Purpose of the Surgery:
To treat tumor or vascular abnormalities less than 3 cm deep in the brain by radiation beam through stereotactic three-dimensional space.

Pre-admission preparation:
  1. The medical team should assess whether patients are suitable for this surgery 1 month before the surgery. If the evaluation result is suitable, patients’ data will be sent to the National Health Insurance Administration for review. Upon review and approval, a specific person will notify patients for admission. If it is not approved by the National Health Insurance Administration, patients may receive this treatment at their own expenses. Besides, patients have to prepay all the treatment-related expenses on the admission date.
  2. When patients receive the admission notice, they should prepare their ID card, NHI card, simple toiletries, and the usual medications. Moreover, it is necessary to confirm that patients are not experiencing fevers, coughing or other flu symptoms.

Admission date:
  1. Patients should receive examinations, such as chest X-ray and ECG, during check-in.
  2. When patients arrive at the unit, nurses will accommodate a unit orientation, collect blood, place an indwelling intravenous catheter, collect medical history, and play a nursing care instruction video of Gamma knife stereotactic radiosurgery lasts approximately 15 minutes.
  3. The attending physician will explain the course of the surgery and the possible risks to patients and their family members, as well as answer their questions. Patients are requested to complete the informed consent forms for various treatments and self-paid items
  4. The patients should wash hair one day before surgery and keep their scalp clean.
  5. If patients suffer from a brain arteriovenous vascular disease, an angiographic examination is required. Nurses will shave the hair around their groin and then wash it with clean water.
  6. Patients should not eat or drink starting from midnight, including food and water. Patients take medications as directed by doctors.

Surgery date:
  1. Patients should wake up and freshen themselves up at 06:00 in the morning, and nurses will administer the infusion at 06:30.
  2. At around 7 am, a specific person will escort patients to the Gamma Knife Preparation Room to put on the head frame.
  3. After the head frame is fitted and patients complete the brain MRI or angiography, they will return to the ward to wait for treatment notice.
  4. After patients return to the ward for resting, nurses will help them take a comfortable sitting or lying position. If patients have received an angiography, they must lie flat for 6 hours and their puncture site should be pressurized with a sand bag or 2 hours. If patients experience any discomfort at this moment, they should immediately ask for assistance from nurses.
  5. After returning to the ward, patients can start eating until they are about 80% full.
  6. Upon completion of preparation, the medical team will notify the ward and then a specific person will escort patients to the Gamma Knife Room for the gamma knife stereotactic radiosurgery. Upon completion of surgery, the head frame will be removed, and the wound will be wrapped with elastic gauze.
  7. If patients experience symptoms, such as headaches, nausea, vomiting, and convulsions, after completing the treatment and returning to the ward, they should notify medical and nursing personnel.

Home care:
  1. If patients do not experience symptoms, such as dizziness, vomiting, and convulsions, they can be discharged from the hospital. Upon returning home, patients must take medications as directed by their doctor according to their condition.
  2. Patients should keep the surgical wound over the head dry at all time, and should not wash their hair for five days. If there is redness, swelling, or seepage, patients must go back to the clinic.
  3. Special restrictions on diet are not required, but patients should maintain a balanced diet.
  4. At the time of discharge, a specific person will schedule patients for the next visit, and patients will receive a follow-up MRI or angiography for assessing the efficacy 6 months later.
 
References
  1. Higuchi, Y., Yamamoto, M., Serizawa, T., Aiyama, H., Sato, Y., & Barfod, B. E.  (2018). Modern management for brain metastasis patients using stereotactic radiosurgery: literature review and the authors’ gamma knife treatment experiences. Cancer Management and Research, 10, 1889-1899. doi:10.2147/CMAR.S116718
  2. Izard, M.A., Moutrie, V., Rogers, J. M., Beath, K., Grace, M., Karle, B, & Fuller, J. W. (2019). Volume not number of metastases: Gamma Knife radiosurgery management of intracranial lesions from an Australian perspective. Radiotherapy and Oncology, 133, 43-49. doi.org/10.1016/j.radonc.2018.12.018
  3. Moreau, J., Khalil, T., Dupic, G., Chautard, E., Lemaire, J. J., Magnier, F., & Biau, J. (2018). Second course of stereotactic radiosurgery for locally recurrent brain metastases: Safety and efficacy. Public Library of Science ONE, 13(4), doi:0195608.
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