What is stereotactic radiosurgery?
Stereotactic radiosurgery is a type of radiation therapy. It treats tumors of the brain and spine and other brain conditions. The procedure involves focusing small, highly precise doses of radiation into the brain or spinal cord. This shrinks tumors or blocks abnormal blood vessels and nerves that are causing pain or seizures. Stereotactic radiosurgery can also treat some brain disorders, such as Parkinson’s disease.
Stereotactic radiosurgery is an effective alternative to neurosurgery for some patients. It is less invasive than neurosurgery and requires less hospitalization and recovery time. Stereotactic radiosurgery lets your doctor treat tumors located in areas that are not safely accessible with conventional surgery. However, radiation kills your normal cells as well as cancer cells. Your doctor and care team will use specialized equipment and techniques to target your tumor and minimize damage to healthy cells. Gamma Knife® is one of several brands of noninvasive neurosurgical tools doctors use to target radiation at brain tumors. Doctors also use Gamma Knife radiosurgery for other, difficult-to-treat brain conditions.
Stereotactic radiosurgery is only one method to treat tumors of the brain and spine and other brain conditions. Discuss all the treatment options with your doctor to understand which options are right for you.
Other procedures that may be performed
Your doctor may perform other procedures to treat brain and spine tumor or other brain conditions. These include:
Biological therapy or immunotherapy boosts or stimulates your body’s immune system to help fight cancer
Conventional radiation therapy
Open surgery to remove part of the spine tumor to relieve pressure on the spinal cord
Why is stereotactic radiosurgery performed?
Your doctor may recommend stereotactic radiosurgery to treat the following tumors and conditions of the brain and spine:
Acoustic neuroma, a tumor of the nerve between the brain and the ear
Arteriovenous malformations (AVMs) and other blood vessel disorders in the brain. Radiation causes AVMs to clot–off so they do not bleed.
Brain tumors including benign (noncancerous) or malignant (cancerous) tumors
Some types of cancer of the eye
Epilepsy due to a brain tumor. Stereotactic radiosurgery may treat a brain tumor that causes epilepsy if medications do not control seizures.
Parkinson’s disease, a brain disorder that leads to uncontrollable shaking, muscle stiffness, and severe problems with coordination and balance
Pineal tumors of the pineal gland, which is located near the center of the brain. It produces hormones.
Pituitary tumors of the pituitary gland, which is located near the center of the brain. It produces hormones.
Psychoneurosis including obsessive compulsive disorder
Skull base tumors
Spinal tumors including benign (noncancerous) or malignant (cancerous) tumors
Trigeminal neuralgia, a nerve disorder causing severe face pain
Stereotactic radiosurgery can also:
enhance conventional radiation treatment
provide another option when other treatments have not worked
treat or control a recurring spinal tumor
treat or control the remaining portion of a tumor after surgery
Who performs stereotactic radiosurgery?
A specialized team performs stereotactic radiosurgery. These teams commonly include the following specialists:
Medical physicists are scientists who specialize in the safety and effectiveness of radiation treatments and imaging procedures.
Neurologists specialize in caring for people with diseases and conditions of the brain and nervous system, including the spinal cord, nerves, muscles, and related blood vessels.
Neuroradiologists specialize in diagnosing and treating diseases of the nervous system using radiological imaging.
Neurosurgeons and pediatric neurosurgeons specialize in the surgical treatment of diseases of the brain, spinal cord, and nerves.
Radiation oncologists specialize in treating cancer with radiation.
Teams may also include one or more of these specialists depending on your diagnosis:
Otolaryngologists, or ear, nose and throat (ENT) doctors, specialize in the medical and surgical care of the ears, nose and throat, and conditions affecting the head and neck.
Neurotologists specialize in the medical and surgical care of diseases of the inner ear and related structures. They are sometimes called otologists or otologists-neurotologists.
How is stereotactic radiosurgery performed?
Your stereotactic radiosurgery will be performed in a hospital radiology department or an outpatient radiology setting. You may have one or more treatments depending on your condition. The procedure generally includes the following steps:
You will dress in a patient gown and remove any jewelry, wigs, glasses, or any other items that may interfere with the treatment.
Your team will fit you with a head frame or other device to immobilize you. The device helps you hold very still during treatments so only the tumor receives radiation. Fitting your device may be done the same day as treatment or up to a week before it. This depends on your condition and type of treatment.
A team member will start an intravenous (IV) line. You will receive fluids and possibly a mild sedative or other medication during the procedure.
Your team will take imaging scans (pictures) to locate your tumor or target area precisely. The scan might be a magnetic resonance imaging scan (MRI), a computed tomography scan (CT), a cerebral angiogram, or a combination of these.
Your team will plan the type and dose of radiation based on the images.
Your team will position you in the immobilization device for the treatment. Your may need to wear a special helmet for brain procedures. The helmet has a special pattern of holes in it. The holes will direct radiation beams to pass through to the exact location in your brain needing treatment.
Your team will leave the treatment room, but they will observe you by video. You will be able to talk with your team over an intercom.
The stereotactic radiosurgery machine will deliver a precise amount of radiation. You may need to be in the device for one to four hours. You will not feel anything during this process. Some people even fall asleep during treatment.
Your team will remove the devices and IV line after treatment.
Your care team will make sure that your vital signs, such as blood pressure and pulse, are stable. They will give you medication for nausea or head pain as needed. Most people who receive stereotactic radiosurgery go home the same day. Some patients stay in the hospital for a night for further observation.
Will I feel pain?
Your comfort and relaxation is important to you and your care team. Stereotactic radiosurgery itself is painless. Children and people who are claustrophobic or have trouble staying still in the immobilization device may have sedative medications to stay comfortable during the procedure.
You may feel brief pressure during attachment of a head frame to the skull. Some people have a headache or nausea after treatments. Your doctor can treat these with medications. Headache and nausea usually go away within a day or two. Tell your doctor or care team if you are uncomfortable in any way.
What are the risks and potential complications of stereotactic radiosurgery?
Complications after stereotactic radiosurgery are not common, but any procedure involves risks and potential complications. Complications may become serious in some cases. Complications can develop during the procedure or recovery.
Complications vary depending on the treatment area but can include:
Adverse reaction or problems related to sedation, such as an allergic reaction and problems with breathing
Bleeding or other discharge at the pin sites of a head frame
Difficulty swallowing if radiation is near the head or neck
Hair loss near the treatment site, which is usually temporary
Skin irritation, dryness, itching, peeling or blistering
Complications that can occur months to years after treatment include:
Development of a new cancer (rare)
Holes between organs or tissues (fistula)
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
Avoiding pregnancy as directed by your doctor. Notify your doctor immediately if there is any chance of pregnancy.
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Notifying your doctor immediately of any concerns, such as severe headache, seizures, or persistent bleeding at the pin sites
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for stereotactic radiosurgery?
You are an important member of your own healthcare team. The steps you take before your treatment can improve your comfort and outcome. You can prepare for stereotactic radiosurgery by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Notifying your doctor if you are nursing or if there is any chance of pregnancy
Notifying your doctor and care team if you have any type of implant, such as a stent, artificial heart valve, surgical clip, or pacemaker
Refraining from eating or drinking as directed by your doctor. This may include not eating solid foods for eight to 12 hours before the procedure.
Stopping smoking. Smoking reduces blood flow to the tissues, which can worsen the side effects of radiation.
Taking or stopping medications exactly as directed
Questions to ask your doctor
Preparing for stereotactic radiosurgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before stereotactic radiosurgery and between appointments.
It is a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need stereotactic radiosurgery? Are there any other options for treating my condition?
How long will the treatment take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home? Will I need a ride home?
How should I take my medications?
How will you treat my pain or discomfort, such as nausea?
What other tests or treatments might I need?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after stereotactic radiosurgery?
Knowing what to expect after stereotactic radiosurgery can help you get back to your everyday life as soon as possible.
How will I feel after stereotactic radiosurgery?
Some people feel fine after stereotactic radiosurgery and never have any side effects. Some people feel nauseous, hungry, or have a headache after treatment of the brain. Other minor side effects, such as fatigue and skin irritation, can develop shortly after treatment. Side effects are generally mild and temporary.
Your doctor will give you medications to help ease your side effects. Call your doctor if you have trouble controlling side effects.
When can I go home?
Most people go home the same day as stereotactic radiosurgery, but some stay overnight for observation. You will still be drowsy if you had sedation and will need a ride home. You should not drive for about 24 hours, and someone should stay with you during that time.
When should I call my doctor?
It is important to keep your follow-up appointments after stereotactic radiosurgery. You will need to have MRI scans to monitor the tumor and may need another treatment, depending on your condition. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Excessive bleeding or discharge from the pin sites of a head frame
Severe headache that is not controlled by your pain medication
Visions problems that have worsened since the surgery