I. Preparation:
The Gamma Knife treatment is generally a one-day, outpatient precedure, including all imaging, planning, treatment and recovery. Most patients return to normal activities 24 hours after the procedure.
Consultations and Appointments prior to your procedure
You will need to complete a consultation appointment with the neurosurgeon responsible for your Gamma Knife treatment, as well as the radiation oncologist who will be assisting the neurosurgeon.
If you have already had imaging by MRI, CT scan or angiography, please bring the films with you for the consultations. This often prevents having to repeat these studies prior to the Gamma Knife treatment day.
On the day of the consultation with the radiation oncologist, you are invited to meet with the Gamma Knife Center manager. An RN, the manager shows you a short video of the procedure and takes you on a tour of the Center. We want you to be thoroughly acquainted with the Gamma Knife Center and we will answer any questions at that time to increase your comfort.
Please bring the completed forms on the day of the Gamma Knife tour. This ensures that the nurse will have everything in order when you arrive the morning of the procedure.
There is a possibility that one of your physicians may require preliminary lab work before the Gamma Knife treatment begins. In this case, blood will be drawn upon arrival the morning of your treatment. All females of childbearing age should expect to complete a urine pregnancy test on the morning of treatment.
The night before your procedure
- Please shower and wash your hair. Do not apply any hair gels or spray. Do not wear makeup, hairpins, nail polish, or jewelry to your procedure.
- Do not have anything to eat or drink after midnight.
- You may take regularly scheduled medications with sips of water the night before and the morning of your procedure.
II. Treatment Day:
The morning of your procedure
Patients who are diabetic take one-half your morning insulin or hold your oral hypoglycemic, as directed by your physician.
Please report to the Gamma Knife Center on the ground floor of Saint Joseph’s Hospital between 6:00 and 6:15 A.M
Bring all your regular medications to the hospital. You may take them throughout the day as scheduled/needed if permitted by your physician. (We will discuss this when you arrive.)
You may bring one or two music CD’s that you would like to listen to during the treatment phase of Gamma Knife.
Wear comfortable clothes for the procedure (loose fitting sweatpants or slacks and shirt, plus socks).
Do not wear any metal such as zippers, metallic paint or designs on clothing, underwear with underwire or metal supports, or jewelry; it interferes with the MRI.
You will not be permitted to drive the day of your treatment, so please make arrangements for a friend or family member to drive you home.
Please leave all valuables at home except for your picture ID and your insurance card(s).
Patients may have visitors; however, due to space we limit it to one or two family members or friends. Because patients may be here all day, visitors often arrange to leave for longer periods and return in the afternoon. The Gamma Knife nurse will communicate with the family/friends in a timely manner with updates and expected treatment times either in person or via telephone. Patients are welcome to bring reading materials.
Preparation for Treatment:
- In preparation for the procedure, a guiding device called a “stereotactic frame” will be fixed firmly onto your head. This frame fits over your head and is attached with four metal posts. The skin will be cleansed and a local anesthetic given to “numb” the area. Any discomfort you feel during placement of the pins will last only a few minutes. The remaining tests and treatment are pain free.
- The stereotactic frame remains on your head until after the completion of the Gamma Knife treatment.
- Before the frame is placed on your head, the Gamma Knife nurse inserts a small gauge IV in your arm or hand. This allows your nurse to give you medications or fluids as needed to assist in your comfort.
Imaging Before the Treatment:
Each patient’s needs are different, but to help the surgeon plan your treatment, you will undergo imaging studies after the frame has been placed, such as:
In addition, a clear plastic helmet with many holes in it will be placed on your head over the frame to measure the size of your head. This is usually done prior to your imaging study and only takes a few minutes. The plastic helmet is then removed.
The Gamma Knife Procedure:
After your treatment plan has been finalized, you will be taken into the Gamma Knife treatment room and transferred onto the treatment couch where the stereotactic frame will be connected to a device known as a “collimator helmet.” The helmet has 201 holes through which the radiation beams pass.
The treatment begins when the doors of the radiation unit open, and the head of the couch moves into position. You will hear a small click as the collimator helmet engages with the machine. You do not hear or feel the treatment.
During this time, you remain in constant contact with the Gamma Knife personnel via the use of an intercom system and your treatment is observed at all times through television monitors. When the treatment is completed, the Gamma Knife couch move backs into its starting position, and you are allowed to get up.
IV. Discharge
After Your Treatment:
When treatment is completed, the frame is removed and an antibiotic ointment is applied along with a dressing. Band-Aids are placed on the pin sites prior to discharge from the unit.
On rare occasions, there may be bleeding at a pin site that does not stop with pressure from the gauze. Should this occur, your doctor uses a stitch to close the pin site.
When you are able to take fluids by mouth, your nurse removes the IV line.
Most patients are able to leave the Gamma Knife Center after a period of observation. If necessary, you may be admitted to Saint Joseph’s Hospital overnight.
Follow-up care is coordinated with the referring doctor and the doctors involved in your treatment. If you are discharged the day of the procedure, you should have a family member drive you home and stay with you for that night.
You may resume normal diet and activities as tolerated. Medications prescribed by your doctor before the Gamma Knife treatment may be resumed, unless your doctor tells you otherwise.
You may gently shampoo your hair the day after treatment; however, avoid scrubbing the pin sites until they have healed for a week or so. Occasionally, patients notice some persistent numbness or tingling of the scalp. The feeling is temporary and is usually gone within a few weeks.
Please call your physician or the Gamma Knife nurse if you have any questions about your treatment.
Discharge Instructions:
Diet
Activity
- Resume previous level of daily activities as soon as you feel able, including work and school.
- Avoid strenuous activity for one week.
- No driving for 24 hours.
Hygiene
- Wait 24 hours before washing your hair. At that time, the rinse water may be tinged pink from dried blood. This is normal.
Normal or Potential Side Effects
- Swelling around eyes and eyelids
- Swelling, bruising, and tenderness around pin site areas
- Mild headaches for 7-10 days after Gamma Knife treatment
- Occasional nausea/vomiting up to 48 hours after treatment
- Numbness at pin sites that may last 3-4 weeks
- General fatigue that may last 1-2 weeks
CALL YOUR DOCTOR OR GAMMA KNIFE NURSE FOR:
Gamma Knife Nurse: Monday through Friday from 6:00 AM until 3:00 PM : 404-851-5513 or 1-866-SJGAMMA
- New or worsening neurological symptoms (weakness, numbness, visual symptoms, etc.)
- Severe headache not relieved with medication
- Persistent pin site drainage or redness
- Seizures
- After hours, call your neurosurgeon.
First Aid:
Eyelid Swelling:
- Use an ice pack to swollen areas 10 minutes on, then 10 minutes off, for comfort and to minimize swelling.
Pin Site Care
- Remove bandages in 24 hours
- Small amounts of pink or bloody drainage is normal
- Cleanse pin sites with soap and water after 24 hours, and pat dry
- Avoid direct sunlight at pin sites for one week
- Monitor for signs and symptoms of infection to include: Fever > 100 F for 24 hours; Redness or warmth increasing with tenderness at pin sites; Persistent drainage from the pin sites
V. Follow Up Care:
Follow up appointments are scheduled before you are discharged from the Gamma Knife Center. These include appointments with the neurosurgeon and the radiation oncologist (if appropriate), and an appointment for follow up imaging if necessary. Appointments and discharge instructions are written out for the patient and reviewed before discharge.
For more information, please contact:
Rebecca O. Heitkam, RN, BSN, CCRN, coordinator
Gamma Knife Center
Saint Joseph's Hospital
404-851-5513
or toll free at 1-866-SJGAMMA
or email
rheitkam@sjha.org
