Stereotactic radiosurgery - Gamma Knife
Stereotactic radiosurgery (SRS) is a form of radiation therapy that focuses high-power energy on a small area of the body.
Despite its name, radiosurgery is not actually a surgical procedure -- there is no cutting or sewing, rather it is a radiation therapy treatment technique.
More than one system is used to perform radiosurgery. This article is about Gamma Knife radiosurgery.
Stereotactic radiotherapy; Stereotactic radiosurgery; SRT; SBRT; Fractionated stereotactic radiotherapy; SRS; Gamma Knife; Gamma Knife radiosurgery; Non-invasive neurosugery; Epilepsy - Gamma Knife
The Gamma Knife radiosurgery system is used to treat either cancers or growths in the head or upper spine area. For cancers or growths lower down in the spine or anywhere else in the body, another focused surgery system may be used.
Before treatment, you are fitted with a "head frame." This is a metal circle that is used to precisely position you into the machine to improve accuracy and pinpoint targeting. The frame is attached to your scalp and skull. The process is performed by the neurosurgeon, but does not require cutting or sewing.
- Using local anesthesia (like a dentist might use), four points are numbed in the skin of the scalp.
- The head frame is placed over your head and four small pins and anchors are attached. The anchors are designed to hold the head frame in place, and do go tightly through the skin into the surface of your skull.
- You are given local anesthetic and should not feel pain, rather only pressure. You also are usually given a medicine to help relax you during the fitting procedure.
- The frame will remain attached for the whole treatment procedure, usually a few hours, and then will be removed.
After the frame is attached to your head, imaging tests such as CT, MRI, or angiogram are done. The images show the exact location, size, and shape of your tumor or problem area and allow precision targeting.
After the imaging, you will be brought to a room to rest while the doctors and physics team prepare the computer plan. That may take approximately 45 minutes to an hour. Next, you will be brought to the treatment room.
Newer frameless systems for positioning the head are being evaluated.
- You will not need to be put to sleep. You will get medicine to help you relax. The treatment itself does not cause pain.
- You lie on a table that slides into a machine that delivers radiation.
- The head frame or face mask aligns with the machine, which has a helmet with holes to deliver small precise beams of radiation directly to the target.
- The machine may move your head slightly, so that the energy beams are delivered to the exact spots that need treatment.
- The health care providers are in another room. They can see you on cameras and hear you and talk with you on microphones.
The treatment delivery takes anywhere from 20 minutes to 2 hours. You may receive more than one treatment session. Most often, no more than 5 sessions are needed.
Why the Procedure Is Performed
Highly focused radiation beans using the Gamma Knife system target and destroy an abnormal area. This minimizes damage to nearby healthy tissue. This treatment is often an alternative to open neurosurgery.
Gamma Knife radiosurgery can be used to treat the following types of brain tumors or upper spine tumors:
- Cancer that has spread (metastasized) to the brain from another part of the body
- A slow-growing tumor of the nerve that connects the ear to the brain (acoustic neuroma)
- Pituitary tumors
- Other growths in the brain or spinal cord (chordoma, meningioma)
Gamma Knife is also used to treat other problems of the brain:
- Blood vessel problems (arteriovenous malformation, arteriovenous fistula).
- Some types of epilepsy.
- Trigeminal neuralgia (severe nerve pain of the face).
- Severe tremors due to essential tremor or Parkinson disease.
- It also may be used as an additional "adjuvant" therapy after a cancer has been surgically removed from the brain, to help reduce the risk of recurrence.
Radiosurgery (or any type of treatment for that matter), may damage tissue around the area being treated. Compared with other types of radiation therapy, some believe that Gamma Knife radiosurgery, because it is delivering pinpoint treatment, is less likely to damage nearby healthy tissue.
After radiation to the brain, local swelling, called edema, may occur. You may be given medication before and after the procedure to lower this risk, but it is still possible. Swelling usually goes away without further treatment. In rare cases, hospitalization and surgery with incisions (open surgery) is needed to treat the brain swelling caused by the radiation.
There are rare cases of swelling causing patients to have problems breathing, and there are reports of fatalities after radiosurgery.
While this type of treatment is less invasive than open surgery, it still can have risks. Talk with your doctor about the potential risks of treatment and of the risks for tumor growth or spreading.
The skin wounds and locations where the head frame is attached to your scalp may be red and sensitive after treatment. This should go away with time. There may be some bruising.
Before the Procedure
The day before your procedure:
- DO NOT use any hair cream or hair spray.
- DO NOT eat or drink anything after midnight unless told otherwise by your doctor.
The day of your procedure:
- Wear comfortable clothing.
- Bring your regular prescription medicines with you to the hospital.
- DO NOT wear jewelry, makeup, nail polish, or a wig or hairpiece.
- You will be asked to remove contact lenses, eyeglasses, and dentures.
- You will change into a hospital gown.
- An intravenous (IV) line will be placed into your arm to deliver contrast material, medicines, and fluids.
After the Procedure
Often, you can go home the same day of treatment. Arrange ahead of time for someone to drive you home, because the medicines you are given can make you drowsy. You can go back to your regular activities the next day if there are no complications, such as swelling. If you have complications, or your doctor believes it is required, you may need to stay in the hospital overnight for monitoring.
Follow instructions given to you by your nurses for how to care for yourself at home.
The effects of Gamma Knife radiosurgery may take weeks or months to be seen. The prognosis depends on the condition being treated. Your provider will monitor your progress using imaging tests such as MRI and CT scans.
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Brown PD, Jaeckle K, Ballman KV, et al. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA. 2016;316(4):401-409. PMID: 27458945 pubmed.ncbi.nlm.nih.gov/27458945/.
Dewyer NA, Abdul-Aziz D, Welling DB. Radiation therapy of benign tumors of the cranial base. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 181.
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