This page tells you about stereotactic radiosurgery. It tells you about what will happen during the procedure. While reading this, please note any information you do not understand. Also, make a list of any questions you may have. Print out this handout when you come for an appointment or treatment. Your doctor or nurse will go over it with you.
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What is stereotactic radiosurgery?
Stereotactic radiosurgery is the method of giving a high dose of radiation to a small area in your brain, usually in one treatment. This allows delivery of the radiation to the abnormal area while the surrounding normal brain tissue receives only a small dose of radiation. Because this treatment is so precise, a special frame is used to keep your head perfectly still. Stereotactic radiosurgery is used to treat many types of brain tumors and arteriovenous malformations (AVM).
How to prepare for stereotactic radiosurgery
- 1. Please make arrangements to have someone drive you home after the procedure. Family members or a friend may come and be with you during the day.
- 2. Prior to the procedure you will have a special MRI scan done called a fusion MRI. This MRI will be used to plan your radiation treatment. It will feel no different than previous MRIs you may have had. If you have never had an MRI before, please let the nurse know, so you can be given an educational handout that describes the MRI in detail.
- 3. Please let the doctor or nurse know if you have any of the following items in your body or conditions: Pacemaker, artificial heart valve, defibrillator, brain aneurysm clips, implanted pumps or chemotherapy ports, neurostimulators, eye or ear implants, stents, coils or filters, or claustrophobia.
- 4. If you are allergic to or have had problems with intravenous contrast or are allergic to shellfish or Iodine, please notify your doctor.
- 5. If you are diabetic and currently taking oral medications (specifically, Glucovance, or Metformin also known as glucophage) or insulin to control your diabetes, please let your nurse or doctor know.
- 6. The night before the procedure do not eat or drink anything after midnight. If you have prescribed oral medication, take them with a small sip of water only.
- 7. Bring your prescribed medication with you on the day of the procedure.
- 8. You can expect to be at the hospital for about 16 hours.
How the procedure is done
- 1. You will be asked to change into a gown for the procedure. A nurse will place a small needle in your hand or arm to give medications during the frame placement, if needed, and for intravenous contrast dye.
- 2. A head frame is applied to your head by a neurosurgeon. The frame placement can cause some pain and discomfort. A local anesthetic will be used to numb four sites of your scalp before the frame placement. This part of the procedure takes about 15-20 minutes.
- 3. After the frame is placed, a CT scan is done. This is to determine the exact location and size of the abnormal area and is used for the treatment planning. After this is completed, you will wait in a comfortable area for the treatment. A television and VCR can be made available for your use. Please feel free to bring videos.
- 4. If you have never had a CT scan before, please let your nurse know so an educational handout can be provided which describes a CT scan in greater detail.
- 5. After the CT scan, you will be able to eat and drink. Breakfast and lunch will be provided.
- 6. Your neurosurgeon, radiation oncologist and physicists do treatment planning. This takes approximately 3-4 hours.
- 7. Late in the afternoon, after planning is completed, you will be brought into the treatment room. You will lie on the treatment table with the frame locked into a special holder. The treatment machine rotates around your head as the radiation is given. This is called an arc. The approximate length of time of the treatment will vary depending on the number of arcs you receive.
Radiation treatments are very similar to having x-rays. You will not be able to see, feel, or hear the x-rays. There is no pain or discomfort with the actual treatment. If you are in pain for other reasons, such as back pain or discomfort from the head frame, please let the doctor or nurse know.
Once you are positioned on the treatment table, all staff will leave the room for the few minutes the machine is on. You will be watched on a television screen and will be able to talk with the staff through a microphone. You can also wave your hand as a signal that you need immediate help while the treatment is in progress. If this happens, the treatment will be stopped and the staff will immediately enter the room to help you.
There will be several staff members present during your treatment: your doctors, a nurse, a therapist who operates the treatment machine, and the physicist(s) who did the treatment planning.
What are the risks?
Your physician will extensively discuss the immediate and long-term risks of this treatment with you. The risks vary from patient to patient and depend on several factors including your diagnosis, the size and location of the lesion, underlying medical problem, the dose of radiation used, and the amount of normal tissue treated. In general, there are few immediate side effects. Rarely, the patients experience nausea, which is controlled with medication. Even more uncommon is the occasional occurrence of seizures, which can also be controlled with medications. In general, there is no significant hair loss as a consequence of stereotactic radiosurgery.
There is some concern that, in a minority of patients, serious long-term side effects could occur. In the most extreme situation, these side effects could include destruction of normal brain tissue and subsequent impairment of brain function because of this. Such impairment of brain function could include problems such as alteration in vision, speech, paralysis, etc. Although very serious, these side effects, in general, are quite rare. A small minority of patients experience brain swelling after several months which may require prolonged steroid medications. These risks will be discussed in detail with you.
After the treatment
You will be taken to an exam room to have the head frame removed. After its removal, we will clean the pin site areas and apply an antibiotic ointment. You will be discharged home shortly thereafter with written instructions. prolonged steroid medications. These risks will be discussed in detail with you.
At Home
You may have some temporary swelling around both eyes that is caused from the local anesthetic placed at the pin sites. This begins about 2-3 days after the treatment and may last for several days to several weeks. This is normal and should go away by itself.
You may have some pain, tenderness or numbness around the pinsite area for a few days to a few weeks. This is normal and should go away by itself.
You may feel a little tired for a day or two; otherwise you will be able to be as active as you want. Keep the pin site areas clean. You will be given antibiotic ointment. Apply it over the next 2-3 days. prolonged steroid medications. These risks will be discussed in detail with you.
When to call the doctor
- Increasing or severe headaches not relieved with Tylenol®.
- Any change in you strength or sensation (numbness or tingling).
- Any change in your speech or vision.
- New onset of confusion.
- New onset of seizures or having more seizures than before the treatment.
- Balance or walking difficulties or dizziness.
- Infection is rare, but any of the following symptoms should be reported to your doctor:
- Fever above 100°F
- Redness around the pin sites
- Discharge from the pin sites
If you have any questions or problems once you are at home, call the Radiotherapy Clinic at (608) 263-8500. If the clinic is closed, your call will automatically be transferred to the hospital answering service. They will put you in contact with the radiotherapy doctor on call.