[ Major point ]

1. The patient should wash hair one day before surgery and keep their scalp clean.
2. The patient should not eat or drink starting from midnight, including food and water. Patient would take medications as directed by doctors.
3. Patients should keep the surgical wound dry at all time, and should not wash their hair for five days. By order go back to the clinic.
    

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

II. Why is this surgery needed?

For some deep brain tumors or arteriovenous malformation (within 3 cm), if gamma radiation therapy is used, it can be treated without bleeding or life-threatening, and it can shrink or control the growth of tumor. Therefore, Smaller brain lesions are more suitable for treatment with Gamma Knife.

III. Preoperative preparation: 

1. The patient would receive examinations, such as chest X-ray, ECG, and collect blood sample during check-in.
2. Nurses will play a nursing care instruction video of Gamma knife stereotactic radiosurgery.
3. The attending physician will explain the purpose and process 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
4. The patient should wash hair one day before surgery and keep their scalp clean.
5. If the patient suffered from an arteriovenous vascular disease, an angiographic examination is required. Nurses will shave the hair around patient’s groin and then wash it with clean water.
6. The patient should not eat or drink starting from midnight, including food and water. Patient would take medications as directed by doctors.
7. Around 7 am, a staff will escort the patient to the Gamma Knife Preparation Room to put on the head frame.
    

IV. Principles of care during surgical planning and after surgery: 

1. 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 further treatment notice. Nurses will assist patient to a comfortable sitting or lying position. The patient can start eating until around 80% full.
2. If the patient has received an angiography, the patient must lie supine for 6 hours and the puncture site should be pressurized with a sand bag for 2 hours. If the patient experience any discomfort at this moment, please immediately ask for assistance from nurses.
3. Upon completion of preparation, the medical team will notify the ward and then a staff 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.
4. 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.
5. 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.
6. 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 exudate, patients must go back to the clinic.
7. At the time of discharge, staff will schedule patient for the next visit, and patient will receive a follow-up MRI or angiography for assessing the efficacy 6 months later.

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