Sunday, August 12, 2012

Gamma Knife surgical teams mark 25 years since first test - Pittsburgh Post Gazette

Prospects of brain surgery would strike fear in most people, but John Lynch would have welcomed it in the mid-1980s.

That's when he, 25 at the time and living in North Braddock, was experiencing severe migraine headaches and seizures including a grand mal seizure that landed him in Braddock Hospital. He was diagnosed with an arteriovenus malformation or AVM -- a vascular malformation in the brain that can cause seizures, stroke and even death if left untreated. But his lesion was too deep in the brain for surgery, doctors said.

He would have to live with the AVM or perhaps die from it.

"I went to all of the best surgeons in Pittsburgh, and no one would touch me," he said. "They said it was inoperable, and surgery would do too much damage."

But what happened a quarter of a century ago is spawning celebration Tuesday at the University of Pittsburgh Medical Center and other neurosurgical centers nationwide.

PG map: Gamma Knife concept
(Click image for larger version)

Mr. Lynch's search led him to L. Dade Lunsford, a neurosurgeon at then-Presbyterian Hospital, and now UPMC Presbyterian, who offered Mr. Lynch a breakthrough procedure to eliminate his pain and suffering. Dr. Lunsford had been seeking such a patient to test the "Gamma Knife," a new technology that focused gamma rays to targeted areas of the brain to shrink or dissolve vascular malformations and benign and malignant tumors.

For Mr. Lynch, it was right place, right time.

And on Aug. 14, 1987, 25 years ago on Tuesday, Dr. Lunsford performed the first Gamma Knife brain surgery in North America and only the world's fifth, making the surgery a part of medical history.

Within a year, the troublesome AVM shrank and symptoms subsided, eliminating Mr. Lynch's need for anti-seizure medications. In due time he began a vending business as "Johnny Hotdog," the nickname he earned at his hotdog cart on the Sixth Street Bridge. He also operated a lunch truck and food trailer until 2002.

On Tuesday, employees at the UPMC Center for Image-Guided Neurosurgery are scheduled to hold a special luncheon in recognition of the historic achievement.

"Over the course of 25 years, people forget what has happened," Dr. Lunsford said. "We'll be treating patients on Tuesday, and one person has a malformation like the first patient had. Now we know a lot more and with better outcomes. We know what to expect and how to get the best results with the least amount of risk."

Dr. Lunsford, a distinguished professor and prior chairman of the Department of Neurological Surgery at the University of Pittsburgh School of Medicine also co-directs the UPMC Center for Image-Guided Neurosurgery with Douglas Kondziolka. In 25 years at the UPMC center, nearly 12,000 patients with brain tumors have undergone the Gamma Knife procedure, along with 1,000 who have undergone radiosurgery to treat disabling facial pain, trigeminal neuralgia, and movement disorders associated with Parkinson's disease or familial tremors.

The UPMC center remains the nation's leading provider of Gamma Knife procedures and serves as a major teaching center for neurosurgeons, radiation oncologists and medical physicists from around the globe.

Dr. Lunsford had years of involvement with Gamma Knife technology before he performed the procedure on Mr. Lynch.

In 1979, he worked in Sweden with Lars Leksell, the neurosurgeon who invented the Gamma Knife technology in 1967. The local surgery would have occurred sooner had it not taken five years to get the procedure approved by the Food and Drug Administration and the Nuclear Regulatory Commission.

Dr. Lunsford remains a consultant for and stockholder in Elekta AB, maker of the Leksell Gamma Knife Perfexion equipment, the latest version of the technology that is now available at UPMC.

The minimally invasive Gamma Knife procedure focuses gamma radiation from the radioactive decay of cobalt-60 onto targeted areas of the brain through a guidance system and imaging. The patient dons a clear helmet bearing about 200 holes through which beams of gamma rays enter the brain and intersect at the target point, where their combined energy obliterates the malformation or tumor with minimal harm to neighboring tissue.

It's called a Gamma Knife because the radiation does the same work formerly done with a scalpel but with greater success and far less risk. The modern process improved results with participation of radiation oncologists and medical physicists.

Computer and robotic technology with guidance systems also can target ever smaller, deep-seated lesions or tumors and treat multiple targets simultaneously. Dr. Lunsford said patients typically return home the day of the procedure and resume normal activities within 12 to 24 hours. Related technology now is used body-wide, including treatment of spinal tumors.

One million patients worldwide have been treated with Gamma Knife technology in the past quarter century.

The West Penn Allegheny Health System has used linear accelerators, rather than the Gamma Knife, since 1988. That technology accelerates electrons to high energy to send radiation beams to targets in the brain or body, said Dave Parda, WPAHS chairman of the Department of Radiation Oncology and overall oncology. Also one of the largest centers in the nation, it delivers 50,000 radiation treatments each year to about 3,000 patients, with several hundred patients receiving the radiosurgery treatments with the linear accelerator.

Both systems produce similar brain-treatment results in patients.

"We are proud of what they were able to do [at UPMC] with good history, but we're delivering the most advanced state-of-the-art treatment at Allegheny General Hospital and WPAHS because that's what our patients deserve and the profession requires," Dr. Parda said. "You can't work in Pittsburgh and not deliver the best state-of-the-art treatments."

Now 52, Mr. Lynch lives at the St. Joseph House of Hospitality in the Hill District and suffers from health problems unrelated to prior problems with the AVM, but he still experiences an occasional migraine. He said he remains proud of his pioneering involvement in the historic operation with open gratitude to Dr. Lunsford for making him the first choice.

"I don't have to worry about a time bomb going off or waking up after a seizure, embarrassed and not knowing where I am," he said, equating the fear to a boiler building with steam pressure, soon to explode. "Dr. Lunsford gave me life, and I can't express my gratitude I have for that man. He gave me a chance."

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