Gamma knife side effects

Contents

Treating a Brain Tumor With a Gamma Knife

It’s called a gamma knife, but there’s not a blade on it. This medical device, which involves no cutting at all, delivers radiation to a spinal cord or brain tumor with the intent of destroying the tumor cells.

Gamma Knife Surgery: What It Is and How It’s Done

Gamma knife surgery is a type of stereotactic radiosurgery, which is a form of radiation therapy that aims low-dose radiation beams, coming from all sides of the head, directly at the brain tumor. This results in a high dose of radiation at the center of the tumor, where the many radiation beams meet.

Gamma knife surgery uses three-dimensional imaging techniques to accurately target the tumor before the radiation is given. After taking MRIs (magnetic resonance imaging scans) and CT (computed tomography) scans, your treatment team will plan your treatment with gamma knife surgery.

After a plan is in place and before you receive the treatment, doctors will put a frame around your head to hold it still. To place the frame, your medical team will numb certain areas of your scalp and use tiny screws or pins to position the head frame in place. Wearing this frame, your head is then placed inside a clear helmet which has small holes through which the radiation beams are directed at the brain tumor.

Gamma Knife Surgery: Is It for You?

Gamma knife surgery is particularly effective for people whose tumors are:

  • Localized
  • Three centimeters or less in diameter
  • Either benign (non-cancerous) or malignant (cancerous)

If you have a spinal cord or brain tumor, talk with your doctor about whether gamma knife surgery is an option for you. Before your medical team makes a decision, team members will carefully review the results of CT and MRI scans, positron emission tomography (PET) scans, cerebral angiography, and other tests.

Benefits of Gamma Knife Surgery

There are many benefits of gamma knife surgery, including:

  • It is extremely accurate. Because the gamma knife so precisely targets the brain tumor, areas outside of the tumor are not exposed to much radiation, which can reduce the risk of side effects and damage to nerves and blood vessels in surrounding areas of the brain.
  • No incision is required. Since gamma knife surgery is actually not a surgery but a form of radiation therapy, no incision is made and general anesthesia is not required. Therefore, the risks associated with skull incisions and general anesthesia can be avoided.
  • Only one treatment is needed. It usually takes just one 10-minute to 70-minute procedure to deliver radiation with the gamma knife.
  • It works. There is evidence that treatment of certain malignant brain tumors with gamma knife surgery can increase a patients’ lifespan.

Risks of Gamma Knife Surgery

Potential risks and side effects of gamma knife surgery include:

  • Tenderness where the screws or pins were placed
  • Nausea and vomiting
  • Dizziness
  • Headaches
  • Hair loss where the radiation was directed
  • Damage to surrounding tissues in the brain, caused by swelling. These effects may be delayed, and may cause symptoms mimicking a stroke or a recurrence of tumor

Gamma Knife Surgery: Preparation

To prepare for gamma knife surgery:

  • Stop taking certain medications before your procedure, as directed by your medical team.
  • Take all medications prescribed by your medical team, which may include steroids and anti-seizure drugs.
  • Follow your medical team’s instructions regarding what to eat and drink in the days leading up to your procedure.
  • Wash your hair the night before your procedure, if your doctor recommends it.
  • Arrange to have someone drive you home after your procedure.

In most cases, you will be able to go home the same day of your gamma knife surgery.. Follow your doctor’s instructions regarding how to care for yourself after the procedure. You will most likely be able to resume your normal activities within a couple of days. Contact your medical team if you have any questions, and attend follow-up appointments as directed.

Gamma Knife® Radiosurgery

Gamma Knife radiosurgery is one of the most precise, powerful, and proven treatments for brain disorders. This painless procedure uses hundreds of highly focused radiation beams to target tumors and lesions within the brain.

With no surgical incision required, Gamma Knife radiosurgery is especially useful when conventional surgical procedures pose a high risk for patients.

Pioneers in Gamma Knife Treatment

UPMC installed the first North American Gamma Knife in 1987 and subsequently introduced and pioneered each succeeding generation of technological improvement. Over its 30-year history at UPMC, Gamma Knife radiosurgery has proved effective for more than 15,000 patients with:

  • Benign or malignant brain tumors
  • Vascular malformations
  • Pain
  • Other functional problems

Today, the Center for Image-Guided Neurosurgery at UPMC is the nation’s leading provider of Gamma Knife procedures, and is a major teaching center for neurosurgeons, radiation oncologists, and medical physicists from around the globe.

Gamma Knife Icon®

UPMC is the first hospital in the region and one of the first in the nation to use the most advanced generation of Gamma Knife radiosurgery – the Gamma Knife Icon. The system allows for a frame-based or frameless approach to radiosurgery, providing surgeons with more options when treating complex neurological conditions.

Icon’s cutting-edge technology uses radiological images to target areas in the brain more precisely than ever, and it uses dosage control and motion management systems to ensure treatment is administered with extreme accuracy.

Conditions We Treat With Gamma Knife Radiosurgery

Our experts in Gamma Knife radiosurgery are able to treat an array of brain disorders.

Brain Tumors

Results After Gamma Knife Treatment: Treatment damages the genetic material in the tumor’s cells, resulting in their inability to reproduce. Following treatment, the cells die and the tumor may gradually shrink.

Arteriovenous Malformation

Results After Gamma Knife Treatment: Treatment causes blood vessels in the AVM to thicken and close.

Trigeminal Neuralgia

Results After Gamma Knife Treatment: After treatment, a lesion gradually forms in the nerve and blocks the transmission of pain signals along the nerve.

Acoustic Neuroma

Results After Gamma Knife Treatment: Treatment can reduce the size or limit the growth of the tumor with little risk of permanent nerve damage.

Pituitary and Skull Base Tumors

Results After Gamma Knife Treatment: Treatment can shrink the tumor and lessen the disruption of pituitary hormone regulation.

How Gamma Knife Radiosurgery Works

  • Before the procedure, a team of our Gamma Knife experts creates a detailed of your brain, precisely pinpointing the tumor or lesion.
  • During the procedure, a focused, custom-designed dose of radiation targets only the diseased tissue, leaving the surrounding healthy tissue intact.
  • Generally, patients only need one radiation treatment to begin experiencing gradual improvements in their condition, over the course of a few months.

Gamma Knife Radiosurgery
Dr. L. Dade Lunsford discusses Gamma Knife Radiosurgery.

FAQS

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:

Early Complications

  • 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:

Uncommon:

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?

Benefits Include:

  • 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.

DISCUSSION

The role of radiosurgery has been gaining importance as a primary or adjuvant treatment modality for meningiomas and many authors have reported excellent outcome for meningiomas treated with GKS.1,3–6,8,10–,19 We identified peritumorous imaging changes on MRI after GKS in 23.6% of lesions. Most of these did not exhibit any symptoms, and all of the symptomatic patients (9.3%) completely recovered. The detailed mechanism and pathophysiology of perilesional imaging changes after radiosurgery are unclear. Most peritumorous imaging changes are believed to be attributable to vasogenic oedema. Whether this is attributable to vascular endothelial growth factor (VEGF)/vascular permeability factor (VPF), an angiogenic growth factor present in most meningiomas,20–,24 or radiation injury to the vasculature is unknown.

There have been many reports about the risk factors for oedema development after radiosurgery. Kalapurakal et al reported that parasagittal location, presence of pretreatment oedema, sagittal sinus occlusion, and radiation doses above 6 Gy per fraction, were significant risk factors for oedema development after radiation therapy.25 In a multicentre review, Kondziolka et al identified 18 of 185 patients with symptomatic oedema that required treatment after GKS.3 They suggested that the presence of a pre-GKS neurological deficit was the most important factor for subsequent symptomatic oedema and that the tumour margin dose was not related to onset of oedema after GKS. Several groups have also reported that non-skull base meningiomas have a higher risk of peritumorous oedema after GKS.8,17,26 Ganz et al suggested that oedema developed preferentially in non-basal tumours, especially those around the midline and sagittal sinus and in cases with a margin tumour dose more than 18 Gy.17 Besides the factors described above, patient age, histological finding, tumour growth, oestrogen and progesterone receptor positivity, and presence of secretory and excretory granules by electron microscopy were suggested as possible risk factors for peritumorous oedema.18,25,26

In our study, post-GKS peritumorous imaging changes developed mostly in cerebral hemispheric meningiomas of the convexity, parasagittal region, or falx cerebri. In univariate analysis, tumour location (skull base or cerebral hemisphere), maximum tumour dose, and tumour margin dose were correlated with the occurrence of imaging changes after GKS. However, in multivariate analysis tumour location was the only significant factor. Other factors reported as significant by other investigators, such as pre-existing oedema, occlusion of venous sinus, or patient age, did not influence the occurrence of imaging changes after GKS.

The influence of tumour location on the rate of occurrence of imaging changes—that is, peritumorous oedema, seems to be related to the different growth patterns of skull base and hemispheric meningiomas (fig 4⇓). While skull base meningiomas spread laterally along the cistern, maintaining a wide base on the dura at the base of the skull, cerebral hemispheric meningiomas are embedded in the brain, and, therefore, have a wider contact area with the brain parenchyma than skull base meningiomas. Unlike skull base meningiomas, which are surrounded by cisterns, hemispheric meningiomas lack any intervening arachnoid or cerbral spinal fluid barrier between the tumour and cortical surface. Therefore, the brain parenchyma surrounding hemispheric meningiomas seems to be more easily affected by the oedema fluid.

Figure 4

Difference of growth pattern between skull base meningiomas and cerebral hemispheric meningiomas. While the first usually expand laterally along cisterns, the second such as convexity, parasagittal, and falx meningiomas grow deeply embedding into the cortex.

GKS has played an important part in the treatment of skull base meningiomas, because the surgical approach carries a high risk of complications and recurrence.1,4–6,9–15,26 Skull base meningiomas were over-represented in our study of GKS treated meningiomas (57.7%), compared with their prevalence in the whole meningioma population. There are many cranial nerves and critical structures around the skull base, especially the cavernous sinus, and careful dose planning is required.6,12,14,15,27

The most critical structure is the optic pathway, which many authors believe tolerates a radiation dose of less than 8 to 10 Gy.4,6,14,27,28 Girkin et al reported that optic neuropathy developed 7 to 30 months after GKS for perichiasmal tumours as an abrupt change in the visual field to a homonymous hemianopic defect.29 MRI showed swelling and contrast enhancement of the affected portion of the visual apparatus. They suggested that risk factors for the development of radiation optic neuropathy after GKS included dose to the optic apparatus of greater than 8 Gy, previous conventional radiation therapy, pre-existing anterior visual pathway dysfunction secondary to previous surgery or tumour compression, treatment plans based on computed tomography rather than MRI, large tumour volume, and treatment isocentres within 5 mm of the anterior visual pathways. Kondziolka et al insisted that only a 1 mm gap between tumour margin and the chiasm might be necessary, if this proximity occurred only at one point, as verified with current high resolution imaging techniques.4 Another report suggested that even more than 10 Gy was safe for the optic apparatus.12 However, we believe that the radiation dose to the optic pathway should not exceed 10 Gy. In our studies, the dose to the optic pathway was less than 9.6 Gy and there were no visual complications. Recent advances in neuroradiological imaging and radiosurgical technique have permitted effective and safe control for tumours with a closer contact to the optic pathway.6

Beyond the optic pathway, attention also should be paid to the radiation dose to the cranial nerves running along the wall of the cavernous sinus, Meckel’s cave, hypothalamus, pituitary gland and stalk, and brain stem.6,12,14,27,28 We previously suggested the optimal radiation dose for critical juxtasellar structures.27 While 48 patients with radiosurgically treated juxtasellar tumours with a dose of less than 16 Gy to the cavernous sinus had no cranial nerve deficits, two other patients with a dose of more than 16 Gy experienced cranial nerve dysfunction. In this study, both of the patients with transient cranial nerve dysfunctions, received more than 16.0 Gy to the cranial nerves.

While 12 Gy to 15 Gy has been recommended as the minimal dose for the meningioma margin,6,8,12,15,17 low dose radiosurgery has been tried by several groups to avoid complications associated with radiation therapy.8,10,19 While a lower dose may be sufficient for effective tumour control with decreased complication rate, the follow up durations of these low dose radiosurgery studies are comparatively short. The minimal dose for tumour margin remains controversial and longer follow up studies are needed.

In our study, we identified four failed cases of meningioma after GKS. One patient had undergone GKS for a residual convexity meningioma after surgical resection. The tumour had nearly disappeared three years after GKS, but recurred on follow up MRI taken at seven years after GKS. The recurrence was thought to arise from the peritumorous dural extension not included within a proper isodose curve. We believe it is essential to irradiate the peritumorous dural extension optimally to achieve long term tumour control.

In conclusion, GKS for intracranial meningiomas is a safe and effective form of primary or adjuvant treatment after incomplete surgical resection. However, patients with cerebral hemispheric meningiomas of convexity, parasagittal region, or falx cerebri have a higher incidence of peritumorous imaging changes after GKS than those with skull base meningiomas. These imaging changes are probably explained by postradiosurgical peritumorous oedema. Therefore, patient age and general condition, tumour size and location, pattern of cortical embedding, relation between the tumour and venous sinuses, presenting symptoms and patient preference need to be considered when treating hemispheric meningiomas with GKS.

Roswell Park is now treating patients with a brand-new, state-of-the-art Gamma Knife radiosurgery device, the Leksell Gamma Knife® Icon™ — the most advanced technology of its kind on the market.

Roswell Park is the first cancer center in the United States to receive a license to operate it and remains the only facility in Western New York with Gamma Knife capabilities. We have used Gamma Knife radiosurgery to treat patients with brain tumors and metastases for 20 years. This latest technology comes with certain advances that mean more patients may qualify as candidates for the treatment, and the ultra-high accuracy minimizes long-term side effects, improving outcomes. Roswell Park’s Gamma Knife program has treated nearly 6,300 patients.

Today, more than two years later, I have no regrets at all. My decision to seek care at Roswell Park was an all-around, complete win. Of all the treatments I’ve been through, Gamma Knife radiosurgery was the least invasive. Read our blog on how Roswell Park’s Gamma Knife Icon frameless technology made all the difference for one patient. In November 2018, Roswell Park celebrated the 20th anniversary of the Gamma Knife program. In 2017, Roswell Park saw the highest volume in the U.S. for a single Gamma Knife device, treating 540 patients.View a larger infographic.

What is Gamma Knife Radiosurgery?

Gamma Knife radiosurgery isn’t a knife at all, but a type of extremely precise and sharply focused radiation therapy that treats cancer tumors and lesions in the brain. The precision of the tool is “surgical,” but there’s no cutting, no incisions, and no requirement for anesthesia. Patients are awake and go home after the treatment, resuming normal activities.

The minimally invasive treatment uses a unique technology that produces 192 intersecting beams of gamma radiation. The individual beams pass through the body without causing damage — preserving healthy brain tissue — until the point where they intersect, destroying cancer cells.

Who Can Receive Gamma Knife Treatment?

Patients with many brain tumors, brain metastases and select brain disorders. Conditions treated with Gamma Knife at Roswell Park include:

The Leksell Gamma Knife® Icon™ offers new treatment options for patients with inoperable tumors that are close to critical parts of the brain.

  • Metastatic brain tumors and lesions arising from primary tumors of the breast, kidney, colon, skin (melanoma), uterus or other organs
  • Brain tumors, malignant or benign, including:
    • Meningiomas
    • Gliomas (glioblastoma, astrocytoma, oligodendroglioma)
    • Craniopharyngiomas
    • Hemangioblastomas
  • Pituitary adenomas
  • Trigeminal neuralgia/tic douloureux
  • Arteriovenous malformation
  • Acoustic neuroma (vestibular schwannoma)
  • Essential tremor and other movement disorders

Advantages of the New Gamma Knife

New Option for Recurrent Tumors

Recurrent tumors of the skull base and head can now be treated with Gamma Knife, offering a new therapeutic approach to patients.

  • Better accuracy. Targets larger tumors with accuracy to within .15 mm, compared to other techniques such as Linac Stereotactic Radiosurgery.
  • Real-time dose confirmation. Integrated cone-beam CT imaging and software continuously control radiation dose delivery. If the patient moves out of the target area, treatment automatically stops.
  • Frameless fixation. The new device can accommodate frameless techniques (such as a molded face mask) rather than a frame (rigid metal device affixed to the skull) to hold the patient’s head in position.
  • Fractionated treatment delivery. The frameless method enhances our ability to fractionate treatment across multiple sessions, allowing for a higher and more effective overall maximum dose to be delivered more safely and with fewer side effects — even for larger tumors, and tumors close to critical structures.
  • Maximizes patient comfort options while maintaining the guaranteed accuracy expected from the Gamma Knife, making it the gold standard for cranial radiosurgery.

Dheerendra Prasad, MD M-CH, Professor of Neurosurgery and Radiation Oncology and Director of Roswell Park’s Gamma Knife Center, has treated more than 9,000 patients with Gamma Knife and serves as an onsite advisor to institutions around the world training to use Gamma Knife and is a pioneer in the use of the Icon.

Improving Outcomes and Quality of Life

Gamma Knife provides a highly favorable approach to treating the brain compared to next-best methods such as conventional neurosurgery, standard whole-brain radiation therapy (WBRT) and Intensity Modulated Radiation Therapy (IMRT).

At facilities and hospitals without Gamma Knife capability, patients with brain tumors and metastases would likely undergo WBRT. This approach involves radiating the brain in such a way that exposes all brain tissues to the potentially damaging effects of radiation. With Gamma Knife radiosurgery, only 0.5% of the brain is radiated, preserving significantly more healthy brain tissue and brain function down the road, improving both medical outcomes and quality of life for patients.

Brain Tumor Warning Signs and Symptoms You Should Know

Symptoms of brain tumors vary depending on the type, size, and exact location in the brain. Following are some general signs and symptoms.

Headache changes

Worsening headaches are a common symptom, affecting about 50 percent of people with brain tumors.

A tumor in the brain can put pressure on sensitive nerves and blood vessels. This may result in new headaches, or a change in your old pattern of headaches, such as the following:

  • You have persistent pain, but it’s not like a migraine.
  • It hurts more when you first get up in the morning.
  • It’s accompanied by vomiting or new neurological symptoms.
  • It gets worse when you exercise, cough, or change position.
  • over-the-counter pain medicines don’t help at all.

Even if you’re getting more headaches than you used to, or they’re worse than they used to be, it doesn’t mean you have a brain tumor. People get headaches for a variety of reasons, from a skipped meal or lack of sleep to concussion or stroke.

Seizures

Brain tumors can push on nerve cells in the brain. This can interfere with electrical signals and result in a seizure.

A seizure is sometimes the first sign of a brain tumor, but it can happen at any stage. About 50 percent of people with brain tumors experience at least one seizure.

Seizures don’t always come from a brain tumor. Other causes of seizures include neurological problems, brain diseases, and drug withdrawal.

Personality changes or mood swings

Tumors in the brain can disrupt brain function, affecting your personality and behavior. They can also cause unexplained mood swings. For example:

  • You were easy to get along with, but now you’re more easily irritated.
  • You used to be a “go-getter,” but you’ve become passive.
  • You’re relaxed and happy one minute and, the next, you’re starting an argument for no apparent reason.

These symptoms can be caused by a tumor in:

  • certain parts of the cerebrum
  • the frontal lobe
  • the temporal lobe

These changes can occur early on, but you can also get these symptoms from chemotherapy and other cancer treatments.

Personality changes and mood swings can also be due to mental disorders, substance abuse, and other disorders involving the brain.

Memory loss and confusion

Memory problems can be due to a tumor in the frontal or temporal lobe. A tumor in the frontal or parietal lobe can also affect reasoning and decision-making. For example, you may find that:

  • It’s hard to concentrate, and you’re easily distracted.
  • You’re often confused about simple matters.
  • You can’t multitask and have trouble planning anything.
  • You have short-term memory issues.

This can happen with a brain tumor at any stage. It can also be a side effect of chemotherapy, radiation, or other cancer treatments. These problems can be exacerbated by fatigue.

Mild cognitive problems can happen for a variety of reasons other than a brain tumor. They can be the result of vitamin deficiencies, medications, or emotional disorders, among other things.

Fatigue

Fatigue is more than feeling a little tired once in a while. These are some signs that you’re experiencing true fatigue:

  • You’re completely exhausted most or all of the time.
  • You feel weak overall and your limbs feel heavy.
  • You often find yourself falling asleep in the middle of the day.
  • You’ve lost your ability to focus.
  • You’re irritable and out of sorts

Fatigue can be due to a cancerous brain tumor. But fatigue can also be a side effect of cancer treatments. Other conditions that cause fatigue include autoimmune diseases, neurological conditions, and anemia, to name just a few.

Depression

Depression is a common symptom among people who have received a diagnosis of a brain tumor. Even caregivers and loved ones can develop depression during the treatment period. This can present as:

  • feelings of sadness lasting longer than what seems normal for the situation
  • loss of interest in things you used to enjoy
  • lack of energy, trouble sleeping, insomnia
  • thoughts of self-harm or suicide
  • feelings of guilt or worthlessness

Suicide prevention

  • If you think someone is at immediate risk of self-harm or hurting another person:
  • •  Call 911 or your local emergency number.
  • •  Stay with the person until help arrives.
  • •  Remove any guns, knives, medications, or other things that may cause harm.
  • •  Listen, but don’t judge, argue, threaten, or yell.
  • If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.

Nausea and vomiting

You might have nausea and vomiting in the early stages because a tumor is causing a hormone imbalance.

During treatment for a cancerous brain tumor, nausea and vomiting could be side effects from chemotherapy or other treatments.

Of course, you can experience nausea and vomiting for a variety of other reasons, including food poisoning, influenza, or pregnancy.

Weakness and numbness

A feeling of weakness can happen just because your body is fighting the tumor. Some brain tumors cause numbness or tingling of the hands and feet.

This tends to happen on only one side of the body and could indicate a tumor in certain parts of the brain.

Weakness or numbness can be side effects of cancer treatment, too. Other conditions, such as multiple sclerosis, diabetic neuropathy, and Guillain-Barre syndrome can also cause these symptoms.

Brain tumours

Long term problems after brain surgery

Some people recover well after brain surgery, but this can take some time. Other people have some problems, or long term difficulties.

The problems you may have depends on the area of the brain where the tumour was (or still is if you only had part of the tumour removed). Problems might include:

  • difficulty walking
  • weakness on an arm or leg
  • difficulty concentrating or remembering things
  • behaviour changes
  • problems with speech

Going back to work

Depending on your job and the problems you might have, it can be hard for you to go back to work immediately after having brain surgery. For example, if you have a job where your mental skills are very important, or if you operate heavy machinery. This can be very difficult to accept and adjust to.

We have more information about going back to work after treatment for a brain tumour.

Support for you

Depending on the problems you have, you might get help and support from different healthcare professionals.

Physiotherapists

Physiotherapists can make you an exercise plan to help you improve your fitness level.

Speech and language therapists

They can help people with speech and swallowing problems.

Occupational therapists

Can assess you and help you find ways to manage your day to day to life. For example, they can get equipment for your house such as rails for stairs.

For support and information, you can call the Cancer Research UK information nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday. They can give advice about who can help you and what kind of support is available.

What are the early symptoms of a brain tumor?

Brain tumor symptoms are similar regardless of whether they are cancerous (malignant) or noncancerous (benign).

They may differ depending on the type, location in the brain, and the stage of the tumor.

Some of the most common symptoms of a brain tumor include:

  • headaches
  • seizures
  • changes in personality
  • vision problems
  • memory loss
  • mood swings
  • tingling or stiffness on one side of the body
  • loss of balance
  • nausea
  • fatigue
  • anxiety or depression
  • difficulty concentrating
  • difficulty communicating as usual
  • feeling confused or disorientated
  • loss of coordination
  • muscle weakness

Primary brain tumors are tumors that begin in the brain.

In the sections below, we look at several types of brain tumor and their specific symptoms:

Meningioma

Roughly one-third of primary brain tumors are meningiomas. They are usually benign and slow growing.

They grow from tissue covering the brain and spinal cord and create pressure on these areas.

Meningiomas are rare in children and most common in women over the age of 60.

Symptoms of meningioma can include:

  • headaches
  • weakness in the arm or leg
  • seizures
  • changes in personality
  • vision problems

Glioblastoma

Glioblastomas are malignant tumors. They can be fast growing and require more intensive treatment.

According to the American Brain Tumor Association, healthcare providers assign a grade to tumors depending on how abnormal the cells they contain are.

Grade 1 tumors are the least malignant and grade 4 are the most malignant. Glioblastomas are grade 4 tumors.

Glioblastomas create pressure on the brain, and symptoms include:

  • nausea and vomiting
  • headaches, which may be more intense in the morning
  • weakness in the body, such as in an arm, a leg, or the face
  • difficulty balancing
  • problems with memory
  • seizures

Astrocytoma

Share on PinterestHeadaches, memory loss, and seizures are all early symptoms of astrocytomas.

Astrocytomas are brain tumors that grow from cells called astrocytes, which make up brain tissue.

They can range from grade 1 to 4, with grade 1 tumors being slower growing than grade 4 tumors.

Some of the early symptoms for astrocytoma include:

  • headaches
  • memory loss
  • seizures
  • changes in behavior

Craniopharyngioma

A craniopharyngioma is a benign tumor that develops close to the pituitary gland. It is much more common in children than adults. Medulloblastoma and ependymomas are also more common among children.

The tumor creates pressure on the pituitary gland and optic tract, which is an extension of the optic nerve. This can cause the following symptoms:

  • delay in development
  • obesity
  • vision problems due to a swollen optic nerve
  • hormone problems

Pituitary tumors

Pituitary tumors develop in the pituitary gland and affect hormone levels. They tend to be more common in women and make up 9–12% of all primary brain tumors.

They are slow growing, though larger tumors can create pressure on surrounding areas of the brain. These tumors can secrete pituitary hormones and cause additional symptoms.

According to the American Cancer Society, tumors that start in the pituitary gland are almost always noncancerous.

Symptoms of pituitary tumors include:

  • headaches
  • vision problems
  • changes in behavior
  • changes in hormone levels

Metastatic

Metastatic brain tumors, or secondary brain tumors, form in other parts of the body where cancer is present and move to the brain through the bloodstream.

Metastatic brain tumors present the same symptoms as primary brain tumors, with the most common symptoms being:

  • headaches
  • seizures
  • short term memory loss
  • changes in personality or behavior
  • weakness on one side of the body
  • balance difficulties

An Overview of Gamma Knife: Risks, Side Effects & Recovery

What To Expect After Gamma Knife Radiosurgery

Though your recovery will depend on the size and location of the area being treated, along with your individual health factors, it can be helpful to have a general understanding of what most patients experience following Gamma Knife radiosurgery. Simply knowing what to expect after Gamma Knife radiosurgery can help you feel more at ease with the entire process.

Immediately After Your Gamma Knife Procedure

Gamma Knife radiosurgery is an outpatient procedure, which means you do not have to stay in the hospital overnight. You will be awake throughout treatment, so you will not need to spend any time recovering from anesthesia. Most patients are released to return home within a few hours of the completion of treatment, which can range from 15 minutes to more than an hour.

During this time, if you received treatment requiring the use of a positioning frame, you may have a little bleeding or soreness at the site of the pins. If you have a headache or nausea, your doctor may give you medication to make you more comfortable. You should be able to resume all normal activities within a day or so.

In the Days After Your Procedure

For the first few days following your treatment, you may feel more fatigued than usual. Your body will need a little time to recover, so be sure you get plenty of rest and give yourself a chance to heal. Some patients experience swelling or discomfort at the site of treatment, which will typically resolve within the first week.

Even if you did not experience a headache or nausea immediately following your Gamma Knife procedure, you may start to feel discomfort after a short delay. Should this be the case, be sure you let your doctor know so she can prescribe you medications if necessary.

In the Months After Your Procedure

Some patients treated using Gamma Knife radiosurgery to the head will experience swelling of the brain approximately six months following treatment. This Gamma Knife risk is managed using medication, and neurological problems following treatment are rare.

You may also be undergoing additional treatments during this time. Though many patients benefit from a single session of Gamma Knife radiosurgery, some conditions will require multiple treatments, depending on the size, location and nature of the area being treated.

Long-term Maintenance After Your Procedure

Regardless of your condition, you can expect to have follow-up visits and monitoring with your doctor following your Gamma Knife radiosurgery. You may need to undergo follow-up imaging, additional treatments or even attend physical therapy to assist in the recovery process. Your doctor will be able to give you a more specific idea of what you can expect in the long term for your individual condition and situation.

Rest Easy Before Your Procedure

Knowing more about your condition and upcoming treatment is a great way to play an active role in your healthcare. Having a better understanding allows you to have more meaningful conversations with your doctor and can give you an idea of what to expect before, during and after your treatment.

Keep in mind throughout this process that your doctor has taken into consideration the Gamma Knife risks and benefits as they relate to your specific circumstances. Before making any treatment recommendation, your doctor must be confident that the benefits outweigh the risks and that the procedure is the appropriate choice for you. Rest easy with this knowledge, and focus on what matters most during this time: your recovery.

Gamma Knife Radiosurgery FAQ

  • What is the Leksell Gamma Knife®?
  • How does the Gamma Knife work?
  • What are the benefits of Gamma Knife Radiosurgery?
  • What if I am older or have other medical conditions?
  • What conditions can be treated by the Gamma Knife?
  • How are patients referred for Gamma Knife treatment?
  • What information is used to determine if Gamma Knife treatment is appropriate?
  • Is Gamma Knife treatment effective?
  • What happens during Gamma Knife treatment?
  • What will I feel during Gamma Knife treatment?
  • Will I be awake during the procedure?
  • Will my head be shaved?
  • What can I expect after treatment?
  • Is Gamma Knife treatment safe?
  • How quickly will the treatment work?
  • What are the complications of Gamma Knife treatment?
  • When can I return to my normal activities?
  • Is Gamma Knife treatment more or less expensive than traditional brain surgery?
  • Will my insurance cover this procedure?

What is the Gamma Knife®?

The Gamma Knife is not actually a knife at all. It is a stereotactic radiosurgical device that non-invasively treats malignant and benign brain tumors, vascular malformations and trigeminal neuralgia in a single patient visit. Patients are treated on an out-patient basis or may require an overnight hospital stay.
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How does the Gamma Knife work?

Utilizing advanced diagnostic imaging and three-dimensional treatment planning software, Gamma Knife delivers 201 precisely focused beams of gamma radiation to small targets inside the brain. Radiation is only delivered at a single, finely focused point where all 201 beams converge to treat the diseased tissue, while nearby healthy tissue is spared.
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What are the benefits of Gamma Knife Radiosurgery?

Gamma Knife treatment has many benefits. It is bloodless, virtually painless, no loss of hair and rapid return to pre-treatment activities. Gamma Knife treatment also has excellent, well-documented clinical outcomes for a variety of brain diseases and disorders. This single day procedure is usually covered by most major health insurance companies and Medicare. Due to these benefits, Gamma Knife treatment may replace traditional surgery or radiation therapy, where deemed appropriate by the treatment physicians. However, Gamma Knife treatment is also often used in conjunction with traditional surgery and radiation.
In some cases, Gamma Knife treatment may replace brain surgery or other traditional treatment methods in some patients with brain tumors, vascular malformations and facial pain. An individual who would be at risk for complications from conventional surgery may be a candidate for Gamma Knife radiosurgery. Gamma Knife treatment can be used when prior surgery or radiation therapy has failed to control the disease process. It can also be used in conjunction with conventional surgery in previously inoperable cases, with other forms of radiation therapy and chemotherapy.
While Gamma Knife radiosurgery is a form of radiation treatment, it has several differences from conventional radiation therapy for the brain. Gamma Knife treatment is only directed to targeted areas and spares unnecessary treatment of adjacent, normal brain tissue. Only a one-day treatment is required rather than many treatments over several weeks, and the treatment often can be repeated if necessary. Gamma Knife can also be used in combination with other forms of radiation therapy.
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What if I am older or have other medical conditions?

Gamma Knife radiosurgery is especially valuable for patients whose neurological disorders require a difficult surgical approach or may be impossible to treat using conventional neurosurgical techniques. Patients of advanced age or in poor medical condition can be at an unacceptably high risk for anesthesia and conventional surgery, making Gamma Knife treatment an ideal solution. Gamma Knife technology also is highly beneficial for patients whose lesions are situated in an inaccessible or functionally critical area within the brain. In addition, the treatment can be used as an adjunct to the care of a patient who has undergone conventional brain surgery, interventional neuroradiology or conventional radiation therapy or chemotherapy.
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What conditions can be treated by the Gamma Knife?

Conditions that can be treated by the Gamma Knife include:

  • Malignant tumors such as:
    • Metastases (cancer that has spread to the brain)
    • Malignant gliomas
  • Benign tumors such as:
    • Meningiomas
    • Acoustic neuromas (vestibular schwannomas)
    • Pituitary tumors
    • Low-grade glioma and skull-based tumors
  • Vascular malformations such as:
    • Arteriovenous malformations (AVMs)
    • Cavernous angiomas (cavernous malformations)
  • Functional disorders such as:
    • Trigeminal neuralgia

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How are patients referred for Gamma Knife treatment?

Most patients are referred to the Gamma Knife program by their doctors. However, some make self-referrals. The Gamma Knife team reviews each patient’s records to determine if Gamma Knife treatment would be advantageous for each patient.
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What information is used to determine if Gamma Knife treatment is appropriate?

The Gamma Knife team uses the following information to make its recommendations:

  • Medical and surgical history
  • Clinical examinations
  • Imaging studies, such as MRI, CT and/or PET scans

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Is Gamma Knife treatment effective?

The Gamma Knife’s success rate is impressive. Supported by more than two decades of clinical research, this neurosurgical tool has met with unprecedented results. Clinical applications continue to grow, and its many benefits as a non-invasive treatment modality continue to make it the treatment of choice for certain clinical conditions.
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What happens during Gamma Knife treatment?

First, a lightweight frame is attached to the patient’s head. Local anesthesia is used before the frame is secured in place. The patient then has an MRI imaging study or, in the case of an arteriovenous malformation, angiography, may be needed in order to precisely locate the diseased area. Data from the imaging study is transferred into the sophisticated treatment planning computer. While the patient rests, the treatment team (a neurosurgeon, radiation oncologist and physicist) uses advanced software to determine the treatment plan. This planning usually takes one or two hours to complete, depending on the complexity and location of the disease. When the individual treatment plan is completed, the patient is placed on the Gamma Knife couch and precisely positioned. The patient is then moved automatically, head first into the machine, and treatment begins. Treatment typically lasts from 15 minutes to over an hour, depending upon the complexity of the case and location of the target. The patient does not feel or see the treatment. Following treatment, the patient is automatically moved out of the machine, and the head frame is removed.
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What will I feel during Gamma Knife treatment?

During the actual treatment, the patient feels nothing unusual. The patient does not see or feel the radiation during treatment. Prior to the actual treatment, patients typically feel slight discomfort from the local anesthetic used when placing the head frame, and some patients have reported feeling pressure for a short time while the pins are inserted to fixate the head frame- but no pain is experienced during the treatment process.
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Will I be awake during the procedure?

The patient remains conscious throughout the entire procedure and may communicate with the treatment team.
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Will my head be shaved?

No, the head is not shaved. In rare cases the treatment may cause some hair loss.
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What can I expect after treatment?

When the treatment is finished, the head frame will be removed. Sometimes there is a little bleeding from where the pins were placed on the head. In this case, gauze and pressure will be applied to stop the bleeding and keep the area clean. A temporary head dressing is placed to keep the pin sites clean. It is recommended that the patient take it easy over the next 12 to 24 hours. Pre-Gamma Knife activities can be resumed within a few days.
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Is Gamma Knife treatment safe?

The Gamma Knife allows non-invasive brain surgery to be performed with extreme precision while sparing healthy tissues surrounding the targeted treatment area. Also, because neither a surgical incision nor general anesthesia is required, the risks usually involved with open brain surgery, such as hemorrhage or infection, may be reduced. Hospitalization is rarely required and recovery time is minimal. While individual patient outcomes may vary, patients may resume their normal pre-surgery lifestyle within a few days.
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How quickly will the treatment work?

The effects of Gamma Knife radiosurgery occur over several days to several years, depending on the type of medical condition treated. The radiation alters the DNA of the tumor or lesion being treated so that the cells no longer reproduce, eventually rendering the lesion static. Some abnormalities dissolve gradually, eventually disappearing. Others simply exhibit no further growth. The effectiveness of the treatment is monitored by MRI scans at regular intervals. The goal of radiosurgery is tumor control, which is defined as stable tumor size or tumor shrinkage. For vascular malformations, control is generally considered total obliteration.
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What are the complications of Gamma Knife treatment?

Early complications may include:

  • Common side effects:
    • Local pain and swelling in the scalp
    • Headache
  • Rare complications:
    • Skin reddening and irritation
    • Nausea
    • Seizure

Delayed complications may include:

  • Uncommon complications:
    • Local loss of hair in superficial lesions
    • Local brain swelling in the treatment site
    • Local tissue necrosis in the treatment site
  • Rare complications:
    • Visual loss (dependent on diagnosis and areas treated)
    • Hearing loss (dependent on diagnosis and areas treated)

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When can I return to my normal activities?

Within a few days. The only restrictions you will have are the same you had prior to your treatment.
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Is Gamma Knife treatment more or less expensive than traditional brain surgery?

Cost studies have shown Gamma Knife radiosurgery to be less expensive than conventional neurosurgery because it eliminates lengthy post-surgical hospital stays, expensive medication and potentially months of rehabilitation. Importantly, there are virtually no post-surgical disability and convalescent costs with this procedure.
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Will my insurance cover this procedure?

Gamma Knife radiosurgery is reimbursed by most insurance companies, PPOs, HMOs and Medicare.

Gamma Knife

Gamma Knife radiosurgery, a non-invasive treatment for brain tumors, vascular malformations and other disorders, does not involve a knife or even an incision at all. It is actually a highly focused, pinpoint-size beam of gamma radiation.

The extremely accurate delivery of a full dose of radiation at one time means tissues near the treatment area are not harmed. Also patients generally do not need ongoing treatment or experience the side effects of many other radiation therapies.

Decades of research and clinical data have proven this revolutionary procedure as safe and efficient. The University of Maryland Gamma Knife Center has been on the leading edge of that research.

What Gamma Knife Treats

Also called stereotactic radiosurgery, Gamma Knife is an alternative for many patients for whom traditional brain surgery is not the best option, either due to their overall health or the location of their tumor. Unlike invasive surgery, Gamma Knife can be used repeatedly over time if new brain tumors occur. It is used to treat:

  • Tumors in which cancer has spread from another part of the body to the brain.
  • Cancerous and non-cancerous tumors that start in the brain
  • AVMs (arteriovenous malformations), or tangled blood vessels in the brain
  • Acoustic neuroma, a skull base tumor on the nerve that connects the ear to the brain
  • Pituitary tumors
  • Some types of epilepsy
  • Trigeminal neuralgia, which causes severe nerve pain of the face

Gamma Knife Surgery Information

From start to finish, the Gamma Knife surgery typically lasts about five hours. The actual treatment is frequently less than one hour.

Patients are fitted with a head frame that attaches at four points with pins that penetrates the skin a very small amount. A local anesthesia minimizes the discomfort. A MRI scan is used to locate the targeted abnormality. Following the MRL, patients move to the treatment area where they lay on a gantry or bed during the procedure.

Because Gamma Knife treatment is so effective, the majority of insurance plans cover it.

  • Gamma Knife Treatment Process
  • Patient Stories

Risks and Side Effects of Gamma Knife

Gamma Knife removes the physical trauma and the majority of risks associated with open surgery.

The long- and short-term side effects of this procedure, if any, are minimal and transient. Some people may complain of a headache, which can be treated with over-the-counter analgesics. There is no hair loss, as with some treatments. Recovery time is usually immediate, or at most a few days with no need for extended rehabilitation.

Doctors may prescribe medication for swelling of the tumor.

In general, any radiosurgery can damage nearby healthy tissue. However, compared to other types of radiation, Gamma Knife treatment is much less likely to damage the surrounding tissue because it is highly focused.

This chart is a list of the most common health insurance plans we accept. This list is subject to change. Please check your individual plan to confirm their participation and the coverage allowed.
Due to the different physician groups and hospitals within the Wake Forest Baptist system, physician services and hospital services are billed separately. Please remember that health insurance coverage varies, so some services may not be covered.
If you don’t see your plan or you have questions, please call our Customer Service Center at 877-938-7497. We will do our best to work with you and your plan.

Key

WFUHS – Wake Forest University Health Sciences (professional services)
NCBH – North Carolina Baptist Hospital
LMC – Lexington Medical Center
CHC – Cornerstone Healthcare
Wilkes – Wilkes Regional Medical Center
HPR- High Point Regional
N/A – Not applicable to services provided at facility and/or CHC
NC – Not Contracted, very low to no volume for facility and/or CHC

Wake Forest Baptist Health Managed Care/MA Contracts – January 2019

AETNA (PPO & HMO): Accepted at all locations

AETNA MEDICARE: Accepted at all locations

AETNA WHOLE HEALTH: Accepted at all locations

BCBSNC (PPO & HMO): Accepted at all locations

BLUE MEDICARE: Accepted at all locations

BLUE VALUE: Accepted at all locations

CAROLINA BEHAVIORAL HEALTH: Accepted at WFUHS, NCBH and CHC (not applicable to services provided at Davie, LMC, Wilkes and High Point)

CIGNA: Accepted at all locations

CIGNA BEHAVIORAL HEALTH: Accepted at NCBH and High Point (not applicable to services provided at Davie, LMC, CHC and Wilkes)

CIGNA HEALTHSPRING MEDICARE ADVANTAGE: Accepted at WFUHS, NCBH, Davie, LMC and CHC (not applicable to services provided at Wilkes and High Point)

CIGNA LIFESOURCE (TRANSPLANTS): Accepted at WFUHS and NCBH (not applicable to services provided at Davie, LMC, CHC, Wilkes and High Point)

COVENTRY/WELLPATH: Accepted at all locations

CRESCENT PPO (ASHEVILLE): Accepted at WFUHS and NCBH (not contracted, very low to no volume for Davie, LMC, CHC, Wilkes and High Point)

DIRECT NET: Accepted at WFUHS and NCBH (not contracted, very low to no volume for Davie, LMC, CHC, Wilkes and High Point)

FIRST HEALTH (COVENTRY): Accepted at all locations

GATEWAY HEALTH ALLIANCE (VIRGINIA): Accepted at WFUHS and NCBH (not contracted, very low to no volume for Davie, LMC, CHC, Wilkes and High Point)

GOLDEN RULE INS (UNITED): Accepted at all locations

HEALTHGRAM (formerly PRIMARY PHYSICIAN CARE): Accepted at WFUHS, NCBH and LMC (not contracted, very low to no volume for Davie, CHC, Wilkes and High Point)

HEALTHTEAM ADVANTAGE: Accepted at all locations

HUMANA CHOICECARE: Accepted at all locations

HUMANA MEDICARE ADVANTAGE: Accepted at all locations

LIBERTY ADVANTAGE (MEDICARE ADVANTAGE): Accepted at WFUHS and NCBH (not applicable to services provided at Davie, LMC, CHC, Wilkes and High Point)

MAGELLAN (BEHAVIORAL HEALTH): Accepted at WFUHS, NCBH and CHC (not applicable to services provided at Davie, LMC, Wilkes and High Point)

MEDCOST: Accepted at all locations

MEDCOST ULTRA: Accepted at WFUHS, NCBH, Davie, LMC, Wilkes and High Point (not applicable at CHC)

OPTUMHEALTH (TRANSPLANTS – APPLICABLE TO NCBH/WFUHS ONLY): Accepted at WFUHS and NCBH (not applicable to services provided at Davie, LMC, CHC, Wilkes and High Point)

PREFERRED CARE OF VA INC: Accepted at WFUHS and NCBH (not contracted, very low to no volume for Davie, LMC, CHC, Wilkes and High Point)

SOUTHERN HEALTH SVCS (COVENTRY-PPO ONLY): Accepted at WFUHS, NCBH, Davie and CHC (not contracted, very low to no volume for LMC, Wilkes and High Point)

TWIN COUNTY (VIRGINIA): Accepted at WFUHS and NCBH (not contracted, very low to no volume for Davie, LMC, CHC, Wilkes and High Point)

UNITED BEHAVIORAL HEALTH: Accepted at WFUHS, NCBH, CHC and High Point (not applicable to services provided at Davie, LMC and Wilkes)

UNITED BEHAVIORAL HEALTH INTENSIVE OUTPATIENT PROGRAM (WFUHS ONLY): Accepted at WFUHS (not applicable for services provided at NCBH, Davie, LMC, CHC, Wilkes and High Point)

UNITED HEALTHCARE: Accepted at all locations

UNITED HEALTHCARE MEDICARE: Accepted at all locations

WELLPATH (COVENTRY): Accepted at all locations

LMC ONLY – Contracts specific to support Lexington employer groups, low volume

BEECHSTREET PPO
NATIONAL PROVIDER NETWORK/MEDICAL RESOURCES
PHCS/MULTIPLAN

CHC ONLY – contracts specific to support CHC

AETNA BEHAVIORAL HEALTH
CIGNA BEHAVIORAL HEALTH (limited providers)
THN-TRIAD HEALTH NETWORK MA Plans only (Humana Medicare and Healthteam Advantage)
TRICARE

Key

WFUHS – Wake Forest University Health Sciences (professional services)
NCBH – North Carolina Baptist Hospital
LMC – Lexington Medical Center
CHC – Cornerstone Healthcare
Wilkes – Wilkes Regional Medical Center
HPR- High Point Regional
N/A – Not applicable to services provided at facility and/or CHC
NC – Not Contracted, very low to no volume for facility and/or CHC

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