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By J. W. Berkelbach van der Sprenkel, N. M. J. Knufman, P. C. van Rijen, P. R. Luyten (auth.), L. Symon, L. Calliauw, F. Cohadon, J. Lobo Antunes, F. Loew, H. Nornes, E. Pásztor, J. D. Pickard, A. J. Strong, M. G. Yaşargil (eds.)
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Using local anaesthesia in adults and general endotracheal anaesthesia in children, the base ring with the stereotactic frame is attached to the skull of the patient either with carbon fiber pins inserted in four shallow holes drilled in the bone or using aluminium screws. Since the space in the collimator helmet is limited, the alignment of the base ring on the head is critical and should therefore be carefully planned. If the target is close to the midline the base ring should be in the midline.
In 1977 we reported 30 AVM treated with the Gamma Knife (Steiner et al. 1977). Between March, 1989, and March, 1991,364 of 1600 referred AVMs have been accepted for radiosurgery. It is pertinent to mention that the majority of cases have been referred by leading neurosurgeons around the world with a large experience in the microsurgery of AVM. Hundred and seventeen patients were treated for residual A VM following microsurgery. Hundred and twelve patients had embolization of their A VM, one patient had radiotherapy and 3 had Bragg-peak proton beam treatment prior to the Gamma Knife radiosurgery.
The collimator helmet (Fig. 3) is provided with axis rods (trunnions). The head of the patient, with the Leksell base instrument rigidly fixed on the skull and with the slide-adjustable socket bearings set according to the 24 L. STEINER et at. A • B Fig. 2. (A) The Gamma Knife: prototype A, (B) the Gamma knife: prototype B (shielding, collimator helmet, remote controlled operating couch) Y and Z coordinates of the target, is suspended in the collimator helmet with the trunnions inserted in the socket bearings.
Advances and Technical Standards in Neurosurgery by J. W. Berkelbach van der Sprenkel, N. M. J. Knufman, P. C. van Rijen, P. R. Luyten (auth.), L. Symon, L. Calliauw, F. Cohadon, J. Lobo Antunes, F. Loew, H. Nornes, E. Pásztor, J. D. Pickard, A. J. Strong, M. G. Yaşargil (eds.)