This handout tells you what to expect before, during and after framed stereotactic radiosurgery. While reading it, highlight any parts that don’t make sense to you. Make a list of any questions you have. Bring this handout with you when you come for your clinic visit or your treatment. Your doctor or nurse will review it with you.
Framed Stereotactic Radiosurgery
Framed stereotactic radiosurgery may be used to treat many types of lesions or tumors in the brain, such as:
Brain tumors
Meningiomas
Vestibular schwannomas
Trigeminal neuralgia
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 targeted area while the normal brain tissue around it gets only a small dose of radiation. Because this treatment is so precise, a special frame is used to keep your head perfectly still.
Before Treatment
Preparing for Stay
Expect to be at the hospital for 10-14 hours the day of your treatment. Family members or a friend may come and be with you during the day.
Planning MRI
You will first have an MRI scan. This MRI will be used to plan your radiation treatment. It will feel the same as any other MRIs you may have had. If you’ve never had an MRI, please let your nurse know. You will be given a handout that describes it in detail.
Before your MRI, let the doctor or nurse know if you have:
Brain aneurysm clips
Implanted pumps
Chemotherapy ports
Neurostimulators
A pacemaker
An artificial heart valve
A defibrillator
Eye or ear implants
Stents, coils or filters
Allergies to IV contrast dye, shellfish or iodine
Claustrophobia (fear of being in enclosed spaces)
Medicines
Let your doctor or nurse know if you:
Have diabetes and are taking oral medicines or insulin.
Have been taking aspirin, ibuprofen (Motrin) or warfarin (Coumadin).
You may need to stop or adjust these medicines before treatment. Bring all medicines on the day of the procedure.
Night Before Treatment
Do not eat or drink anything after midnight the night before treatment. If you have prescribed oral medicines, take them with a small sip of water only, or as directed.
The Day of the Treatment
Getting Ready
After you arrive, you will change into a hospital gown. A nurse will place a small needle (IV) in your hand or arm to give medicines, if needed, and IV contrast dye.
Head Frame
A head frame is applied to your head by a neurosurgeon. The frame placement can cause some pain. A local anesthetic is used to numb 4 sites on your scalp (2 on the forehead and 2 in the back of your head) before the frame placement. This takes about 15-20 minutes.
CT Scan
After the frame is placed, you will have a CT scan. This will help pinpoint the exact place and size of the treatment area. It is also used for treatment planning. After the CT, you will wait in a comfortable area for the treatment. A television is available for your use. If you have never had a CT scan, please let the nurse know. You will be given a handout that describes it in detail.
Diet
You will be able to eat and drink after the CT scan. Please drink extra fluids the day of the treatment. Try to drink an extra 1-2 quarts of fluid. This will flush the dye from your system. You will be given a meal after the CT scan is done.
Treatment Planning
Your doctors (a neurosurgeon, radiation oncologist and physicists) start treatment planning. This takes about 3 to 4 hours. Late in the afternoon, you will be brought into the treatment room after planning is done.
Treatment
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 have other pain, such as back pain or discomfort from the head frame, please let your doctor or nurse know.
Your doctors, nurse, therapist who operates the treatment machine, and your physicist(s) who did the treatment planning, will be present during your treatment.
Once you are in place on the treatment table, all staff must leave the room while 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.
Afterwards, you will be taken to an exam room to have the head frame removed. Then, we will clean the pin sites and apply antibiotic ointment to these sites. You will be sent home shortly after that.
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 your diagnosis, the size and location of the lesion, underlying health problems, the dose of radiation used, and the amount of normal tissue treated. Most of the time, there are few immediate side effects.
Short-Term Risks
Brain swelling, which is treated with steroids (most common)
Nausea, which is controlled with medicine (rare)
Seizures, which can also be controlled with medicines (very rare)
Very little hair loss for most people
Long-Term Risks
There is some concern that, in a very few patients, long-term side effects could occur. Although serious, these are quite rare.
At worst, these side effects could include:
Damage of normal brain tissue leading to the loss of some brain function, causing:
Vision changes
Speech changes
Paralysis
Severe brain swelling which may require long-term steroid use
After the Treatment
You will be sent home with discharge instructions.
Transportation
Do not drive. Arrange for someone pick you up.
Fluids
The day of the procedure and the next day, please drink extra fluids to flush the IV contrast from your system.
Swelling
You may have some short-term swelling around both eyes. This is caused by the numbing medicine 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.
Starting the day after treatment, you can place cold cloths on your eyes to help reduce the swelling. Put the cloths on for about 20 minutes at a time, 3-4 times a day. Keep using the cold cloths for about 4 days after treatment.
Pain and Fatigue
You may have some pain, tenderness or numbness around the pin site areas for a few weeks. This is normal and should go away by itself.
You may feel a little tired for a day or two. You can be as active as you wish.
Medicines
If you are taking diabetes and/or anti-platelet medicines, you will be given special instructions about restarting them.
Pin Site Care
Keep the pin sites clean. You will be given antibiotic ointment. Put it on the pin sites for the first 2-3 days.
Do not wash your hair for at least 2-3 days after treatment or until the pin sites have healed.
If you are taking anti-platelet medicines, you may have bleeding from a pin site. If this occurs, place clean gauze on the pin site. Hold pressure.
Call the doctor on call, go to urgent care or an emergency room if you can’t get the bleeding to stop after 5-10 minutes.
When to Call
Call the clinic right away if you notice:
Increasing or severe headaches that are not relieved by Tylenol
Headaches that occur daily or several times a day, even if relieved by Tylenol
Headaches with nausea and vomiting
Nausea or vomiting
Numbness or tingling
Clumsiness or trouble moving a hand or leg
Vision, hearing or speech changes or problems
Trouble with balance, walking or dizziness
New onset of confusion
New seizures or worsening seizures
Who to Call
Radiotherapy Clinic
(608) 263-8500 or 1-800-323-8942
After hours, your call will transfer to the operator. Ask for the radiotherapy doctor on call. Give your name and phone number with area code. The doctor will call you back.