SEATTLE -- Radiosurgery by gamma knife.
The costly and controversial gamma knife, developed years ago in Sweden, uses focused radiation to target small tumors or diseased areas in the brain for noninvasive "excision" as an alternative to brain surgery.
For some physicians, the gamma knife is an expensive gimmick and a perfect example of wasteful excess in health care.
Dr. Kim Wright, a neurological surgeon at Seattle's Providence Medical Center, and others say there is little evidence the gamma knife does a better job than the standard practice of focused radiation therapy using a linear accelerator. And, critics note, the gamma knife costs twice as much -- about $20,000 a treatment, compared with $10,000.
But for Lyle Ellefson, the new gamma knife at Northwest Hospital in Seattle is the hoped-for "end of a long trail" of misdiagnoses, including one unnecessary surgery that caused a heart attack, and years of discomfort and worry.
"I didn't want surgery," said Mr. Ellefson, 73, who last week became the third patient to undergo gamma knife treatment at Northwest.
About seven years ago, Mr. Ellefson developed an audible NTC pounding in his head and severe headaches. His physician at Northwest decided it was a blood flow problem, Mr. Ellefson said, and surgery was performed to open one of the carotid arteries -- the main arteries supplying the head and neck with blood.
"I had a massive heart attack right after surgery," Mr. Ellefson said, and the problem in his head persisted.
He went to Seattle's Swedish Hospital Medical Center, where a neurologist told him he had a brain tumor.
"They said I had a tumor the size of a walnut and that it was inoperable," Mr. Ellefson said. "But my wife wasn't about to give up."
Helen Ellefson did her own research and found out about the high-energy proton synchrotron radiation treatment at Loma Linda University in Riverside, Calif. In 1991, the Ellefsons made the trip south, only to find after six weeks of testing that he didn't have a tumor.
An angiogram (a standard X-ray image using contrast medium) revealed a mass of malformed blood vessels in his brain. The relatively common condition is called an ateriovenous (artery-vein) malformation.
The Ellefsons packed up and went home, where Mr. Ellefson received a series of embolizations (deliberate blocking of blood vessels) to starve the mass and shrink it. This reduced the jumble of blood vessels to one-fourth its size, but the pounding continued in his head.
Mrs. Ellefson said another physician finally mentioned, in an almost offhand way, the new gamma knife at Northwest. She said they checked it out, decided to try it.
Lyle Ellefson won't know whether the procedure was effective for up to a year, but he said that for now, "I feel great. I'm going to recommend this to all my friends who might have the same problem. . . ."