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Gamma knife

Gamma knife uses highly focused beams of radiation to treat conditions, such as brain tumours and trigeminal neuralgia. It's a non-surgical treatment and usually given as a single dose.

You will meet the doctor carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

Gamma knife is a non-invasive procedure. This means that no cut is made to your skin and all of the treatment takes place outside your body. It’s a specialised treatment which is only carried out at a few hospitals.

Gamma knife treatment gives a high dose of radiation. It’s targeted precisely to reach a very small area of your brain. Hundreds of energy beams are directed from different angles into your brain. Where they all cross is the area where you need treatment. All of the energy beams together are very powerful. However, each beam on its own is weak. You’ll have just one treatment session. You can have gamma knife treatment as an alternative to open surgery.

Gamma knife can be used to treat a number of different conditions including:

  • brain tumours, both benign (non-cancerous) and malignant (cancerous) – gamma knife can treat tumours smaller than 4cm in size
  • vascular malformations – this is when some of the arteries and veins in your brain aren’t connected properly
  • other conditions, such as trigeminal neuralgia and some types of epilepsy
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Details

  • Preparation Preparing for gamma knife

    You will probably need to stay overnight in hospital after gamma knife treatment. You will stay awake during the procedure.

    During your procedure, you will need to have a frame attached to your head. This keeps your head still during treatment. You will be given a local anaesthetic to completely block any pain from the areas where the head frame is attached.

    You may have gamma knife to treat a pituitary tumour. If so, your doctor may ask you to stop taking some of your medicines two months before the procedure.

    At some hospitals you may be able to eat and drink throughout the day while you have the procedure. At other hospitals you will be asked not to eat or drink. In these hospitals you will be given a drip instead (fluids which go into your vein) to make sure you don’t get dehydrated.
    You will be asked to remove all make-up (including nail polish), hairpieces, contact lenses, glasses and dentures.

    Your nurse may check your heart rate, blood pressure, temperature and weight.

    Your doctor will discuss with you what will happen before, during and after your procedure, and any pain you might have. You can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.

    There are a number of different steps involved in preparing for gamma knife treatment. These are explained here.

    Frame fitting

    You will need to have a light-weight frame fitted to your head. Your doctor will inject local anaesthetic into the skin at four places on your head. This is where the frame will be fixed with pins. Having the frame fixed in place can be uncomfortable and it may be sore, but the pain shouldn't last long. The fitting usually takes about 10 minutes. The frame will stay attached to your head during the treatment and will be taken off afterwards.

    Imaging

    You will have an MRI scan or a CT scan to find the exact position of the area that needs to be treated. An MRI scan uses magnets and radiowaves to produce images of the inside of your body..

    You may have a cerebral angiogram (an X-ray image of the blood vessels in your head and neck) if you’re having gamma knife treatment for a vascular malformation.

    Treatment planning

    The images taken by CT, MRI or angiography will be fed into a computer. This will help to calculate the exact treatment you need. A team of people including a neuroradiologist will plan your treatment, deciding the exact area to be treated. This may take several hours.

  • Alternatives What are the alternatives to gamma knife?

    Depending on your condition, there are a number of alternative treatments. If you have a brain tumour, you may be offered open surgery, radiotherapy or chemotherapy. If you have trigeminal neuralgia you may be offered medicines or surgery to treat your condition. Talk to your doctor for more information about your options.

  • The procedure What happens during gamma knife?

    You will lie on the treatment couch. The radiographers will position the frame attached to your head either into a docking device on the couch or a helmet. This will depend on the type of gamma knife unit. It’s important because it will keep your head still during the procedure.

    Once your head has been positioned and the relevant checks have been completed, the radiographers will leave the treatment room. You can speak to the radiographers at any time during the procedure via a microphone. They can see you from the control room by cameras positioned in the treatment room.

    When your treatment begins, the couch will move you into the gamma knife unit. The radiation treatment will be made up of a series of exposures to radiation in different places. After each exposure you will be moved by the staff or the machine into a new position for the next stage of treatment. The exposure of each shot may only take a few minutes but the entire procedure can last more than an hour. You won't feel any pain during the treatment.

    Once the treatment has finished your head frame will be taken off. You may notice slight bleeding around the area where the frame was. It may feel sensitive for several days.

  • Prompt access to quality care

    From treatment through to aftercare, with Bupa health insurance we aim to get you the help you need, as quickly as possible. Find out more today.

  • Aftercare What to expect afterwards

    After your treatment you will be taken back to your room where you can rest. If you have a headache or feel sick, you can have medicines to ease your symptoms.

    Your doctor may prescribe you steroids to take after the procedure. This can help to prevent any swelling or inflammation around the area that was treated with radiation.

    You may need to arrange for someone to drive you home depending on how you’re feeling. Try to have a friend or relative stay with you for the first 24 hours.

    After your treatment, your doctor will arrange a follow-up appointment to check how you're recovering and what your response has been to the treatment. You may also have an MRI scan in the follow-up appointment.

    Some people find that the symptoms of a brain tumour get worse after this kind of treatment. This is a reaction to the treatment itself and doesn’t mean the tumour has got any worse.

  • Recovery Recovering from gamma knife

    If you have a headache, or if your head is painful, you can take painkillers such as paracetamol and ibuprofen. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist for advice.

    If you notice pain, swelling or redness, or have any concerns following your treatment, contact your doctor.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with gamma knife. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

    Side-effects

    These are the unwanted but mostly temporary affects you may get after having your treatment.
    Gamma knife treatment usually has few side-effects because it only targets the affected area.

    However, possible side-effects include:

    • tiredness
    • headaches
    • feeling sick and dizzy
    • losing some hair if your tumour is close to the surface of your skull
    • bleeding from the places where the head frame was fixed

    Complications

    This is when problems occur during or after the procedure. Any complications that may arise are specific to you and your condition. Your doctor will have discussed these with you prior to the gamma knife treatment.

    Because a high dose of radiation is used on a small area in your brain, some of the healthy cells can die. This is called radiation necrosis. For a small number of people this can cause the brain to swell. This doesn’t usually cause any symptoms. However, if you do develop symptoms your doctor will prescribe steroids to treat the problem.

    You can have seizures (fits) 24 to 72 hours after gamma knife treatment. For this reason you should not drive until your doctor says it’s safe to.

  • FAQs FAQs

    Can you have more than one gamma knife treatment?

    Answer

    Yes, you can have gamma knife treatment more than once if you need it.

    Explanation

    You may be able to have gamma knife again if you have more than one tumour or if the tumour spreads to another area. Gamma knife treatment can also be carried out if you have already had another form of radiotherapy that hasn’t worked. This is because gamma knife treatment is very precise and does little damage to healthy nerves and tissues.

    Do the pins on the head frame go right through my skull?

    Answer

    No, the pins only go through your skin to the outer part of your skull. If you have had any previous operations or a serious injury to your head, you should let your surgeon know.

    Explanation

    The pins on the head frame are used to keep the frame rigid because it’s important that your head is kept very still during the procedure.

    You will be given four injections of local anaesthetic to numb the area where the pins will be attached. This can feel slightly uncomfortable. You may get a feeling of increased pressure or tightness in your head when the frame goes on.

    When can I drive after gamma knife treatment?

    Answer

    The Driver and Vehicle Licensing Agency (DVLA) in the UK doesn’t have any specific recommendations about gamma knife treatment. However, if you have a brain tumour you must tell the DVLA about it. You may be asked to stop driving.

    Explanation

    The DVLA has very comprehensive guidelines that help to ensure that drivers are still fit to drive after illnesses, surgery and other procedures.

    If you have a brain tumour you must tell the DVLA. You will need to complete a form which gives details of your condition. The DVLA will make a decision about whether you can continue to drive, depending on your condition and how you’re affected.

    You can have seizures (fits) 24 to 72 hours after gamma knife treatment. For this reason you should not drive until your doctor says it’s safe to.

    If you’re in any doubt about driving, contact your motor insurer so that you’re aware of their recommendations, and always follow your surgeon’s advice.

    When can I go back to work after gamma knife treatment?

    Answer

    This will depend on whether you have any side-effects and how you feel after the treatment.

    Explanation

    Gamma knife treatment usually has few side-effects. You can return to your usual routine as soon as you feel well enough.

    You may find you feel very tired for a few days after treatment. The treatment is non-invasive and you can go back to work the next day, although most people find that they need a few days rest before they return to work.

    Will I lose my hair when I have gamma knife treatment?

    Answer

    Most people who have gamma knife treatment don't lose their hair.

    Explanation

    You’re unlikely to lose your hair after having gamma knife treatment. This is because the treatment is directed to a specific area and doesn't usually damage healthy tissue. You may lose a patch of hair if the area targeted is near the surface of your skull. If you do lose some hair, it will usually grow back within three months. It may grow back lighter and finer. You will never lose all your hair.

  • Resources Resources

    Further information

    Sources

    • Radiotherapy for brain tumours. Macmillan Cancer Support. www.macmillan.org.uk, published May 2012
    • Possible treatments for brain tumour. Brain and Spine Foundation. www.brainandspine.org.uk, accessed 10 September 2013
    • Stereotactic radiosurgery. eMedicine. www.emedicine.medscape.com, published August 2013
    • Treatments for brain tumours. Macmillan Cancer Support. www.macmillan.org.uk, published May 2012
    • What about treatment? Trigeminal Neuralgia Association. www.tna.org.uk, published February 2013
    • Radiosurgery for brain tumours. Cancer Research UK. www.cancerresearchuk.org, published march 2012
    • What is an arteriovenous malformation? American Stroke Association. www.strokeassociation.org, published February 2013
    • Health conditions and driving. Driver and Vehicle Licensing Agency. www.gov.uk, accessed 10 September 2013
  • Related information Related information

  • Author information Author information

    Reviewed by Dylan Merkett, Bupa Health Information Team, March 2014.

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