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What is Gamma Knife Radiosurgery?
Gamma Knife® stereotactic radiosurgery is one of the most advanced minimally or non-invasive options for the treatment of brain tumors and other neurological conditions. For patients, this computer-guided therapy can deliver targeted radiation to treat tumors and lesions deep within the brain with pinpoint accuracy that can’t be easily matched by other radiation techniques. It also can be used to treat multiple targets at once and is much less invasive than traditional brain surgery. This outpatient procedure requires no incisions and is typically painless, allowing patients to resume their normal day-to-day activities within hours of their treatment.
While Gamma Knife radiosurgery is most commonly used to treat brain metastases, it may also be used as a therapy for primary malignant tumors as well as benign brain tumors, trigeminal neuralgia, arteriovenous malformations and certain movement disorders, such as essential tremor.
Having offered Gamma Knife radiosurgery since 1997, Cleveland Clinic Gamma Knife experts have treated tens of thousands of patients (both adults and pediatrics) and were the first in North America to use the state-of-the-art Elekta Esprit Gamma Knife machine.
Housed in the Taussig Cancer Center and part of Cleveland Clinic’s Neurological Institute, our multidisciplinary team of neurosurgeons, radiation oncologists, neuro-oncologists and physicists offer immediate access and personalized treatment, aided by the highest precision. Use of the latest generation Gamma Knife technology ensures our ability to spare healthy tissue and optimize safety and quality of life for our patients. With two Gamma Knife machines on our main campus, we offer immediate access and highly personalized, same-day planning and treatment, minimizing disruptions to daily life and returning our patients home within a single day.
How Does It Work?
For Gamma Knife® radiosurgery, a single treatment is typically required, in which 192 beams of gamma rays are focused at multiple points throughout the target, with the aim of matching the delivered radiation to the shape of the tumor or lesion. Thus, the gamma radiation is concentrated in the tumor or specific area, and falloff in adjacent tissue is very steep, minimizing radiation to tissue lying in the entry or exit pathways. Because of this precise focusing ability, aggressive, high-dose gamma radiation can be delivered to stabilize, shrink, or destroy some lesions – even those deep in the cerebral hemispheres or brain stem.
Gamma Knife radiosurgery is used to treat several conditions, including:
- Metastatic brain tumors
- Primary brain tumors - both cancerous (malignant) and non-cancerous (benign)
- Acoustic neuromas (like vestibular schwannomas)
- Arteriovenous malformations (AVMs)
- Essential tremor
- Trigeminal neuralgia
Advantages of Treatment
What are the advantages of Gamma Knife® treatment?
For appropriate patients, Gamma Knife radiosurgery offers many advantages over both conventional radiation and neurosurgery, including:
- Minimally invasive/non-invasive procedure with no incision
- An option for some tumors located deep in the brain that cannot be reached safely by traditional brain surgery
- An outpatient procedure that rarely requires an overnight hospital stay
- Generally safe, effective treatment with a low complication rate (Lower risk than conventional brain surgery)
- Little or no post-treatment discomfort or pain
- Rapid return to normal activities, without the need for physical therapy or other rehabilitation (Typically patients resume their normal pre-treatment activity the next day)
- For patients on systemic cancer treatments, often minimal or not time off therapy required
- Covered by most insurance companies and Medicare
- Frame and frame-less mask options for patient comfort
Before Treatment
What can I expect before my treatment session?
A family member or friend will need to accompany you on the day of your Gamma Knife® procedure and drive you home after the treatment.
It is recommended that you wash your scalp/hair the night before your Gamma Knife treatment, and you wear your hair loose. Do not use any clips, pins, bands, hair spray or styling products.
The day of the procedure, wear slip-on shoes; comfortable pants, slacks or shorts; and a button-up or zip-front shirt with loose-fitting or short sleeves. Shirts that fit over your head are not recommended because you may have a frame placed on your head, which will make it difficult for you to change clothing during your procedure
During Treatment
What can I expect during the treatment?
Gamma Knife® treatment involves several steps. The initial steps are fitting of the head frame or mask, and subsequent steps vary depending on the use of a head frame or frame-less mask for your procedure. Head immobilization with either of these approaches is essential in order to deliver precision targeting with Gamma Knife.
- If using a head frame, first, a box-shaped head frame is positioned on your head. The head frame is made of aluminum and weighs less than two pounds. Cleveland Clinic currently has the option of using Elekta’s Vantage frame on patients – the first in the U.S. to offer it. This frame allows patients to experience more comfort and overall better experience than the traditional head frame. For patients wearing a head frame, oral medication is given to relax the patient, and then a local anesthetic is administered.
- If using a frame-less mask, a thermoplastic mask is placed over your face and a mold of your face is created. During the procedure, the mask is then secured to the Gamma Knife table and your head is held completely still. For patients wearing a frame-less mask, oral medication is given to relax the patient, but a local anesthetic is not given.
Either prior to, or just after, you are fitted with your head frame or mask, a magnetic resonance imaging (MRI) and/or computerized tomography (CT) scan will be performed. These scans will provide your physician with the most up-to-date mapping of your brain so that they can pinpoint the exact location of the target areas. Next, a computerized mapping of your treatment is planned out by your neurosurgeon/radiosurgeon and radiation oncologist, which can require up to a few hours to complete.
The treatment begins when radiation is delivered directly to the target area through openings inside the machine. The treatment phase can range in length from less than 30 minutes to a few hours. The treatment is painless. There is no heat or noise, nor will you feel any discomfort during the treatment.
When your treatment is complete, your head frame or mask and IV will be removed and discharge instructions will be reviewed with you. You will be asked to remain for observation for 30 minutes. It is recommended that someone stay with you the first night after treatment to monitor you for any side effects from the procedure.
After Treatment
What can I expect after treatment?
For most conditions, results of Gamma Knife® treatment develop over time, ranging from a few weeks to two years. Gamma Knife gradually affects the cells that make up tumors or lesions. Because of that, patients are often monitored with MRI and/or CT scans after surgery. Our multidisciplinary approach to care offers patients continued care after surgery, including further treatments, monitoring, and follow-up from our team of neurologists/neuro-oncologists, radiation oncologists and neurosurgeons.
Gamma Knife has proved to be a very effective means of controlling some tumors and other neurological disorders. Depending on the condition, success rates can be as high as 70 percent to 90 percent; however, there is no guarantee of individual results. Outcome depends on the size, location and type of lesion, as well as your personal medical history. You should discuss your expectations with your physician before treatment.
Appointments
How do I make an appointment?
To schedule an appointment with a Gamma Knife specialist, please call 216.636.0007 and select option 1.
Do you offer virtual visits?
If you are located in Ohio, you can receive an initial evaluation or follow-up care from a Cleveland Clinic specialist virtually. Established patients are also eligible for virtual follow-up care. Patients can use their phone, tablet or computer during a virtual visit. This means there's no travel or parking, less waiting and significant time savings. Call 216.636.0007 to schedule a virtual visit for you or a loved one and get details on cost and set-up instructions.
Virtual Second Opinion
If you cannot travel to Cleveland Clinic, we can still help! You can connect with Cleveland Clinic specialists from any location in the world via a phone, tablet, or computer, eliminating the burden of travel time and other obstacles through our Virtual Second Opinion program. If you’re facing a significant medical condition, this program provides virtual access to a Cleveland Clinic physician who will review your diagnosis and treatment plan. Following a comprehensive evaluation of medical records and labs, you’ll receive an educational second opinion from an expert that addresses your diagnosis, treatment options and alternatives, as well as recommendations regarding future therapeutic considerations. You’ll also have the unique opportunity to speak with the physician expert directly to address questions or concerns.
Patient Education and Support Services
Patients treated Cleveland Clinic’s Gamma Knife® Center can take advantage of all of the services the Taussig Cancer Center offers. In addition to state-of-the-art treatment, our team provides an array of resources that can help patients cope with the complexities of their condition. Patients are encouraged to take advantage of these resources.
Still have questions about Gamma Knife radiosurgery for brain and spine tumors?
If after reviewing this guide, you have additional cancer-related questions, Cleveland Clinic’s Cancer Answer Line can help. Our oncology clinical nurse specialists and their staff can provide information and answer questions about cancer. The Cancer Answer Line is operational from 8 a.m. - 5 p.m., ET, Monday - Friday. Please call toll-free 866.459.1874.
How can I access my records?
Cleveland Clinic MyChart® is a secure, online personal healthcare management tool that connects patients to their medical record. Patients can register for MyChart through their physician’s office or online.
Why Choose Us?
Cleveland Clinic’s multidisciplinary Neurological Institute is a nationally recognized leader in the diagnosis and treatment of primary and metastatic tumors of the brain, spine, and peripheral nerves and other conditions affecting the nervous system. Our team collaborates with the Taussig Cancer Institute to provide innovative solutions for these complex problems.
Experience by the Numbers
Our internationally recognized Gamma Knife radiosurgery program has:
- Offered > 25 years of Gamma Knife stereotactic radiosurgery
- Was the first in the U.S. to offer staged stereotactic radiosurgery and has done so for 10 years
- First in the U.S to offer Elekta’s Vantage frame, providing patients a more comfortable experience
- More than 35 surgeons, neuro-oncologists, radiation oncologists, physicists, radiation therapists and nurses who support our patients
- Performed more than 10,000 stereotactic radiosurgeries
- Treated more than 24,000 brain metastases
- Authored more than 390 peer-reviewed publications
Resources
How Can I Stay Connected with Cleveland Clinic?
- Explore our services, locations and more
- Patient Education and Support resources
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