Gray Matters.

"O UTPATIENT BRAIN SURGERY. THE Gamma Knife is a revolutionary procedure that allows patients with brain lesions to resume normal activities the same day as treatment." At first, the pitch sounds like a late-night TV ad for one of those gizmos that slices and dices veggies. But that belies the seriousness of the

extraordinary medical tool.

The Gamma Knife beams gamma radiation to dissolve tumors and lesions and other disorders in inaccessible areas of the brain. It uses no scalpel or incision, typically requires only a mild sedative, takes between 1-4 hours and allows most patients to go home within 24 hours after surgery. In short, it is a less dangerous, painful and costly medical treatment. To date, more than 120,000 patients worldwide have undergone the treatment without a single fatality.

"It is a very attractive alternative to conventional surgery," says Ernest Bates, a neurosurgeon and CEO of San Francisco-based American Shared Hospital Services, which sells the Gamma Knife in a joint venture with the only firm that manufactures the device, Sweden's Elekta AB. "We believe the market is quite significant."

Later this year, American Shared will install the device at Lima's Clinica San Felipe and Rio de Janeiro's Hospital Barra D'or. To offset the cost--a Gamma Knife costs about US$3.2 million--the San Francisco firm will charge each hospital between $7,500 and $9,500 for each use of the equipment. (The hospital then charges the patient between $13,000 and $20,000.) "If there are no patients, we don't make a dime," says Rich Magary, American Shared's senior vice president for corporate development.

A novel brain operation may sound like a tough sell in Latin America, or anywhere else for that matter, but many Latin Americans seek alternative treatments for an array of ailments.

While living in Rio de Janeiro, I vividly remember the thousands of Brazilians who flocked annually to the operating room of a "psychic doctor" who called himself Dr. Fritz. His patients, who included a former president, were mostly frightened of traditional surgery and hopeful of an alternative from a man who said his hands were directed by the spirit of a long-dead German doctor.

Some doctors still prefer traditional surgery in cases where a young person suffers from a non-malignant tumor. Recently, my 39-year-old sister-in-law opted for conventional surgery to remove a benign brain tumor. "The cumulative risks of recurrence requiring surgical salvage and/or late radiation complication is too high in my opinion," to use the Gamma Knife, San Francisco neurosurgeon Robert K. Jackler told me before the operation. Layman's translation: if a tumor came back, it would be much harder to operate in an area that had radiation-induced changes.

For now, the Gamma Knife is available only in some 125 hospitals worldwide, of which nearly half are located in the United States. In Latin America, there are reportedly only two hospitals, in Mexico City and Sao Paulo currently offering the treatment.

South Doctor Hospital in Coral Gables, Florida, performs about 2,000 Gamma Knife operations annually, 35% of which are on patients from Latin America and the Caribbean, according to Maria White, head of international marketing. She claims many are attracted by the experience of a Colombia-born neurosurgeon named Aizik Wolf, who has performed more than 3,000 Gamma Knife procedures.

The spread of the state-of-the-art brain surgery to Latin America may eventually make the treatment available to the masses there but White isn't worried about losing patients--just yet. "If you have the choice of going to a guy who is just learning to use the machine and someone with the experience of a Dr. Wolf, where would you go?" she asks. "We're talking about your brain here."