Over a 23-year period, 10,000 Gamma Knife radiosurgery procedures were performed at the University of Pittsburgh. 

     We reviewed the evolution of the program over that time period. 

     In this interval, seven faculty neurosurgeons, three radiation oncologists, and three medical physicists participated in the procedures with three physicians having in excess of 20 years experience. A total of 60 fellows from 19 countries came for specialized training. A total of 75 one to two-week practical training courses were conducted that included 1,170 trainees. 

     We studied practice patterns over time.

     The mean annual number of specific cases in each 5 year interval (1987-92, 93-98, 99-04, 05-09) was as follows: brain metastases (98, 420, 1303, 1296), vestibular schwannomas (202,310,530,367), meningiomas (110,299,555,362), arteriovenous malformations (449,336,393,234), and trigeminal neuralgia (1,278,332,268). A total of 410 peer-reviewed journal articles were published. Gamma Knife models U, B, C, 4C, and Perfexion were used and evaluated. Indications for radiosurgery currently advocated but not performed during our first three years experience include trigeminal,sphenopalatine, or glossopharyngeal neuralgia, cluster headache, obsessive-compulsive disorder, epilepsy, staged volume AVM Radiosurgery, glomus tumors, cavernous hemangiomas, and thalamotomy for tremor. Multiple metastases, initially considered a contraindication to radiosurgery has become one of the commonest indications.

     This was a retrospective review.

     Over the long term, the technique, indications, and outcomes of Gamma Knife radiosurgery have been evaluated. All programs must anticipate significant evolution in their own practice.

      Despite the proliferation of competing technologies, many with little published experience, gamma knife radiosurgery continues to provide valuable options for patients with brain disorders.