Leksell gamma knife unit

Manufactured by Elekta

Sourced in Sweden

The Leksell Gamma Knife Unit is a medical device designed for stereotactic radiosurgery. It uses multiple beams of gamma radiation to precisely target and treat lesions, tumors, or other abnormalities in the brain. The device features a specialized patient positioning system and advanced imaging capabilities to ensure accurate targeting and treatment delivery.

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Lab products found in correlation

Perfexion unit, by Elekta (2 mentions) Gammaplan software, by Elekta (1 mentions) Perfexion, by Elekta (1 mentions)

7 protocols using leksell gamma knife unit

Leksell Gamma Knife Radiosurgery Protocol

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All of patients underwent GKRS in our hospital. The procedure was performed using model B Leksell Gamma Knife Unit before April 2014 and Perfexion Unit (Elekta Instrument, Inc. Stockholm, Sweden) thereafter. Following stereotactic Leksell frame placement, thin-slice stereotactic MRI with contrast was performed through the sellar. Subsequently, GKRS treatment planning was made in consultation with a medical physicist, radiation oncologist and neurosurgeon. Dose selection for GKRS was mainly dependent on the tumor type, tumor volume, distance to the optic nerve and chiasm. The median tumor margin dose was 14.4 Gy (range, 8.0-30.0 Gy) at a median prescription isodose 40% (range, 18.8-80.0%). The median maximum dose was 33.3 Gy (range, 14-90 Gy).

Fu J., Li Y., Wu L., Yang X., Quan T., Li X., Zeng J., Deng Y, & Yu J. (2021). Pituitary hemorrhage in pituitary adenomas treated with gamma knife radiosurgery: incidence, risk factors and prognosis. Journal of Cancer, 12(5), 1365-1372.

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Stereotactic Radiosurgery for Pituitary Adenomas

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The SRS technique for treatment of patients with pituitary adenomas at our institution has been previously described. 11 In brief, a high-resolution MRI was obtained before and after contrast administration, combined with fat suppression, at 1mm slice thickness. A Leksell stereotactic Gamma Knife frame was placed under monitored anesthesia care. Following frame placement, a CT was obtained and merged with the high-resolution MRI. Dose planning was performed using the GammaPlan software (Elekta AB, Sweden) by a multidisciplinary team comprising a neurosurgeon, radiation oncologist, and medical physicist. SRS was performed using the Leksell Gamma Knife Unit (Elekta AB, Sweden); the model varied depending upon the time of treatment.

Ironside N., Snyder H., Xu Z., Schlesinger D., Chen C.J., Vance M.L., Hong G.K., Jane JA J.r, & Sheehan J.P. (2022). Effect of distance from target on hypopituitarism after stereotactic radiosurgery for pituitary adenomas. Journal of neuro-oncology, 158(1).

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Gamma Knife Radiosurgery for Tumors

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GKRS was performed on a Leksell Gamma Knife unit (model 4C, Elekta). Depending on tumor size and localization, the margin dose varied from 9.7 to 18 Gy (Table 1). The treatment was planned on a Leksell GammaPlan 10.1 workstation (Elekta) to carefully avoid undue radiation to sensitive structures such as the optic system or the cochlea and to keep the coverage index as high as possible (mean 96.8%). The margin dose was 12-18 Gy (mean 13.9 Gy) applied in a single session with the exception of 1 case, which was treated by hypofractionated GKRS (3 × 5 Gy, corresponding to a single fraction equivalent dose of 9.7 Gy, applying an α/β ratio of 3.76 Gy, according to Vernimmen and Slabbert 23 ).

Speckter H., Bido J., Hernandez G., Rivera D., Suazo L., Valenzuela S., Miches I., Oviedo J., Gonzalez C, & Stoeter P. (2018). Pretreatment texture analysis of routine MR images and shape analysis of the diffusion tensor for prediction of volumetric response after radiosurgery for meningioma. Journal of neurosurgery, 129(Suppl1).

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Multimodal AVM Treatment Approach

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Endovascular treatment is considered to be the first treatment option in our hospital unless decompressive craniotomy and hematoma removal are urgently required. If complete obliteration could not be achieved with one or a few sessions of endovascular embolization, most patients were subsequently treated with gamma knife radiosurgery (Leksell Gamma Knife Unit; Elekta, Norcross, Georgia, USA). Staged gamma knife radiosurgery was performed to treat large AVMs as described previously.^{8) (link)} AVMs located in superficial cortical areas were surgically removed after endovascular embolization, depending on patient preferences. After gamma knife radiosurgery, follow-up magnetic resonance imaging (MRI) and computed tomography (CT) images were evaluated every 6 months for 3 years. Digital subtraction angiography (DSA) was performed at 1 year and 3 years after the initial embolization. Once complete obliteration of the AVM was confirmed, patients were followed up annually with MRI and CT.

TAMURA G., KATO N., YAMAZAKI T., AKUTSU Y., HOSOO H., KASUYA H, & SONOBE M. (2015). Endovascular Embolization of Brain Arteriovenous Malformations with Eudragit-E. Neurologia medico-chirurgica, 55(3), 253-260.

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Gamma Knife Radiosurgery Protocol

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Model B Leksell Gamma Knife Unit was performed from 1993 to 2014 and Perfexion Unit (Elekta Instrument, Inc.) thereafter. Thin-slice stereotactic MR imaging with contrast was performed with axial and coronal images through the sella following stereotactic Leksell frame placement. Subsequently, the planning of GKRS treatment was made in consultation with a medical physicist, radiation oncologist and neurosurgeon. The prescribed dose was adjusted depending on tumor volume, distance to the optic nerve and chiasm, and history of previous radiotherapy. The maximal dose to the optic nerve and chiasm was restricted to 9 Gy, and to the lateral wall of the cavernous sinus was restricted to 15 Gy. Small collimators of 4 mm and 8 mm were mainly adopted to achieve better GKRS treatment plan conformality.

Deng Y., Li Y., Li X., Wu L., Quan T., Peng C., Fu J., Yang X, & Yu J. (2020). Long-term results of Gamma Knife Radiosurgery for Postsurgical residual or recurrent nonfunctioning Pituitary Adenomas. International Journal of Medical Sciences, 17(11), 1532-1540.

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Stereotactic Radiosurgery for AVM

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A stereotactic head frame was placed for all patients using local anesthesia supplemented by intravenous sedation. Next, biplane digital subtraction stereotactic angiography was performed followed by MR imaging (Figures 1(g) and 1(h)). Volumetric 3D dose planning was performed using Leksell GammaPlan software. For patients with larger lesions and prospectively volume-staged SRS plans, the lesion was divided into approximately equal volumes using anatomic landmarks. SRS treatment plans consisted of the margin SRS dose including the entire AVM nidus volume. SRS was performed with Leksell Gamma Knife units (Elekta AB).
The median initial AVM volume was 28 cm³ (largest being 112 cm³). The mean Flickinger Pollock grade was 3.65 (range 1.1 to 11.8).
The postembolization mean maximal diameter was 2.2 cm (range 0.3–6 cm). The median total target volume was 4.24 cm³ (range 0.26–9.1 cc³) on the first SRS treatment and 5.09 cm³ on successive SRS treatments. The median margin dose was 21 Gy.

Dalyai R., Theofanis T., Starke R.M., Chalouhi N., Ghobrial G., Jabbour P., Dumont A.S., Fernando Gonzalez L., Gordon D.S., Rosenwasser R.H, & Tjoumakaris S.I. (2014). Stereotactic Radiosurgery with Neoadjuvant Embolization of Larger Arteriovenous Malformations: An Institutional Experience. BioMed Research International, 2014, 306518.

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Gamma Knife Radiosurgery Technique

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Details of the single fraction Gamma Knife technique employed during the radiosurgical treatment of the included patients have been extensively described by our group.^{20 (link),21 (link)} Briefly, patients were placed in a Leksell Gamma Knife Frame (Elekta AB) under sedation and local anesthesia to obtain thin-slice axial and/or coronal magnetic resonance imaging for treatment planning and delivery. In all cases, a multidisciplinary team of neurosurgeons, radiation oncologists, and radiation physicists was involved in different aspects of the treatment. Different models of Leksell Gamma Knife units (model B, U, 4C, Perfexion, and Icon; Elekta AB) were used depending on the available technology at the medical center and the time of procedure.

Ruiz-Garcia H., Trifiletti D.M., Mohammed N., Hung Y.C., Xu Z., Chytka T., Liscak R., Tripathi M., Arsanious D., Cifarelli C.P., Caceres M.P., Mathieu D., Speckter H., Lekovic G.P., Mehta G.U, & Sheehan J.P. (2020). Convexity Meningiomas in Patients with Neurofibromatosis Type 2: Long-Term Outcomes After Gamma Knife Radiosurgery. World neurosurgery, 146, e678-e684.

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