Lars Leksell

Lars Leksell (1907-1986) was a Swedish physician and Professor of Neurosurgery at the Karolinska Institute in Stockholm, Sweden. He was the inventor of radiosurgery.

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Life and work

Lars Leksell was born in Fassberg, Sweden on November 23rd 1907. He graduated in Medicine at the Karolinska Institute in 1935 and began training in neurosurgery in the same year. He became a professor of surgery at University of Lund in 1958. From 1960 until his retirement, in 1974, he was Professor of Neurosurgery at the Karolinska Institute in Stockholm, succeeding Herbert Olivecrona, who was the department's founder in 1920. He died in 1986.

Professor Lars Leksell was one of the first to develop a stereotactic apparatus exclusively for human functional neurosurgery in 1949, following the pioneering work of American neurosurgeons Ernest A. Spiegel and Henry T. Wycis in 1947. It was based on the Horsley-Clarke apparatus developed for animal experimentation by the British neurosurgeon Sir Victor Horsley at University College London in 1908, but instead of using the cartesian coordinate frame, it used polar coordinates. The Leksell Stereotactic Frame was and still is in wide use today. Using it, Leksell and his collaborators stand also among the pioneers in the surgical approach to the treatment of Parkinson's Disease, a degenerative condition of the motor system of the brain, by precisely lesioning a small structure in the basal ganglia, by means of an operation called pallidotomy.

In 1951, using the Uppsala University cyclotron, Leksell and the physicist and radiobiologist Borje Larsson, developed the concept of radiosurgery. Leksell and Larsson first employed proton beams coming from several directions into a small area into the brain, in experiments in animals and in the first treatments of human patients. He called this technique "strålkniven" (ray knives). Thus, he achieved a new non-invasive method of destroying discrete anatomical regions within the brain while minimizing the effect on the surrounding tissues. Later, a special apparatus known as the Gamma Knife, was developed by Lars Leksell in 1968. It is a sterotactice device which contains multiple radioactive cobalt sources and is dedicated solely to radiosurgery. Today, Leksell's technique is used as an effective treatment for many conditions such as vestibular schwannomas (first surgery performed at Karolinska in 1969), pituitary tumors (also in 1969), arteriovenous malformations (in 1970), craniopharyngiomas, meningiomas (in 1976), metastatic and skull base tumors (in 1986), and primary brain tumors. The Leksell Gamma Knife is manufactured by Elekta Instruments AB, a Swedish company which manufactures stereotactical surgery and radiosurgery equipment, based on the inventions of Lars Leksell. It was founded by him and his son, Laurent Leksell, in 1972.

Lars Leksell served as the mentor for a number of other leading neurosurgeons who are leaders in the field of radiosurgery. Among them are Ladislau Steiner (who succeeded Leksell as head at Karolinska) and Dade Lunsford who established two of the most successful Gamma Knife centers in the world at the University of Virginia and University of Pittsburgh respectively. Cyberknife inventor John Adler worked with Leksell as well.

Leksell has worked also in neurophysiology. His most noted contribution was the description of the gamma motor system of the nervous system.

Quotation

Tools used by the surgeon must be adapted to the task and where the human brain is concerned, no tool can be too refined. Lars Leksell.

To know more

• The History of Stereotactical Radiosurgery, by Stephen B. Tatter, MD, PhD, Massachusetts General Hospital, Dept. Neurosurgery.
• Montagno, E.A. and Sabbatini, R.M.E. - Radiosurgery. Brain & Mind Magazine, June 1997
• The History of Gamma Knife Surgery (in PDF format)
• Elekta Instruments, Inc, Home Page
• Lunsford LD: Lars Leksell. Notes at the side of a raconteur. Stereotact Funct Neurosurg. 1996-97;67(3-4):153-68.

References

• Larsson B, Leksell L, Rexed B, et al: The high energy proton beam as a neurosurgical tool. Nature 182:1222-3, 1958;
• Leksell L: The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 102:316-19, 1951.

Source

The History of Psychosurgery
Renato M.E. Sabbatini, PhD
Brain & Mind Magazine, June 1997
Reprinted by permission