Days before an appointment to have 201 radioactive beams shot into his brain, Canadian actor Gordon Pinsent was gripped with a familiar sort of dread. He had dealt with it before: mostly before stepping onstage or shooting commenced on films such as Away from Her and The Shipping News .
So, in order to get himself through the hospital doors, he relied on a trick he has used to combat stage fright throughout his long acting career.
"I said, this time I'm going to look forward to the experience," recalled Mr. Pinsent, 78, about a month after he was treated at Toronto Western Hospital for trigeminal neuralgia, a neuropathic disorder that causes episodes of intense pain in the eyes, scalp and face.
Now Mr. Pinsent is grateful for the Gamma Knife, a medical device that treats certain tumours and pain conditions without the slicing involved in regular brain surgery. The treatment trained 201 gamma beams at a millimetre-sized area of Mr. Pinsent's brain.
The process was painless, fast and allowed him to leave the hospital the same day. "It felt a bit Star Trekky," he said.
Toronto Western appreciates its high-profile patient and hopes he will generate exposure for the device. Even though the Gamma Knife cost $7-million and is one of only three in Canada, it's being underused.
"It's such a unique way of treating disorders," said Mojgan Hodaie, co-director of the Gamma Knife program at the Krembil Neuroscience Centre at Toronto Western.
Because the Gamma Knife delivers single doses of radiation therapy to a targeted area of the brain with such precision, surrounding normal tissue receives minimum radiation. Since the mid-1980s, Gamma Knife radiosurgery has proven effective for patients with benign or malignant brain tumours, some vascular malformations and chronic pain conditions.
But until six years ago, Canadians seeking the treatment had to travel to the United States, where there are now more than 100 Gamma Knife centres. Health Sciences Centre Winnipeg got Canada's first Gamma Knife in 2003, followed by the University of Sherbrooke in 2004 and Toronto Western in 2005.
Today as many as 500 patients a year are treated at the Joey and Toby Tanenbaum Family Gamma Knife Centre in Toronto. But the device is only in operation two days a week. In Winnipeg, the machine also runs two days a week, for a total of about 250 patients a year.
"We could do another 50 to 100 patients, and we probably at that point would be very busy, but we have enough staff to do it," said Michael West, co-director of the Winnipeg Centre for Gamma Knife Surgery, which takes patients from throughout Western Canada and Northern Ontario.
Although both centres have the capacity to treat more patients, both Dr. West and Dr. Hodaie say that because many health professionals and the public aren't aware of the Gamma Knife or all of its applications, patients who could be eligible for treatment aren't being referred.
Mr. Pinsent, who lives in Toronto and struggled with his pain condition for nine years, hadn't heard of the Gamma Knife until he attended a writers' conference in Nova Scotia. There he met a doctor from Toronto who said the Gamma Knife might fix his pain problem.
He had other options, including a needle to the face, which can be effective but often leaves permanent numbness in the cheek.
On Oct. 14, Mr. Pinsent was fitted with a specialized metal helmet that created a stationary and exact target for the gamma rays. He lay down, placing his head into a dome-like cap with 201 holes that helped focus the gamma beams. For about 90 minutes, the 201 rays were focused on one spot, killing the cells.
Mr. Pinsent recited Shakespeare during the procedure. He went home that afternoon.
Dr. Hodaie says in typical trigeminal neuralgia cases, it takes between three and eight weeks for the full effect of the treatment to work and the pain to go away. The pain is erased in about 70 per cent of patients, she said.
"My feeling is that this is an extraordinary piece of technology," Mr. Pinsent said. "And the doctor and so on, they were all terrific."