J Neurol Surg A Cent Eur Neurosurg 2014; 75 - p60
DOI: 10.1055/s-0034-1383789

The Gamma Knife Center in Lausanne University Hospital: Experience and Preliminary Results after Treating 616 Patients

M. Levivier 1, 2, C. Tuleasca 1, 2, 3, 4, L. Schiappacasse 2, 5, M. Zeverino 6, J.-M. Duff 1, 2, J. Bloch 1, 2, R.-T. Daniel 1, 2
  • 1Centre Hospitalier Universitaire Vaudois (CHUV), Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland
  • 2University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
  • 3Swiss Federal Institute of Technology (EPFL), Laboratory of Transmission Signal (LTS-5), Lausanne, Switzerland
  • 4Centre Hospitalier Universitaire Vaudois (CHUV), Medical Image Analysis Laboratory (MIAL), Lausanne, Switzerland
  • 5Centre Hospitalier Universitaire Vaudois (CHUV), Radiation Oncology Service, Lausanne, Switzerland
  • 6Centre Hospitalier Universitaire Vaudois (CHUV), Institute of Radiation Physics, Lausanne, Switzerland

Aim: Gamma Knife surgery (GKS) is a non-invasive neurosurgical stereotactic procedure, combining image guidance with high-precision convergence of multiple gamma rays emitted by sources of Cobalt-60 (Leksell Gamma Knife®, Elekta Instruments, AB, Sweden). It is increasingly used as an alternative to open microsurgery and to open functional procedures, in many neurosurgical conditions. We present our current experience in Lausanne, after treating more than 600 cases, in a wide variety of pathologies, including benign and malignant tumors, as well as vascular and functional disorders.

Methods: Leksell Gamma Knife Perfexion (LGK-PFX, Elekta AB, Sweden) was installed in Lausanne University Hospital in July 2010. Since then, a total of 616 cases were treated. The procedure is performed on ambulatory basis. All patients are followed prospectively on a regular basis, according to the treated indication. In this sense, a case report form was created, adapted to each pathology.

Results: Treated indications include 183 (30%) vestibular schwannomas, 155 (25%) meningiomas, 63 (10%) vascular (mainly arterio-venous malformations, but also cavernomas and dural arteriovenous fistulas), 34 (6%) pituitary adenomas, 110 (18%) metastases, 37 (6%) functional disorders (mainly trigeminal neuralgia, but also Vim thalamotomies for tremor, glossopharyngeal neuralgia and hypothalamic hamartomas) and 34 (6%) other pathological conditions, including various benign tumors (other cranial nerve schwannomas, cavernous sinus hemangiomas, choroid plexus papilomas, low-grade gliomas, paragangliomas), and focal recurrences of glioblastomas. Technically, LGK-PFX allowed treating all patients as expected, without experiencing limitation or downtime. The technical improvement of LGK-PFX compared with its predecessors allowed to treat more challenging situation, especially regarding safety for organ at risks (e.g., optic apparatus, cochlea) and lesions with very complex shapes. Our current experience and follow-up shows that clinical practice and outcome match the expected results, in agreement with the current worldwide experience.

Conclusion: GKS is currently a minimally invasive, safe alternative to many neurosurgical pathologies. Although preliminary experience is encouraging on the wide application of LGK-PFX for cranial radiosurgery, further long-term results are needed to fully evaluate its potential.