From Leksell’s Arc to El Salvador: The Thalamotomy of Pain and the Global Democratization of Functional Radiosurgery

Lars Leksell's pioneering vision of bloodless neurosurgery through radiosurgical precision revolutionized functional neurosurgery. This editorial revisits the historical and philosophical roots of radiosurgical thalamotomy for pain and explores its modern revival in low- and middle-income countries (LMICs), specifically in El Salvador. The integration of artificial intelligence (AI), connectomic targeting, and non-ablative dosing has redefined the possibilities of functional radiosurgery beyond traditional centers of innovation. At the Centro Internacional de Cáncer, we have implemented a wide range of radiosurgical targeting strategies, including sub-necrotic 90 Gy treatments to the thalamus and hypophysis for pain control. This experience highlights both the versatility of precision radiosurgery and its feasibility within resource-constrained environments. This article argues that the next frontier of functional neurosurgery lies not only in technical innovation but also in the ethical and global democratization of access. Were Leksell alive today, he would find his prophecy fulfilled in the convergence of data-driven precision and humanitarian purpose.