What is Gamma Knife Radiosurgery (GKSRS)?
Gamma Knife radiosurgery (GKSRS) is a safe, effective and non-invasive procedure that uses radiation to treat conditions in and around the brain. It is sometimes used as a replacement for conventional surgery, but at other times it may be effective in situations where there is no conventional surgical alternative available. The radiation treatment is delivered with great precision to the target tissue within or around the brain, whilst at the same time minimising any dose to surrounding healthy tissue. The name ‘Gamma Knife’ is in some ways misleading – no knife or cutting implement is actually involved at any stage. The term ‘Gamma Knife’ is intended to convey the idea that this radiation treatment is in some ways delivered as though it were an actual knife, because it offers a similar sort of precision and targeting to that offered by actual surgery. It uses radiation in much the same way as a surgeon uses a knife.
Is this treatment right for you?
If you are unsure if Gamma Knife would be a suitable treatment for your condition or you would like to find out more please contact us. Someone will be in touch to tell you more about the treatment and if it is potentially suitable for you. The multidisciplinary Gamma Knife team meet regularly to discuss new cases and are happy to review your scans. There is no cost for this service. The team includes a neurosurgeon, radiation oncologists, medical physicist and nurses. Once your case has been discussed we will be in contact shortly afterwards to let you know if Gamma Knife is an option for you or if not we may be able to advise on other treatments. It can be a very valuable second opinion free of charge.
How does Gamma Knife work?
Radiation damages the DNA in the cells of the tumour or other abnormality being treated, such that the cells that make up the targeted tissue can no longer reproduce. Eventually, when these cells come to the end of their natural life span, they find that they are unable to reproduce and replace themselves because the DNA essential to this process is no longer functioning properly. Some lesions which are very inactive in terms of cell function may take up to 2 or 3 years or more to respond to treatment -this is typically the case for instance with blood vessels, and arterio-venous malformations (AVM) which usually resolve over this sort of time period.
Is Gamma Knife radiosurgery safe?
Yes – in terms of the risk of damage to tissue around the target area. GKSRS risks can nearly always be brought down to very low levels – one of the more common reasons for recommending GKSRS is that the overall risk compared to open surgery is frequently much lower. This is sometimes so much the case that the surgical alternative may actually carry a higher overall risk than that of the condition being treated, thereby rendering it effectively inoperable other than by radiosurgery. The precise nature and magnitude of any risk will vary with the size, nature and position of the lesion being treated. You should ask your treating doctor to elaborate on the details of this with respect to your own individual situation – they will be more than happy to give you a very full explanation of all that is involved. As with any form of surgical or radiation treatment, there will always be some small risk attached and this can never be reduced to zero.
What are the possible complications of Gamma Knife radiosurgery?
Serious complications of GKSRS are really very unusual. Minor side effects, which generally resolve within a few hours, are sometimes seen and do not usually present the patient (or the doctor) with a significant problem. It is fair to say that the large majority of patients suffer no side effects whatsoever, apart perhaps from a feeling of being a bit tired and ‘washed out’ at the end of a busy day’s treatment! We tend to think of complications in terms of those which may occur early i.e. soon after treatment, and those which can occur at a later stage, some weeks or months following GKSRS:
- Some local discomfort of the scalp relating to the pin sites which are used to fix the frame – resolves within a few hours, almost certainly by the following morning.
- Numbness of the scalp around pin sites may occur which resolve over a day or two.
- Headache – again usually mild, resolving rapidly.
- Mild nausea.
- Delayed complications:
Visual Loss, Hearing loss, Epileptic seizures, Radiation effects on surrounding brain tissue. Hair loss (very localised) adjacent to treated area. These complications tend to relate only to treatment for particular conditions. Again your treating doctor will be able to elaborate on the details of this with respect to your own individual situation
WHAT ARE THE POTENTIAL BENEFITS OF GAMMA KNIFE RADIOSURGERY OVER CONVENTIONAL SURGICAL TECHNIQUES?
- The risks of infection, haemorrhage and spinal fluid leakage are eliminated, as is the scarring and potential disfigurement that results from conventional neurosurgery.
- The small risk associated with general anaesthesia is also eliminated. A mild sedative is occasionally used.
- GKSRS is a day procedure except in occasional circumstances.
- GKSRS sometimes can be used in conjunction with conventional surgery, usually taking the place of the more risky component of the latter. In other words, where conventional surgery is absolutely required, its risk can be reduced by partially substituting GKSRS as a ”boost” to perform the final part of the job.
- An individual who might be a relatively high risk candidate for conventional surgery may be a much safer candidate for GKSRS.
- Unlike whole brain radiotherapy GKSRS is directed very specifically at the target. This spares most of the adjacent normal brain tissue from exposure to unnecessary excess radiation.
- “Fractionation” is not required – unlike radiotherapy (such as Linac and SRS which may require fractionation) which is often delivered in many fractions over several weeks, GKSRS can nearly always be delivered as a single treatment over the course of less than a day. Multiple hospital visits are therefore avoided.
- As a day case treatment GKSRS offers the prospect of return to work, driving, and other normal social activities within a few days in the vast majority of cases. This is frequently as soon as the day following treatment.
- Established effectiveness over 40 years of experience worldwide, with a very low rate of complications
WILL THE GAMMA KNIFE PROCEDURE HURT?
The stereotactic frame is fitted under local anaesthesia. This involves the administration of 4 small injections around the circumference of the head, in order to numb the sites where the 4 pins are to be used to secure the frame. The experience of these is the same as when visiting the dentist for the purpose of having a tooth put to sleep for filling. The same local anaesthetic drug is used in both instances. Very quickly, after a brief stinging sensation, these areas will go numb. The frame is then attached. As the pins are secured you will feel a strange “pressure” sensation which quite soon passes. The whole procedure takes about 5 – 10 minutes, and after the frame is fitted you will gradually get used to the sensation. After a short while you will no longer feel this, and you will almost forget that the frame is there at all! Frame fitting involves a small degree of discomfort, but most patients tolerate it remarkably well, and tend to comment that it was much preferable to the idea of having a major surgical procedure performed. At the end of the procedure the frame is removed. This only takes a minute or two, and is really not at all traumatic. Some patients experience headaches after frame removal which can be treated with simple pain relief.
WILL I BE RADIOACTIVE?
No. All radiation stays within the treatment room. The Gamma rays used in the treatment do not remain in the body.
WILL I HAVE SWELLING OR OEDEMA?
In the postoperative period some tumours may swell a little as a result of being injured by a dose of radiation. This may show as a slight increase in apparent size of the tumour as assessed by MRI or CT scanning at about 6-9 months post treatment. This appearance must not be misinterpreted as tumour growth. It is self-limiting, and will soon be followed by reduction back to original size, or even smaller. If this temporary swelling (which is actually indicative that the treatment is starting to work) causes any symptoms, then a short course of steroids or other medication is sometimes used to treat the swelling.
WILL I LOSE MY HAIR?
The vast majority of patients have no risk whatsoever of losing any hair at all. Furthermore, even in those few cases where hair loss is a possibility, such hair loss will never involve the entire scalp – as typically happens with whole brain radiotherapy. Only a small number of patients will have tumours sufficiently close to the scalp to carry the risk of any hair loss at all. If a lesion to be treated is very close to the inside of the skull, it is possible that enough radiation will be delivered to the scalp such that a patch of hair the size of a 10 or 20 cent coin may be lost. This hair usually grows back, though it may be a little lighter in colour and finer in texture than previously.
Can Gamma Knife Radiosurgery cause another tumour?
Theoretically yes – all forms of radiation can in principle cause tumour formation – but instances of this actually happening are so rare that there is no direct scientific proof that it has been caused by treatment. There are some individuals (with rare conditions) who are at risk from developing further tumours because of their underlying condition, and very occasionally (perhaps a dozen times out of tens of thousands of patients over several decades), such new tumour formation has been reported. Based on existing experience, the incidence of radiation caused tumours is extremely low, much less than the risk of a complication arising from a general anaesthetic for example.
HOW WILL I FEEL FOLLOWING TREATMENT?
Most patients feel just as well as they did at the beginning of the day. Some tiredness is quite common, especially if the treatment has occupied most of the day. A little discomfort at the pin sites and a mild headache are also quite common – this may persist for up to a day or two. Mild nausea may also occur during the first 48 hours following treatment. Mild anti-nausea and headache medication is routinely prescribed for patients who may require it. Patients are observed for one to two hours post treatment.
FOLLOWING TREATMENT WHEN CAN I GO BACK TO WORK?
As soon as you feel well enough. There is no reason why you should not go back to work the following day – some patients have even been known to return to work later the same day, but you should not feel pressured to return to work too quickly. It is fair to say that most people return to work within less than a week.
FOLLOWING TREATMENT HOW SOON CAN I TRAVEL (BY MOTOR VEHICLE, BUS, TRAIN, PLANE)?
Again, as soon as you feel well enough. There is no reason why you could not travel the following day, or even some time later on the actual day of treatment. Any driving restrictions already in place will continue to apply.
WHAT WILL HAPPEN AFTER TREATMENT?
You will see a Neurosurgeon and/or Radiation Oncologist approximately 4 to 6 weeks post treatment, just to check that everything is ok. Depending on the condition treated, they will arrange for follow-up scans to be performed usually at 3 months post treatment.