THE USE OF HIGH ENERGY PROTONS FOR CEREBRAL SURGERY IN MAN
Exploratory studies in three patierts using the 185-Mev proton beam of the 230-cm Uppsala synchrocyclotron for localized irradiation of brain lesions are reported. Such a narrow beam of ionizing radiation may be used to transect intracerebral fiber tracts and to destroy discrete deep-seated volumes of brain tissue. With this technique it is not necessary to open the skull, and bleeding and infection are thereby avoided. Such stereotaxic radiosurgery of the brain might be useful as a supplement to conventional techniques for localized tissue destruction. Since D 1958, the 185-Mev proton beam has been used on a small group of patierts, and the results of the first three operations performed one to three years ago are reported. One patient had a psychic disorder, another pain due to cancer metastases, and the third Parkinsonism. Preliminary measuremerts indicated that irradiation of small, restricted regions in the brain could be done with more precision by using the high-energy part of the course of penetration of the 185-Mev protons rather than by the use of the Bragg peak of the depth-dose curve. Therefore, the same cross-fire techniques as described earlier in the previous experiments on goats was used. Thus, the protons entered the patiert's skull at almost full energy in a parallel, 2- or 3-mm wide beam, practically unaffected by scattering in the window, air, and ionization chamber through which they passed after leaving the vacuum of the synchrocyclotron. Cross-firing was performed by stepwise rotation of the patiert, the target region being at the rotation center of the stereotaxic instrument through 16 to 21 fields giving doses of 16 to 25 krad at this point. The ionization chamber used was calibrated in terms of ideal center dose by measuring the C/sup 11/ activity induced in small polstyrene cylinders, 1 mm in diameter, irradiated at the rotation center. The irradiation parameters are tabulated. The stereotaxic instrument used supported the patient's head during irradiation is described. Using local anesthes the instrument was fixed to the skull by means of drills which penetrated a few millimeters into the bone. The target structure was localized in relation to reference points visible on the pneumoencephalogram of the patient by comparison with a template, prepared from a standard ventriculogram from a cadaver brain. Only the patient with Parkinsonism was irradiated under general anesthesia. Therapeutically effective lesions were produced during the first weeks following irradiation. No side effects due to the radiosurgical procedure were observed. The patient with the carcinoma died and the lesion found at autopsy was studied histopathologically. The early radiosurgical lesion in man was found to be similar to lesions studied earlier in animals. (BBB)
- Research Organization:
- Uppsala Univ.
- NSA Number:
- NSA-18-013580
- OSTI ID:
- 4088796
- Journal Information:
- Acta Chirurgica Scandinavica (Sweden), Vol. Vol: 125; Other Information: Orig. Receipt Date: 31-DEC-64
- Country of Publication:
- Country unknown/Code not available
- Language:
- English
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