Consultations and Appointments Prior to Your Procedure
You will need to complete a consultation appointment with the neurosurgeon that will be responsible for your Gamma Knife® treatment as well as a consultation appointment with the radiation oncologist who will be assisting the neurosurgeon with treatment. If you have already had imaging by MRI, CT scan, or angiography, please bring your films with you when you come for consultations.  Many times this will prevent your having to repeat these studies prior to your Gamma Knife® treatment day.  

If you would be interested in doing so, you may arrange to spend about an hour or so with the Nurse Coordinator of the Gamma Knife® Center prior to your treatment date. This person is a registered nurse who is employed by St. Luke’s The Woodlands Hospital. The nurse will show you a short video of the procedure unless you have already seen it and will take you on a tour of the Center. The objective during this appointment is to acquaint you with the Gamma Knife® Center and answer any questions that will make you more comfortable.

The day before your treatment, you need to register at the hospital and bring the completed forms. The Gamma Knife® Nurse Coordinator will let you know the time to arrive at the hospital. This will assist the nurse in having things ready for you when you arrive the morning of your procedure.  

There is a possibility that one of your physicians may require some preliminary lab work before your Gamma Knife® treatment can begin. If this is the case, blood will be drawn once you arrive for registration or the morning of your treatment. All females of childbearing age should expect to have a pregnancy test done after arrival to the Gamma Knife® Center on the morning of treatment.

The Night Before Your Procedure

• Please shower and wash your hair. Do not apply any hair gels or spray. Do not wear makeup, hairpins, nail polish, or jewelry to your procedure.
• Do not have anything to eat or drink after midnight.
• You may take regularly scheduled medications with sips of water the night before and the morning of your procedure. If you are unsure whether you should take a particular medication, please ask your doctor first.
  

The Morning of Your Procedure

• Patients who are diabetic: take one-half your morning insulin or hold your oral hypoglycemic, as directed by your physician.
• Please park in the parking lot and enter the hospital in the Main Entrance. The Nurse Coordinator will meet you and your family there and escort you to the Gamma Knife® Holding Area.
• Please report to the Gamma Knife® Center location at the assigned time.
• Bring all your regular medications to the hospital. You may take them throughout the day as scheduled/needed if permitted by your physician. (We will discuss this when you arrive.)
• You may bring one or two music CD’s that you would like to listen to during the treatment phase of Gamma Knife®, if you so desire.
• Wear comfortable clothes for the procedure (loose fitting sweatpants or slacks and shirt, plus socks). Do not wear any metal such as zippers, metallic paint or designs on clothing, underwear with underwire or metal supports, or jewelry, because it will interfere with the MRI which is performed after the headframe is placed.  
• You will not be permitted to drive the day of your treatment, so please make arrangements for a friend or family member to drive you home.
• Patients may have visitors; however, due to space we will limit it to one or two family members or friends. The Gamma Knife® nurse should communicate with the family/friends in a timely manner with updates and expected treatment times either in person or via telephone.  Patients are welcome to bring reading materials.
• Please leave all valuables at home except for your picture ID and your insurance card(s).
  

Preparation for Treatment: 

• In preparation for the procedure, a guiding device called a “stereotactic frame” will be fixed firmly onto your head. This frame fits over your head and is attached to your head with four titanium pins.  The skin will be cleansed and a local anesthetic given to “numb” the area.  Any discomfort you feel during placement of the pins will last only a few minutes. You will be given medication for comfort and sedation prior to beginning the procedure. The remaining tests and treatment should be pain free.
• The stereotactic frame will remain on your head until after the completion of the Gamma Knife® treatment.
• Before the frame is placed on your head, the nurse will insert a small gauge IV in your arm or hand. This will allow your nurse to give you medications or fluids as needed to assist in your comfort.
  

Imaging Before the Treatment:
Each patient’s needs are different, but to help the neurosurgeon and radiation oncologist plan your treatment, you will undergo imaging studies after the frame has been placed, such as:

• MRI and/or CT        
• Angiogram (for AVM patients)
  

During imaging a plastic apparatus called a “fiducial box” will be attached to the stereotactic frame. The fiducial box helps target the area to be treated by adding coordinate markers to the images. The fiducial box simply snaps onto the headframe and causes no discomfort. It will be removed after imaging is complete.

In addition to these devices that assist in planning and targeting, a clear plastic helmet with many holes in it will be placed on your head over the frame to measure the size of your head. This may be done prior to your imaging study or after and only takes a few minutes. Similar to the fiducial box, the plastic helmet simply attaches to the headframe and causes no discomfort. After the measurements are taken, the plastic helmet will be removed.

Neither the fiducial box nor the plastic helmet will cause discomfort or obstruct your view.

The Gamma Knife® Procedure:
After your treatment plan has been finalized, you will be taken into the Gamma Knife® treatment room and transferred onto the treatment couch where the stereotactic frame will be connected to a device known as a frame adapter. The adapter will support your head during treatment and ensure that your position is secure. There is nothing uncomfortable about this process.   

The treatment begins when the doors of the radiation unit open, and the head of the couch moves into position. You may hear a small click as the frame adapter engages with the machine. During your treatment, the radiation beams are channeled through specially-sized holes which target the treatment area designated by your physicians. There are a total of 192 holes (or channels) through which the radiation will pass. These holes are located within a “collimator helmet” behind your head. You will not hear or feel the treatment.

During this time, you will remain in constant contact with the Gamma Knife® personnel via the use of an intercom system. Your treatment is observed at all times through camera monitors. When the treatment is completed, the Gamma Knife® couch will move back into its starting position, and you will be allowed to get up. If at any time during the treatment you need to get up or go to the bathroom, the treatment will be paused, and the Gamma Knife® personnel will assist you.

After Your Treatment:
When your treatment is completed, the frame will be removed and an antibiotic ointment will be applied along with a dressing. Band-Aids will be placed on the pin sites prior to discharge from the unit.

On rare occasions, there may be bleeding at a pin site. Most times the bleeding is minimal and stops with direct pressure on the site.  

When you are able to take fluids by mouth, your nurse will remove your IV line.

Side Effects, Risks, and Complications:
Most patients return to their normal daily activities within twenty-four hours of Gamma Knife® radiosurgery. Side effects are generally minimal and temporary. Neurological risks, if any, are dependent upon the size, shape, and location of the particular area to be treated. Your physician will discuss any possible risks associated with your specific treatment prior to your admission.  

Although steps will be taken to minimize the likelihood of any of the following, should you experience any of these after treatment, please contact your physician immediately:

• Seizures
• New onset of numbness
• Weakness or paralysis
• Loss of balance
• Visual disturbance
• Hearing Loss
• Severe headache
  

These symptoms may be caused by irritation or swelling in the brain around the treated area and should be reported so that appropriate treatment can be provided.  

Occasionally patients experience a mild headache or nausea after the Gamma Knife® treatment. Should this occur, your nurse can give you medications ordered by your doctor for your comfort. In addition, before your discharge your nurse will discuss any side effects that may be experienced after treatment such as local scalp swelling, tenderness or bleeding at the pin sites, or puffiness around the eyes or forehead.  Your discharge instructions will include measures that can be taken to minimize any of these temporary symptoms.

Discharge:
Most patients will be able to leave the Gamma Knife® Center after a period of observation (usually about an hour). Your follow-up care will be coordinated with the doctor who referred you and the doctors involved in your treatment. If possible, your nurse will make appointments for your follow-up visit(s) prior to your discharge.

You should have a family member drive you home and stay with you for that night.

You may resume your normal diet and activities as tolerated. Medications prescribed by your doctor before the Gamma Knife® treatment will be reviewed by your treating physicians on the day of your treatment, and recommendations will be made for continuing those medications.

You may gently shampoo your hair the day after treatment; however, avoid scrubbing the pin sites until they have healed for a week or so. Occasionally, patients notice some persistent numbness or tingling of the scalp. The feeling is temporary and is usually gone within a few weeks.

Please call your physician or your Gamma Knife® nurse if you have any questions about your treatment.

* Leskell Gamma Knife® Facts and Figures: elekta.com/patient
 
For More Information
Neuroscience/Gamma Knife®
Gamma Knife® Center
St. Luke’s The Woodlands Hospital
936-266-2871 (office)