1. Nursing Instruction
  2. Overview
  3. Neurosurgery

[ Major point ]
  1. Please wash your hair the day before your procedure to ensure a clean scalp.
  2. Do not eat or drink anything after midnight before the surgery. Patient would take medications as directed by doctors.
  3. Keep the wound dry. Avoid washing your hair for five days and return for follow-up as instructed by your doctor.

I. What is Gamma Knife Stereotactic Radiosurgery ?
It is a treatment that uses three-dimensional stereotactic localization and focused radiation beams to treat tumors or vascular abnormalities in the deep brain, typically less than 3 cm in size.

II. Why is this surgery needed ?
For small deep-seated brain tumors or arteriovenous malformations (within 3 cm), Gamma Knife radiosurgery offers a non-invasive, bloodless, and low-risk treatment option. It reduces the risks of bleeding and other complications, making it an effective option for shrinking or controlling lesion growth.

III. Preoperative preparation
  1. The patient will undergo routine tests such as an ECG, chest X-ray, and blood work.
  2. A neurosurgeon will explain the purpose and process of the surgery to you and your family. Nurses will also go over important care instructions related to Gamma Knife radiosurgery.
  3. After the consultation, you or your family will be asked to sign consent forms for surgery, anesthesia, MRI, and self-pay item.
  4. The patient should wash their hair and keep scalp clean the day before surgery.
  5. If the patient has a brain blood vessel condition, an angiogram will be needed. Before the test, nurse will shave excess hair in the groin area, and the patient will be asked to clean the area thoroughly.
  6. Do not eat or drink after midnight on the night before surgery. Take medications as instructed by the physician.
  7. Around 7:00 a.m., a staff member will escort the patient to the Gamma Knife preparation room for head frame placement.

IV. Principles of care during surgical planning and after surgery:
  1. After the head frame is in place, the patient will be taken back to the ward to rest. The nurse will assist with positioning. The patient may begin eating, but should avoid overeating.
  2. While the head frame is in place, rest in the ward as much as possible and avoid collisions or leaving the room.
  3. If the patient has undergone angiography, they must lie flat for 6 hours. The puncture site will be compressed with a sandbag for 2 hours. Notify the nurse immediately if any discomfort occurs.
  4. After the medical team finishes planning the treatment, they’ll let the ward know. The patient will be taken back to the Gamma Knife room for the radiation procedure. When it’s done, the head frame will be removed, and the wound will be wrapped with elastic gauze. Pressure will be applied to the area for at least two hours, and then the nurse will help change the dressing.
  5. After returning to the ward, notify the nurse if symptoms such as headache, nausea, vomiting, or seizures occur. If no complications occur and the doctor approves, they may be discharged the same day.
  6. The patient should keep the wound dry and follow the home care instructions provided. Washing the hair should be avoided for five days. If there is any redness, swelling, or discharge, the patient should return to the neurosurgery outpatient clinics.
  7. A follow-up appointment will be scheduled upon discharge. MRI or angiography will be performed six months later to assess the treatment effect.

References
  1. Chen, H.C., Hu, C.J., & Pan, D.H.C (2021). Stereotactic gamma knife radiosurgery for orbital cavernous hemangioma: Clinical outcome and visual function protection. Journal of Neuro-Oncolog, 152. 183–193. https://doi.org/10.1007/s11060-020-03692-5
  2. Pavlica, M., Dawley, T., Goenka, A., & Schulder, M. (2021). Frame-based and mask based stereotactic radiosurgery: The patient experience, compared. Stereotactic and Functional Neurosurgery, 99, 241–249. https://doi.org/10.1159/000511587
  3. Shanker, M.D., Webber, R., Pinkham, M. B., Huo, M., Olson, S., Hall, B., Jayalath, R., Watkins, T., & Foote, M. C., (2022). Gamma knife stereotactic radiosurgery for intracranial cavernous malformations. Journal of Clinical Neuroscience, 106. 96-102. https://doi.org/10.1016/j.jocn.2022.10.015
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    Taipei Veterans General Hospital 
    No.201, Sec. 2, Shipai Rd., Beitou District,  3e72dadb9904d06fa0fb3744e4ed2612.png
    Taipei, Taiwan 11217, R.O.C.
    Tel: +886-2-2871-2121 #04
    • Smoking and chewing betel nut significantly induce oral cancer. Obesity will potentially increase the risk of breast cancer and colorectal cancer. Please control body weight and keep away from tobacco and betel nut.
    • Information provided above can’t overcome physician's treatment and replace physician patient relationship.
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