Care for Gamma Knife Stereotactic Radiosurgery

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:

The medical team should assess whether patients are suitable for this surgery one month before the surgery. If the evaluation results indicating the results are for surgery, patient's 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.
When the patient receives admission notification, the patient should prepare their ID card, NHI card, simple toiletries, and the usual medications. Moreover, it is necessary to confirm that the patient is not experiencing fevers, coughing or other flu symptoms.

Admission date:

The patient would receive examinations, such as chest X-ray and ECG, during check-in.
When the patient arrives 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.
The attending physician will explain the course of the surgery and the possible risks to the patient and family members, as well as answer questions. The patient is requested to complete the informed consent forms for various treatments and self-paid items
The patient should wash hair one day before surgery and keep their scalp clean.
If the patient 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.
The patient should not eat or drink starting from midnight, including food and water. Patient would take medications as directed by doctors.

Surgery date:

The patient would wake up and freshen at 06:00 in the morning, and nurses will administer the infusion at 06:30.
Around 7 am, a specific person will escort the patient to the Gamma Knife Preparation Room to put on the head frame.
After the head frame is fitted and the patient has completed the brain MRI or angiography, the patient will return to the ward to wait for treatment notice.
After the patient return to the ward for resting, nurses will assist taking a comfortable sitting or lying position. If the patient has received an angiography, the patient must lie flat for 6 hours and the puncture site should be pressurized with a sand bag or 2 hours. If the patient experience any discomfort at this moment, the paitent should immediately ask for assistance from nurses.
After returning to the ward, the patient can start eating until around 80% full.
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.
If the patient experience symptoms, such as headaches, nausea, vomiting, and convulsions, after completing the treatment and returning to the ward, patient should notify medical and nursing staff.

Home care:

If the patient does 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.
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.
Special restrictions on diet are not required, and the patient should maintain a balanced diet.
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

Bowden, G. N., Kim, J. O., Faramand, A., Fallon, K., Flickinger, J., & Lunsford, L. D. (2020). Clinical dose profile of Gamma Knife stereotactic radiosurgery for extensive brain metastases. Journal of Neurosurg, 8, 1-5. https://thejns.org/doi/abs/10.3171/2020.3.JNS193369
Hsien, C. C., Hu, C. J., & Hung, D. 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
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. https://doi.org/10.1016/j.radonc.2018.12.018
Pavlica, M., Dawley, T., Goenka, A., & Schulder, M. (2021). Frame-Based and Mask-Based stereotactic radiosurgery: the patient experience, compared. Stereotactic and Functional Neurosurgery, 5, 1-9. https://doi.org/10.1159/000511587

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