Carol,
The university of Pittsburgh , like UVA are definitely top centers in terms of radiosurgery. Pitt does have both GK and CK, but as becknell correctly points out they tend to reserve GK for cranial lesions ( which is the limit of what it has ever been designed to do) and utilize CK for the rest of the body ( which is the real breakthrough provided by this machine). Like UVA, Pitt was among the first US medical centers to embrace the GK as a treatment option
From their web site
During UPMC's first 18 years of experience, more than 7,000 patients have undergone radiosurgery in the department's Gamma Knife units. In May of 2004 our center added a third Gamma Knife unit, becoming the only center in the world with three operating units. UPMC physicians have performed Gamma Knife radiosurgery on more than 1,100 patients with acoustic neuroma, a deafness-causing tumor of the sheath of the hearing nerve. Gamma Knife surgery prevented tumor growth in 97 percent of patients, and up to 80 percent of patients retained their hearing on a long-term basis.
Based on some posts from Doctors on the CPSG web site, like UVA, Pitt has a long relationship with the GK manufacturer Elektra which creates some politics that may dictate how they choose to use the two machines
Also from their web site
Professional Training
UPMC Presbyterian is a major teaching center for Gamma Knife radiosurgery as neurosurgeons, radiation oncologists and medical physicists from around the world come here to train. The center leadership consults with the Gamma Knife manufacturer, Elekta Instruments, to build new technologies for the future.
Pitt does appear to use to use CK for some number of brain lesions , but sees it's value as being in other areas such as the spine
from their web site
CyberKnife is the only system capable of performing single session or staged radiosurgery on lesions located anywhere in the body. This is made possible through the use of image-guidance and robotics. UPMC installed the software necessary to begin spinal treatments in 2002 and is now established as the most active CyberKnife spinal radiosurgery center in the U.S.
"Spinal stereotactic radiosurgery using the CyberKnife can now be performed safely, accurately, and effectively. This technique offers a successful alternative therapeutic modality for the treatment of a variety of spinal lesions not amenable to open surgical techniques, in medically inoperable patients, lesions located in previously irradiated sites, or as an adjunct to surgery. The major potential benefits of radiosurgical ablation of spinal lesions are short treatment time in an outpatient setting with no recovery time and good treatment effect," said Peter Gerszten, M.D., M.P.H., Assistant Professor of Neurosurgery at University of Pittsburgh.
The two key GK guys at Pitt are Lunsford and Kondziolka who are extremely well published ( and I suspect) closely tied to GK. Lunsford is the "lars Leskell ( inventor of GK) proffesor and chairman of radiosurgery. Gee, I wonder who put the money up for the Lars Leskell chair? Can you spell Elekta?
From their web site
"The field of brain and body radiosurgery continues to grow dramatically as neurosurgeons respond to the shift of patient care to less invasive, multidisciplinary, and more effective treatment options for patients with tumors and vascular malformations," comments L. Dade Lunsford, MD, Lars Leksell professor and chairman of the Department of Neurological Surgery and co-director of the Center for Image-Guided Neurosurgery.
"As an international training and outcomes analysis site, the UPMC Center for Image Guided Neurosurgery uses the latest generation brain -- the Leksell Gamma Knife -- and body -- CyberKnife -- radiosurgical technologies to enhance patient outcomes and to train the next generation of neurosurgeons and radiation oncologists."
"Our expanded Gamma Knife services will allow us to treat more patients efficiently," adds Douglas Kondziolka, MD, co-director of the center, "particularly those with metastatic cancer to the brain which represent the largest current indication for radiosurgery."
Additional minimally invasive technologies of the center include dedicated intraoperative CT scanning and CyberKnife radiosurgery, exclusively applied to spinal tumors.
Bottom line from my perspective it that Pitt is a great place for radiosurgery, but you would probably be pushed to GK over CK for "political" reasons instead of effectiveness.
The nice thing about radiosurgery is the degree of computerziation and muti clinician team review elimainates a lot of risk as opposed to picking the best surgeon and hoping they are on a good day when you are scheduled. So, in the case of CK, Stanford is the oldest and most experienced but for something as simple ( relatively speaking) as an AN I would feel equally comfortable at Georgetown, BI in Boston, Barrow in Phoenix, etc. Most of these places also have GK but have migrated to CK. It really depends which machine you feel most comfortable with, but I think you could get great treatment at UVA, PItt, Stanford etc.
Mark
