Radiosurgery is a type of stereotactic radiotherapy. It's not a type of brain surgery.
What it is
Radiosurgery gives a very high dose of radiation to a very small precise area. You usually have a single dose of treatment, or up to 5 treatments.
You might have this treatment using a common radiotherapy machine, the linear accelerator (also called LINAC). Or you might have it with one of the following machines:
- Gamma Knife
Radiosurgery is sometimes called Gamma Knife or Cyberknife treatment because of the type of machine that is used.
Radiosurgery treatment can work very well for some types of brain tumour. You are most likely to have it if you have an acoustic neuroma that is less than 3cm across.
It is also used to treat:
- small pituitary adenomas
- haemangioblastomas that couldn't be removed, were only partly removed, or came back after surgery
- meningiomas smaller than 3cm
- a glioma that has come back and is smaller than 3cm
- small secondary brain tumours
Specialists don't recommend radiosurgery:
- for larger brain tumours
- if there are certain nerves running through the treatment area - the nerves could get too much radiation and be damaged
Keeping your head still
To have radiosurgery, your head needs to be kept as still as possible during the treatment. This is called immobilisation.
You might have:
- a head frame
- a mask
Your treatment team attach a frame to your skull using 4 pins. Before they attach the frame, you have 4 injections of local anaesthetic at the points where the frame is attached to your head. This takes about 10 minutes.
As the the frame is fitted, you feel some pressure and tightness, but it usually feels better within a few minutes.
Another way of fixing the frame is to have a mask made from plastic. It is called a thermoplastic mask. The frame fixes to the mask. The mask in turn attaches to the scanner or radiotherapy machine bed while you are wearing it. This means that you can't move, but there is nothing actually attached to you directly.
How you have radiosurgery
Treatment with a head frame
Once the frame is in place, the doctors and radiographers check it and you have a CT scan or MRI scan.
After the scan there is a wait while your treatment team plan the treatment. This can take up to a couple of hours. During this time, you can have something to eat and drink.
When the planning is complete, you go to the treatment room. Your head frame is fixed into the radiotherapy machine while you are lying on the treatment couch. The radiographers leave the room before treatment starts.
Once everything is in place, the couch slides into the machine and the treatment begins. You are awake the whole time.
You won't feel anything while you are having treatment.
It takes about takes around 20 to 40 minutes for each treatment session. Or if you're having treatment with a Gamma Knife or Cyber Knife it takes an hour or two.
Treatment with a mask
Once the mask is made you have a CT scan. You then go home and your treatment team tell you when to go back for the treatment.
You lie on the radiotherapy treatment couch when you have treatment. The radiographers fit your mask and attach it to the treatment couch. They then fix a frame to the mask. Although you can't move your head, there is nothing directly attached to you.
The radiographers leave the room and you may feel the couch move as they adjust it. The treatment then starts. It takes around 20 to 40 minutes.
After your radiosurgery
After treatment with a head frame
When the treatment is over, the radiographers help you out of the machine. They remove the frame.
You go back to the ward and usually stay overnight in hospital.
After treatment with a mask
You can go straight home after your treatment.
Side effects of radiosurgery
Your doctor might give you a dose of steroids before the treatment or straight afterwards. This is to help prevent side effects due to swelling of the brain.
It's not common to have side effects straight after radiosurgery. Let your doctor or nurse if you have any new symptoms or your old symptoms seem to be getting worse.
These side effects might include:
You might feel a bit sick at first. Your nurse can give you anti-sickness medicines to help.
You might feel a bit faint. Make sure you take things slowly.
Let your nurse know if you are feeling very weak or dizzy.
You might have a headache after your treatment. Let your doctor know. Painkillers can help.
You may lose a patch of hair if your tumour was near the surface of your skull. But hair loss is not normally a side effect of radiosurgery.
There is a small risk of a fit (seizure) after radiosurgery. So the Driver and Vehicle Licensing Authority (DVLA) do not allow you to drive for at least a month afterwards. It may be longer depending on your type of brain tumour.
You may have slight bleeding from the points where the frame was attached to your skull. You might also have tingling or itching where the frame was attached.
This is a normal sign of healing.
It's normal to feel tired for a few days after your treatment.
Long term side effects
A small number of people have long term side effects from radiosurgery. This is because you have very high dose radiation to a very small area. Over a period of time the treated area might develop a small area of dead cells. This is called radiation necrosis.
You are unlikely to have symptoms because the affected area is very small. But in some people radiation necrosis causes swelling that leads to symptoms. This happens in fewer than 1 in 10 people.
You can have treatment with steroids or surgery. You might need high dose steroids for long periods of time.
Fewer than 1 in 20 people need surgery to have the area of dead tissue removed.