A perspective on radiosurgery: Creativity, elegance, simplicity, and flexibility to change

摘要

Radiosurgery is a minimally invasive technique designed by Lars Leksell to deliver a destructive amount of radiation to intracranial lesions that may be inaccessible or unsuitable for open surgery. Undoubtedly, the experiences of delivering ether anesthesia to neurosurgical patients for Dr. Olivecrona motivated Leksell to develop a technique with fewer complications than open surgery. A passage from Leksell's autobiography proved the idea of a minimally invasive neurosurgical approach as on his mind for some time. At the first Scandinavian neurosurgical meeting held in Oslo, Leksell left the conference room during a less-than-exciting presentation and decided to walk in a garden. While on this walk, Leksell met Sir Hugh Cairns. Leksell confessed to Cairns his doubts concerning the state of neurosurgical techniques available at the time and was convinced that something new had to be developed. He explained his plans to mechanically direct a probe into the brain using perhaps the brain's own electrical activity and ablate pain pathways. He also mused about the idea of using narrow-beam X-ray or ultrasound as the physical agent and doing away with the probe entirely. His enthusiasm and ideas were given a warm reception by Cairns, and the encouraged young Leksell began work that led to the development of an "arc-radius" type stereotactic system. Leksell wrote, "I was born under the sign of the 'archer' and looked forward to sharpshoot into the brain" (39).Leksell first built upon the principles of a target-centered semicircular stereotactic arc. In the early 1950s, he replaced electrodes with ionizing radiation via the use of X-rays. Building on the work of radiation therapists who were treating pituitary adenomas with a greater dose and fewer fraction protocols, Leksell postulated that a single fraction of radiation could be even more beneficial for intracranial pathology.