physics by the American Board of Health Physics and in Medical Health Physics by the American Board of Medical Physics. He was recently appointed to the NRC Advisory Committee on the Medical Use of Isotopes (ACMUI) as the Radiation Safety Officer representative. Mike is also a member of the Pennsylvania Radiation Protection Advisory Committee and Low-Level Waste Advisory Committee.

Gregory Bowden

Many of our authors describe the role of Leksell Radiosurgery for tumors. Gregory Bowden, MD is currently working in our UPMC system in Erie, Pennsylvania. Greg is a Canadian citizen but attended medical school at the University of Queensland in Australia before completing his neurosurgical training in London, Ontario. He first served as an introductory fellow while in his residency at the University of Western Ontario and then returned for a full 1-year fellowship in 2016–2017. Greg’s report defines current outcomes related to the management of vestibular schwannoma (also known as acoustic neuroma).

Tom Flannery

The chapter on skull base meningiomas was written by Tom Flannery, MD, PhD. Tom is a Northern Irishman who received his medical and research training at Belfast and Beaumont Hospital in Belfast. He completed his 1-year fellowship in Pittsburgh in 2009. During that time, he co-authored several peer-reviewed articles related to petroclival meningiomas and other skull-based tumors.

Masaaki Yamamoto

The chapter on brain metastasis is written by a close friend from the Mito Gamma House in Japan, Masaaki Yamamoto, MD, PhD. Masaaki is a dedicated and prolific author and vocal exponent of the increasing role of radiosurgery for brain metastasis. He has emphasized the importance of the volume of treated tumors, not the number of treated tumors. Known in a friendly way as “Doctor Crazy,” he is in fact a dedicated thought leader in the field of metastatic tumors.

Veronica Chang

A discussion on adverse radiation effects was authored by Dr. Veronica Chang, who is currently Professor of Neurological Surgery at Yale University. She has studied both the causes and management of adverse radiation effects, including the possible use of laser interstitial hyperthermia to reverse the radiation vasculopathy effects encountered in a small group of patients. Dr. Chang is an Australian native and received her medical training at the University of Western Australia followed by residency at Yale. Among her other activities she serves as the Secretary Treasurer of the International Radiosurgery Research Foundation.

Jason Sheehan

Jason Sheehan, MD, PhD is the senior author on the chapters on pituitary and glomus tumors. He completed his education at the University of Virginia and subsequently his residency there. Jason is a brilliant medical writer and one of the most prolific neurosurgeons in the world. Since he completed his intra-residency fellowship at the University of Pittsburgh in 2002 he has become a close colleague and friend to the team at UPMC. He one of the most versatile and hardest working neurosurgeons our team has encountered. Dr. Sheehan has become a leader within the International Radiosurgery Research Foundation. He is also the editor of the Journal of Neuro-Oncology and a thought leader in the field. He currently serves as Professor of Neurological Surgery at the University of Virginia.

Selcuk Peker

My colleague Selcuk Peker, MD completed his medical education in Ankara and his neurosurgery residency there at Hacettepe University. He currently serves as Professor of Neurosurgery at Koc University Hospital in Istanbul. He describes his experience in the management of non-vestibular schwannomas. Prof. Peker also served as a fellow at our center during the year 1999.

David Mathieu

The discussion related to Leksell radiosurgery for pineal region tumors was completed by Dr. David Mathieu. He currently serves as Professor of Neurosurgery at the University of Sherbrooke in Montreal. He received his MD degree from the University of Sherbrooke in 1999. David is an outstanding clinician and researcher. He also completed a radiosurgery fellowship at our center in 2006.

Stephen Johnson

Johnson et al. describe the role of Leksell radiosurgery in the management of the 3 H tumors – hemangiomas, hemangiopericytomas, and hemangioblastomas. The primary author, Stephen Johnson, is our current neurosurgery chief resident who completed an enfolded 9-month radiosurgery fellowship at UPMC in 2018.

Aja Nakamura

Aya Nakamura authors a report on Leksell radiosurgery for central neurocytoma. Dr. Nakamura received her neurosurgical training at the University of Tokyo, which was the first Japanese center to install a Leksell Gamma Knife. She spent a 6-month radiosurgical fellowship at UPMC before moving to work further with Douglas Kondziolka at New York University.

Bruce Pollock

Bruce Pollock contributes a chapter related to of the important role of radiosurgery in the treatment of brain vascular malformations. Bruce currently serves as Professor of Neurological Surgery at the Mayo Clinic in Rochester, Minnesota. He completed his neurosurgical residency at the University of Pittsburgh in 1996, during which he did enfolded fellowship training in radiosurgery. He briefly served on the faculty at Pitt before moving to Rochester. He is an internationally known advocate for radiosurgery in many circumstances and one of the pioneers in developing grading scales for outcome prediction in AVM radiosurgery.

Huai-Che (Wade) Yang

The discussion related to dural arteriovenous fistulas is authored by Huai-Che (Wade) Yang, MD, PhD and colleagues from Taipei. They review their extensive experience and define the important adjuvant role of endovascular embolization in selected cases. Wade was an outstanding radiosurgery fellow at UPMC between 2008 and 2009. He completed his medical education at Taipei Medical University and his neurosurgical training at the National Taiwan University Hospital.

Dan Tonetti

To further the discussion related to vascular malformations, Dan Tonetti reports new methodologies to define clinical outcomes after AVM radiosurgery. Training with UPMC endovascular team mentors Brad Gross and Brian Jankowitz, Dan is currently a senior resident in neurological surgery. He completed his medical training at the University of Pittsburgh.

Douglas Kondziolka

Douglas Kondziolka has crafted his chapter on the role of Leksell radiosurgery for trigeminal and other facial neuralgias. Dr. Kondziolka completed his neurosurgical training at the University of Toronto, did his enfolded fellowship at UPMC in 1991, during which he obtained a Master of Science degree. He then returned to Pittsburgh for his first academic job in 1992. His lightning-like progression up the academic ladder has been related to his prodigious clinical and research output, including the evaluation of radiosurgery in animal models as well as patients. Dr. Kondziolka now serves as Professor of Neurological Surgery at New York University.

Roberto M. Alvarez

Roberto Martinez Alvarez, MD, PhD describes his experience related to the use of Leksell radiosurgery for behavioral disorders. While one of the earliest indications for the use of radiosurgery, its role continues to evolve. Roberto received his medical education in Madrid, where he was awarded his Master Degree in Neurosurgery at the Autonomous University of Madrid. He initiated the first Spanish radiosurgery program. He has served as the head of the functional neurosurgery and radiosurgery unit at Ruber International Hospital since 2002.

William Ares

The primary author of a discussion related to radiosurgery for choroidal tumors is William Ares, who currently serves as chief resident in neurological surgery at the University of Pittsburgh.

Roman Liscak

Finally, Roman Liscak is an outstanding collaborator and director of the Gamma Knife program at Na Homolce Hospital in Prague. He has drafted his report on the use of Leksell radiosurgery for a wide variety of other eye pathologies, a work which is still evolving in North America. Roman received his MD and PhD degrees at the Charles University of Prague, where he currently serves as Associate Professor. He also gathered additional radiosurgical experience during his fellowship at our center in 1995.