[The gamma-knife in stereotaxic surgery. A new era in brain surgery]

The gamma knife is a dedicated neurosurgical equipment for brain surgery to treat predetermined intracranial normal or pathological targets through the intact skull without damaging the surrounding normal brain tissue. The operating method is called radiosurgery and it works with the biological effect of stereotactically directed, highly focused ionizing beams of 201 independent cobalt-60 sources. The treatment is a single day procedure with obvious advantages over the invasive conventional craniotomy-related surgery. It has the benefits of increased biological efficacy of the irradiation along with decreased hospital stay and side effects. The device and radiosurgery was originally developed to treat functional neurological diseases, but very soon arteriovenous malformations and tumours became the main objects for the method, and a new dimension opened in the treatment of brain pathologies with difficult access. The first gamma knife was installed in Stockholm, Sweden in 1968. Since then 85 units have been set up, and more than 70,000 patients were treated with the device worldwide. The simple management technique and high mechanical and beam accuracy made the gamma knife a reliable and effective tool for its intended purpose over 30 years now. This review summarizes the history of the device, the basic radiation physics and biology related to stereotactic radiosurgery, the description of the unit and the possibilities and limits of the treatment modality.