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Radiosurgery for brain tumours

Radiosurgery is a type of stereotactic radiotherapy. Stereotactic radiotherapy aims the radiotherapy beams very precisely at the area of the brain tumour. So it gives a very high dose of radiation to a very small precise area. Radiosurgery is usually a single dose of treatment.

This treatment works very well for some types of brain tumour. It is used for small tumours less than 3cm in size, including acoustic neuromas, secondary brain tumours, pituitary adenomas, haemangioblastomas, meningiomas, and glioma that has come back.

Having radiosurgery treatment

To have radiosurgery your head needs to be kept as still as possible during the treatment. Doctors call this stereotactic immobilisation. You may have treatment with a head frame or treatment with a mask.

Treatment with a head frame takes the best part of a day. Your treatment team make a frame to attach to your skull using pins. They attach the head frame to your head. You feel some pressure and tightness and it may be sore. Your doctors and radiographers check the frame and you have a CT scan or MRI scan. You wait for a couple of hours while your treatment team plans the treatment. Then your head frame is fixed into the radiotherapy machine while you lie on the treatment couch. You will be awake the whole time. The couch slides into the machine. The treatment may take 20 to 40 minutes or up to 2 hours. Afterwards, the radiographers help you out of the machine and take the frame off. Then you go back to the ward, usually for an overnight stay.

Treatment with a mask is done in 2 stages. You have a thermoplastic mask (mould) made in the mould room. Then you have a CT scan. You then go home and your treatment team tells you when to go back for the treatment. On the treatment day you lie on the radiotherapy treatment couch. The radiographers fit your mask and attach it to the couch. They then fix a frame to the mask. The radiographers leave the room. The treatment takes around 20 to 40 minutes and afterwards you can go home.

Side effects of brain tumour radiosurgery

There are usually very few side effects from radiosurgery. Your doctor may give you a dose of steroids before the treatment or straight afterwards to help prevent side effects. It is usual to feel very tired for some days after the treatment. You may feel sick or faint at first, or have a headache. You may also feel a bit weak and dizzy. There is a small risk of having a fit (seizure) after treatment and so you should not drive for at least a month. Your treatment team will advise you about this.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating brain tumours section.

 

 

What radiosurgery is

Radiosurgery is not a type of surgery. It is a type of stereotactic radiotherapy. Stereotactic radiotherapy aims the radiotherapy beams very precisely at the area of the brain tumour. So it gives a very high dose of radiation to a very small precise area. Radiosurgery is usually a single dose of treatment.

Sometimes radiosurgery is called Gamma Knife or CyberKnife treatment after the machines used to give it. You can also have the treatment using the more common radiotherapy machine, the linear accelerator (also called LINAC). Several LINAC machines are designed to give stereotactic radiotherapy and they include the Novalis Tx and Axeese.

 

Tumour types that radiosurgery can treat

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 can be used for other tumours, including

Doctors also use this type of treatment for non cancerous conditions, such as arteriovenous malformation (AVM).

Specialists don't recommend radiosurgery for larger brain tumours. It isn't possible to get the same dose of radiotherapy throughout the treatment area with a large tumour. 

Radiosurgery may also not be suitable if there are certain nerves running through the treatment area. The nerves could be given too much radiation. Then they would be damaged. This could cause problems, depending on the role of the affected nerves.

 

Having radiosurgery treatment

To have radiosurgery your head needs to be kept as still as possible during the treatment. Doctors call this stereotactic immobilisation. There are a number of different ways of doing this. You may have

Treatment with a head frame

Your treatment team make a frame to attach to your skull using pins. They make it very carefully and specifically for you using information from your scans. This treatment takes the best part of a day. 

The head frame is fixed to your head, which takes about 10 minutes. This is a bit uncomfortable because you need about 4 local anaesthetic injections at the points where the frame is attached to your head. When the frame is fitted, you will feel some pressure and tightness and it may be sore. 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 plans the treatment. This can take a couple of hours. During this time, you can have something to eat and drink unless there are medical reasons why you shouldn't. 

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. You will be awake the whole time. Once everything is in place, the couch slides into the machine and the treatment begins. 

Treatment with the Gamma Knife or CyberKnife machines takes an hour or two, depending on the amount of treatment and position of your tumour. If you have treatment with a LINAC machine it takes around 20 to 40 minutes. When the treatment is over, the radiographers will help you out of the machine. They take the frame off. Then you go back to the ward, usually for an overnight stay.

Treatment with a mask

For some radiosurgery treatments using the LINAC system, you have a thermoplastic mask (mould) made instead of a frame. You go to the mould room to have the mask made. You can find out how the mask is made on the page about having brain tumour radiotherapy. Once the mask is made you have a CT scan. You then go home and your treatment team will tell you when to go back for the treatment.

On the day of treatment you lie on the radiotherapy treatment couch. The radiographers will 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 takes around 20 to 40 minutes. After the treatment you can go home.

 

Side effects of brain tumour radiosurgery

There are usually very few immediate side effects from radiosurgery. Your doctor may give you a dose of steroids before the treatment or straight afterwards to help prevent side effects due to swelling of the brain. You may feel sick or faint at first, or have a headache. You may also feel a bit weak and dizzy.

If you had treatment with a head frame, you may have slight bleeding from the points where the frame was attached to your skull. You may also have tingling or itching where the frame was attached. This is a normal sign of healing. 

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. It is usual to feel very tired for some days after the treatment.

There is a small risk of a fit (seizure) after radiosurgery so the Driver and Vehicle Licensing Authority (DVLA) does not allow you to drive for at least a month afterwards. It may be even longer depending on your type of brain tumour.

There are not usually any other side effects. But tell your doctor or nurse if you have any new symptoms or your old symptoms seem to be getting worse.

 

Long term side effects

A small number of people have long term side effects from radiosurgery. This is because you have a very high dose of radiation given to a very small area. Over a period of time the treated area may develop a small area of dead cells. This is called radiation necrosis. Most people who develop this have no symptoms. The affected area is too small to make any difference to them.

In people who develop radiation necrosis after radiosurgery, fewer than 1 in 10 have swelling that is large enough to cause symptoms. If you do develop this, your specialist will give you steroids to take. Some people need high doses of steroids for long periods of time. An even smaller proportion of people need surgery to remove the dead tissue. In people who develop radiation necrosis, fewer than 1 in 20 need surgery to have the area of dead tissue removed.

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Updated: 30 December 2013