Twenty-six patients underwent the Leksell Gamma Knife (Elekta C) between June 2010 and December 2019, and five patients then received the Leksell Gamma Knife (Elekta ICON). First, a head frame was applied under local anesthesia. Second, thin slice (≤1 mm) MRI images were acquired with the frame in place. Then, the neurosurgeon and radiologist collaborated to establish the treatment plan. Generally, maximum doses to optic structures were kept to less than 9 Gy by optimized tumor treatment plans. Last, positioning the patient in the gamma knife, we delivered the plan after the head frame was rigidly affixed to the treatment table.
Leksell gamma knife
Manufactured by Elekta
Sourced in Sweden
The Leksell Gamma Knife is a medical device designed for non-invasive stereotactic radiosurgery. It uses multiple beams of highly focused gamma radiation to precisely target and treat lesions or tumors in the brain. The device is engineered to deliver a high dose of radiation to the treatment area while minimizing exposure to surrounding healthy tissue.
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Lab products found in correlation
Leksell gammaplan, by Elekta (5 mentions)
Leksell coordinate g frame, by Elekta (3 mentions)
Leksell frame, by Elekta (3 mentions)
T2 ciss fiesta sequence, by Siemens (2 mentions)
Leksell gammaplan software, by Elekta (2 mentions)
Kula planning system, by Elekta (2 mentions)
Leksell gamma knife 4c, by Elekta (1 mentions)
Perfexion, by Elekta (1 mentions)
Signa hd, by GE Healthcare (1 mentions)
Leksell gammaplan treatment planning system, by Elekta (1 mentions)
Gammaplan, by Elekta (1 mentions)
23 protocols using leksell gamma knife
1
Leksell Gamma Knife for Brain Treatments
2
Gamma Knife Thalamotomy for Movement Disorders
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All SRS-T procedures were performed in Marseille (CHU Timone) by J.R., who used the Leksell Gamma Knife and the associated Leksell GammaPlan software (Elekta Instruments AB). To avoid artifacts we first acquire, pretherapeutically, diffusion tensor imaging (DTI) data without the frame. We further coregister the DTI study with the therapeutic stereotactic images. We always apply the Leksell coordinate G Frame (Elekta AB) under local anesthesia the day of the thalamotomy. After the frame is placed, patients undergo both stereotactic CT and MRI. We further define the landmarks of interest, including the anterior and posterior commissures, which were identified on the MR ventriculography study (T2 CISS/FI-ESTA sequence, Siemens). We perform uniform indirect targeting using the Guiot diagram, 37 placed 2.5 mm above the anterior commissure-posterior commissure line and 11 mm lateral to the wall of the third ventricle. We always use a single 4-mm isocenter. A maximum prescription dose of 130 Gy at the 100% isodose line is uniformly prescribed. 37
3
Surgical Management of Brain Tumors
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For the tumors that presented with profound surrounding edema on preoperative MRI or caused any neurological symptoms, complete surgical resection was performed for immediate decompression irrespective of whether they were solitary or multiple. Cystic walls with contrast enhancement were always surgically removed. For multiple small asymptomatic tumors that could not be reached in the craniotomy for the removal of the main tumors, and for small tumors in the brain stem, gamma knife surgery (GKS, Leksell Gamma Knife; Elekta Instrument, Stockholm, Sweden) was planned. In cases of VHL disease with multiple recurrent tumors, GKS was first considered as the primary treatment option, while a surgical procedure was reserved for future treatment. However, for tumors with a significant cystic component, surgical treatment was always considered as the primary treatment option as their radiosurgical outcomes are relatively unfavorable7 (link).
4
Gamma Knife Thalamotomy for Movement Disorders
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Thalamotomy was performed with GK between September 2014 and April 2016, always at the Centre Hospitalier Universitaire de la Timone in Marseille. The surgeon in charge was JR, who used the Leksell Gamma Knife and associated Leksell GammaPlan software (Elekta Instruments, AB, Stockholm, Sweden). To avoid artifacts, DTI data was first acquired without the frame, and then co-registered with the therapeutic stereotactic images. The Leksell coordinate G frame (Elekta Instruments, AB, Stockholm, Sweden) was always applied under local anesthesia on the day of the thalamotomy. After positioning the frame, patients underwent both stereotactic CT and MRI.
Landmarks of interest, including the anterior and posterior commissures, were identified on an MR scan (particularly on T2 CISS/FIESTA sequence, replacing a former ventriculography). Uniform indirect targeting was performed using the Guiot diagram (Tuleasca et al., 2017 (link)), placed 2.5 mm above the anterior-posterior commissure line, and 11 mm lateral to the wall of the third ventricle. A single 4 mm isocenter was always used, and a maximum prescription dose of 130 Gy at the 100% isodose line was uniformly prescribed (Tuleasca et al., 2017 (link)).
Landmarks of interest, including the anterior and posterior commissures, were identified on an MR scan (particularly on T2 CISS/FIESTA sequence, replacing a former ventriculography). Uniform indirect targeting was performed using the Guiot diagram (Tuleasca et al., 2017 (link)), placed 2.5 mm above the anterior-posterior commissure line, and 11 mm lateral to the wall of the third ventricle. A single 4 mm isocenter was always used, and a maximum prescription dose of 130 Gy at the 100% isodose line was uniformly prescribed (Tuleasca et al., 2017 (link)).
5
Gamma Knife SRS Protocol
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Standard SRS procedures were performed with a Leksell Gamma Knife (Elekta AB). All patients received a dose of 18–25 Gy with 99–100% coverage of the target. Dose limits for organs at risk were 18 Gy for the brainstem and 8 Gy for the optic chiasm or optic nerves.
6
Leksell Gamma Knife Radiosurgery Protocol
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GKRS was performed using a Leksell Gamma Knife (Elekta Instrument, Stockholm, Sweden) model C. The planning system was a Leksell Gamma Plan version 8.3.1 (Elekta Instruments AB). For magnetic resonance imaging (MRI) of radiosurgical planning, T1-weighted axial images with double-dose contrast and T2-weighted axial images were obtained with 2-mm slice thickness without gaps. Mean tumor volume was 3.2 cc (range, 0.001–14.1 cc). GKRS treatment was done with a mean volume coverage of 98.8% (range 96–100%). The mean prescription dose of 18.6 Gy (range, 12–24 Gy) was delivered to the mean 56.3% (range, 50–90) isodose line.
7
Gamma Knife for Recurrent Glioblastoma
8
Gamma Knife Irradiation of AVF Tissues
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After 6 weeks of creating the fistulas, three rats were irradiated using the Leksell Gamma knife (Elekta, Stockholm, Sweden) at Macquarie University Hospital by delivering 15 Gy to the AVF tissues directly, minimizing the dose to the trachea to less than 10 Gy. The remaining three rats were used as controls.
9
Single-Fraction Stereotactic Radiosurgery with Gamma Knife
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All patients underwent single-fraction SRS with Leksell Gamma Knife (Elekta Medical Systems, Stockholm, Sweden). Patients were treated with the Perfexion model Gamma Knife unless treated prior to April 2008, in which case a Model C unit was utilized. A high-resolution contrast-enhanced brain MRI and non–contrast-enhanced head computed tomography scan were obtained for treatment planning. A medical physicist, radiation oncologist, and neurosurgeon completed target delineation and treatment planning in concert. The prescription dose was based on recommendations from Radiation Therapy Oncology Group trial 90-05 with adjustments made at the discretion of the treating physician. In general, lesions measuring ≤2 cm were treated to 20 to 24 Gy, lesions 2.1 to 3 cm were treated to 18 Gy, and lesions >3 cm were treated to 15 Gy.
10
Gamma Knife Radiosurgery for Lesions
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GKRS, performed using the Leksell Gamma Knife (model C or Perfexion, Elekta AB, Stockholm, Sweden), was used to treat 455 lesions in the 147 patients included in this study. The median maximal dose was 37 Gy (range, 18–62.5 Gy), with a median marginal tumor dose of 21 Gy (range, 14–25 Gy) at the 40–85% isodose line.
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