Stereotactic Radiosurgery -A Patient Guide
This handout tells you what to expect before, during and after stereotactic radiosurgery. While reading it, highlight any parts that do not make sense to you. Make a list of any questions you may have. Bring this handout when you come for your clinic visit or your treatment. Your doctor or nurse will go over it with you.
What is stereotactic radiosurgery?
Stereotactic radiosurgery is used to treat many types of lesions or tumors in the brain, including: brain tumors, meningiomas, vestibular schwannomas, trigeminal neuralgia and arteriovenous malformations (AVM). High doses of radiation are given to a small area in your brain. In most cases it is done in one treatment. The radiation can be given to the abnormal area while the normal brain tissue around it receives only a small dose of radiation. Because this treatment is so precise, a special frame is used to keep your head perfectly still.
Before the Procedure
1. Arrange to have someone drive you home after the treatment. Family members or a friend may come and be with you during the day.
- You will have a special MRI scan done called a stealth MRI. This MRI will be used to plan your radiation treatment. It will feel no different than other MRIs you may have had. If you have never had an MRI, please let the nurse know, so that you can be given a Health Facts for You that describes it in detail.
- Please let the doctor or nurse know if you have:
| A pacemaker |
| An artificial heart valve |
| A defibrillator |
| Brain aneurysm clips |
| Implanted pumps |
| Chemotherapy ports |
| Neurostimulators |
| Eye or ear implants |
| Stents, coils or filters |
| Claustrophobia (fear of being in closed spaces) |
- If you are allergic to IV (intravenous) contrast dye, shellfish or iodine, please tell your doctor.
- If you have diabetes and are taking oral medicines (Glucovance®, metformin, Metaglip®, Avandamet®, or Glucophage®) or insulin, please let your nurse or doctor know. These medications may need to be held or adjusted for the treatment.
- The night before the treatment, do not eat or drink anything after midnight. If you have prescribed oral medicines, take them with a small sip of water only., or as directed.
- If you are taking Aspirin, Ibuprofen (Motrin®) or coumadin (Warfarin®), please let your nurse or doctor know, as these medications may need to be adjusted prior to the radiation treatment.
- Bring your prescribed medicines with you on the day of the procedure.
- Expect to be at the hospital for about 10 to 14 hours.
The day of the treatment
1. You will be asked to change into a gown. A nurse will place a small needle in your hand or arm to give medicines during the frame placement, if needed. It will also be used for IV 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 is used to numb four sites on your scalp (two on the forehead and two in the back of your head) before the frame placement. This takes about 15-20 minutes.
3. After the frame is placed, a CT scan is done. This is done to pinpoint the exact place and size of the abnormal area. It is also used for treatment planning. After the CT, you will wait in a comfortable area for the treatment. A television and VCR is available for your use. Please feel free to bring videos.
- If you have never had a CT scan before, please let your nurse know so you can receive a Health Facts for You to tell you about a CT scan in greater detail.
- After the CT scan, you will be able to eat and drink. Please drink EXTRA fluids today to flush the dye from your system. You will be given breakfast after the CT scan is completed.
- Your doctors (a neurosurgeon, radiation oncologist and physicists) do treatment planning. This takes about 3 to 4 hours.
- Late in the afternoon, after the planning is done, you will be brought into the treatment room. You 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 length of the treatment will vary. It depends on the number of arcs you receive.
Radiation treatments are a lot like having x-rays. You will not be able to see, feel, or hear the radiation. There is no pain or discomfort with the 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.
Your doctors, a nurse, a therapist who operates the treatment machine, and the physicist(s) who did the treatment planning will be present during your treatment.
Once you are in place 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. You will be able to talk with the staff through a speaker. You can also wave your hand as a signal that you need help right away. If this happens, the treatment will be stopped and the staff will come into the room to help you.
What are the risks?
Your doctor will talk with you about the short and long-term risks of this treatment. The risks vary from patient to patient. They depend on a number of factors such as your diagnosis, the size and location of the lesion, underlying medical problems, the dose of radiation used, and the amount of normal tissue treated. Most of the time, there are few immediate side effects. Rarely, patients have nausea, which is controlled with medicine. Even more rare are seizures. Seizures can also be controlled with medicines. In most people, there is little hair loss as a result of the treatment. The most common side effect can be brain swelling, which is treated with steroids (Dexamethasone® or Decadron®).
There is some concern that, in a very few patients, long-term side effects could occur. At worst, these side effects could include the damage of normal brain tissue leading to the loss of some brain function. This could include changes in vision, speech, or paralysis. Although serious, these side effects are quite rare. A very few patients have severe brain swelling and may need steroids for a long time. 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 it is removed, we will clean the pin sites and put on an antibiotic ointment. You will be sent home shortly after that with written instructions.
At home
You may have some short-term swelling around both eyes. This is caused by the local anesthetic placed at the pin sites. This begins about 2-3 days after the treatment. It may last from days to weeks. This is normal and should go away by itself.
You may have some pain, tenderness or numbness around the pin site area for up to a few weeks. This is normal and should go away by itself.
You may feel a little tired for a day or two. You should be able to be as active as you wish to be.
Keep the pin sites clean. You will be given antibiotic ointment. Put it on the pin sites for the first 2-3 days.
When to call the doctor
- Increasing or severe headaches that are not relieved by TylenolÒ
- Headaches that occur daily or several times a day, even if relieved TylenolÒ
- Headaches associated with nausea and vomiting
- Nausea or vomiting
- Any change in strength or sensation (numbness or tingling)
- Clumsiness or coordination difficulty of a hand or leg
- Vision, hearing or speech changes or difficulties
- Balance or walking difficulties or dizziness
- New onset of confusion
- New seizures or worsening of seizures
If you have any questions or problems once home, call the Radiotherapy Clinic at(608) 263-8500. If the clinic is closed, your call will be transferred to the hospital answering service. Ask the operator for the radiotherapy doctor on call. Give your name and phone number with the area code. The doctor will call you back.
If you live outside of the area, call toll-free by dialing 1-800-323-8942.
The Spanish version of this Health Fact for you is 6193
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 03/16/2012
Copyright © 06/24/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5218
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