Gamma Knife

Center for Image-Guided Neurosurgery

The Center for Image-Guided Neurosurgery, led by L. Dade Lunsford, MD, Lars Leksell Professor, incorporates the expertise of individuals in image-guided stereotactic and functional neurosurgery, brain tumor surgery, Gamma Knife radiosurgery, neuro-oncology, radiation oncology and neuro-radiology. Ajay Niranjan, MD, MBA, is associate director of the center. Edward Monaco III, MD, PhD, joined the center in July of 2013 as co-associate director. The goal of the center is to provide quality patient care using minimal access or minimally invasive stereotactic and radiosurgery technology, high resolution neuroimaging and advanced computer systems. In 1981, the center was the first U.S. center to install a dedicated computed tomography (CT) scanner in a unique stereotactic operating room suite. The suite was updated in 2009.

As the first North American group to initiate a clinical program for Gamma Knife stereotactic radiosurgery in 1987, the Center for Image-Guided Neurosurgery continues to be a leader in this field. Currently two Gamma Knife units are located at UPMC Presbyterian, one of the few clinical sites in the world with two clinical units. In the fall of 2007, the Leksell Gamma Knife Perfexion™ was installed. This generation Gamma Knife unit incorporates advanced robotics, expands the role of radiosurgery to include extracranial targets, provides greater patient access, and enhances patient safety. Gamma Knife technology represents one of the most advanced means available to help patients with brain tumors, arteriovenous malformations (AVMs), and pain or movement disorders. Almost 15,000 patients have undergone Gamma Knife stereotactic radiosurgery at UPMC Presbyterian. In addition, spinal radiosurgery using several radiosurgical systems is offered under the direction of Peter Gerszten, MD, who serves as the Peter E. Sheptak Endowed Chair in spinal neurological surgery. In 2016, UPMC installed its sixth Gamma Knife, the newest generation ICON Gamma Knife with cone beam CT imaging.

The Center for Image-Guided Neurosurgery is also an international training site for radiosurgery and minimally invasive neurosurgery, holding six week-long training courses per year. Over the last 20 years, more than 2,200 neurosurgeons, neurootologists, radiation oncologists, medical physicists, and nurses have trained at this center. These courses are among the highest rated post-graduate courses offered at the University of Pittsburgh. In 2015, the center opened a new state-of-the-art education and training facility equipped with the latest generation high definition display systems. The center also has a dedicated Elekta NeuroMag® magnetoencephalography (MEG) unit that performs brain mapping in patients with structural brain lesions, epilepsy, trauma and degenerative brain disorders. Dr. Niranjan is the operations director of the MEG project.

In addition, the center conducts numerous clinical, long-term outcome research projects and is the coordinating center for the International Gamma Knife Research Foundation (IGKRF), a multi-institutional international clinical consortium of centers of excellence performing stereotactic radiosurgery using the Leksell Gamma Knife. The IGKRF currently has members from the US, Canada, the Czech republic, Spain, Taiwan, Egypt and Turkey. Multiple retrospective clinical trials have been published or are underway. More than 5,000 articles have now been published worldwide in the field of stereotactic radiosurgery. The University of Pittsburgh has the highest number of studies that have been cited more than 100 times. More than 500 peer reviewed articles, several hundred book chapters, and eleven books have been published by individuals affiliated with this center since it opened in 1981.

This multidisciplinary center includes the clinical and research efforts of neurosurgeon Hideyuki Kano, MD, PhD, and radiation oncologists John Flickinger, MD; Yoshio Arai, MD; Susan Rakfal MD; Duk il Sung, MD; and Melvin Deutsch, MD. The participating medical physics group consists of Jong Oh Kim, PhD; Kevin Fallon, MS, and Greg Bednarz, PhD. Grace Yum provides assistance in medical informatics.

More than 100 U.S. or international fellows have received training at this center since 1987. The center provides an opportunity for advanced training in image-guided stereotactic and functional surgery at the fellowship level. Current international research fellows are from China and Japan. The fellowship has two tracks, one for candidates interested in a functional focus (movement disorders, pain, and epilepsy) under the mentorship of R. Mark Richardson, MD, PhD, and one for candidates focusing on neurooncology and radiosurgery. This one-year opportunity is approved by the Society of Neurological Surgeons Committee on Advanced Specialty Training (CAST).