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L. Dade Lunsford, MD
University of Pittsburgh School of Medicine

JAMA. 1988;260(17):2505-2506.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.—

Dr Kjellberg has extensive experience (more than 2200 patients) using a variation of the radiosurgery technique for the treatment of intracranial AVMs and brain tumors. The first gamma unit was constructed by Lars Leksell in 1965 to provide neurosurgeons with a simple and practical tool to treat previously unresectable brain lesions. By then Leksell had determined that the cyclotron-generated proton beam was too cumbersome and inefficient. Larsson et al¹ have detailed the advantages of the irradiation of small structures through the intact skull using the gamma unit. Experience with the gamma unit now extends to more than 2500 patients at four centers worldwide. Our experience using the Pittsburgh gamma unit offers further evidence to support the results already reported using older-generation gamma units.

We believe that complication rates must be defined to include not only unwanted, delayed radiation-induced brain injury but, in the case of AVM, rebleeding. . . . [Full Text PDF of this Article]

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