Gamma Knife a sharp tool for brain surgeons.

Byline: Tim Christie The Register-Guard

Clyde Pierce, an 84-year-old retired carpenter, is alone in a room in the basement of Sacred Heart Medical Center, prone on a table, his head secured inside a 400-pound tungsten helmet.

The mellifluous crooning of Frank Sinatra wafts through the room - "The summer wind, came blowing in ..." - and Pierce appears to doze off as 179 beams of radiation emitting from tiny pellets of cobalt-60 converge on a troublesome nerve inside his brain.

In the next room, behind 20-inch-thick concrete walls, a group of doctors and nurses gathers around a control panel, watching Pierce on a video monitor and keeping an eye on his vital signs. After 30 minutes, they turn off the machine, unhook Pierce and wheel him back to his room. After talking with his doctor, Pierce has lunch, and then his son takes him home to Springfield.

Pierce has just undergone brain surgery, but there's no blood, no anesthesia, no lengthy recovery. Powerful, precisely placed beams of radiation take the place of a knife. It's called radiosurgery, and it's changed the way neurosurgeons and oncologists treat tumors and other brain disorders.

Radiosurgery is not new - the Swedish-made Leksell Gamma Knife has been around since the 1960s - but in recent years, the technology has improved and the machines have been marketed more aggressively to hospitals.

Sacred Heart took delivery of a Leksell Gamma Knife, a $3.2 million radiosurgery machine, last September and, after doctors and nurses underwent intensive training, they did their first surgeries in late November.

Radiosurgery enables surgeons to treat tumors that would be inaccessible with conventional brain surgery and allows them to treat patients who are too frail or elderly to withstand open brain surgery.

Each individual beam is not powerful enough to damage the tissue it passes through. But when as many as 201 beams come together in a single spot, they're powerful enough to kill a tumor or scar a nerve.

Dr. Andrew Kokkino, a neurosurgeon and co-medical director of the Gamma Knife Center at Sacred Heart, compares the rays of the Gamma Knife converging on a tumor or nerve to the conical effect of a magnifying glass focusing rays of sun on a single spot.

"The idea is to interrupt the cellular machinery that allows the cells to replicate," said Dr. Glenn Keiper, a neurosurgeon who performed the first Gamma Knife procedure at Sacred Heart last month.

The treatment is not without risks. High-dose radiation treatment could spawn additional tumors over the long term, said Dr. Richard Clatterbuch, assistant professor of neurosurgery at Johns Hopkins University School of Medicine in Baltimore.

The risk of radiation-caused tumors generally would not be an issue for an elderly patient or someone fighting terminal cancer, he said, but it could become an issue for children being treated with radiosurgery.

Radiosurgery is used to treat tumors from cancers that have migrated to the brain from other parts of the body, but is not viewed as an effective primary treatment for brain cancer because the tumors are too numerous and widespread.

Radiosurgery also is used to treat trigeminal neuralgia, a condition that afflicts Pierce, in which a blood vessel in the brain touches a nerve, causing excruciating facial pain.

Neurosurgeons could treat the condition with brain surgery, but for someone Pierce's age, such an operation could be risky. Radiosurgery is less risky, but also less effective than a open brain surgery to fix trigeminal neuralgia, Clatterbuch said.

"For younger patients who are good surgical risks I advise them to have the surgery," he said.

Still, Kokkino said, the Gamma Knife is a proven technology - 99 percent of patients will require no additional treatments. More than 340,000 patients have been treated worldwide with the Gamma Knife, and it has been the subject of more than 2,000 peer-reviewed articles in medical journals, he said.

Insurance companies generally cover a Gamma Knife procedure; the operation is not cheap, but is it cheaper than open brain surgery.

Sacred Heart's average charge for the first six cases was $35,000, although each case varies depending on the level of treatment required, hospital spokeswoman Andrea Ash said. Doctors' fees and imaging costs, which run in the thousands of dollars, are in addition to the hospital charges.

The average hospital charge in Oregon for open brain surgery is $45,000, which doesn't include lengthy recovery time, Ash said.