Sunday, March 3, 2024

What Are Long-term Side Effects Of Gamma Knife Radiation

Worsening Of Your Brain Tumour Symptoms

Gamma Knife Side Effects

Radiotherapy for brain tumours can sometimes make symptoms worse before they get better. This is because the treatment can cause swelling in the brain. The swelling increases the pressure in the head and makes the symptoms worse.

This can be frightening because you might think the radiotherapy isn’t working. Increased pressure in the brain might cause:

How Is Gamma Knife Surgery Performed

Gamma Knife treatment involves several steps.

The initial steps are different if the Gamma Knife system uses an external rigid head frame or uses a frameless mask. If using a head frame:

  • First, a box-shaped head frame is positioned on your head. The head frame is made of aluminum and weighs less than two pounds. The head frame acts as a “frame of reference” in the planning of your treatment and is essential in keeping the target perfectly aligned during the precision treatment. Your neurosurgeon positions the frame.
  • Youll receive four injections of a local anesthetic, one on each side of your forehead and two in the back of your head. These are the areas where specials pins are placed to fasten the head frame to your skull. You may feel pressure as the pins are tightened, but this usually only lasts a few minutes. After the head frame is positioned, a radiation therapist will take measurements of your head. Typically an imaging scan, such as CT or MRI scan is performed with the head frame in place. These measurements and the scans are used for planning your treatment.

Frameless Gamma Knife systems use a thermoplastic mask that is placed over your face. The mask is then secured to an existing frame on the Gamma Knife table. Your head is held completely still.

These remaining steps are the same for both the frame-based and frameless systems.

What Is Recovery From Gamma Knife Radiosurgery Like

Many patients are surprised by how quickly they are back on their feet after the Gamma Knife procedure.

People walk out pretty much the way they came in, except theyll have a head bandage on, says Dr. Chiang. Many people go back to work the following day.

Side effects after Gamma Knife are rare and typically minor.

You may experience fatigue, related to the length of the procedure, and headaches related to the head frame. And while Gamma Knife therapy will not cause significant hair loss, the scalp can remain numb in some areas for a few weeks after the procedure.

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Clinical And Radiological Evaluations

All patients were followed up with magnetic resonance imaging of the sellar, clinical and endocrinological evaluations. The follow-up evaluations were reviewed by clinicians and radiologists.

Tumor dimensions were obtained manually from MR imaging in the axial, sagittal, and coronal planes. The dimensional indices of the tumors were measured and recorded in 3 orthogonal planes: transverse , anteroposterior , and craniocaudal . The tumor volumes were estimated using the following formula: V = /6 . Unfortunately, all of the digital data from model B Leksell Gamma Knife in Gamma plan was missing. So, tumor volumes were calculated based on the measurement of tumor diameters. Taking into account the irregular shape of postsurgical residual or recurrent pituitary adenomas, tumor volume measurement was only a rough estimate of the actual volume. Tumor progression was defined as tumor enlargement at least 20% in tumor volume or tumor regrowth. Tumor shrinkage was defined by at least 20% shrinkage in tumor volume. Stable tumor was defined as tumor volume change within 20%. Parasellar invasion was defined as the Knosp grade 3 or 4. Suprasellar extension was defined as the tumor close to the optic nerve and chiasm .

Early Side Effects Of Gamma Knife Radiosurgery


The procedure is done as an outpatient, and no general anesthesia is necessary . All patients leave the medical center on the same day. This signifies that Gamma Knife Radiosurgery, for the most part, goes very smoothly, and there are only minimal side effects. Early Gamma Knife side effects can be divided into common side effects and rare complications.

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What Happens After Gamma Knife

One to Two Days After Gamma Knife Surgery

You may experience headache, nausea, fatigue or irritation at the pin sites in the days after the procedure. The pin sites typically heal on their own. They do not need to remain covered past the day of your treatment. You may shower or bathe as usual.

Whats The Outlook After Undergoing The Gamma Knife Procedure

The success of the Gamma Knife procedure depends on the size, location, type of lesion, your personal medical history, and other factors. Discuss your expectations and outlook with your neurosurgeon and your radiation oncologist before treatment.

The goal of Gamma Knife surgery is for the radiation to stabilize, shrink or destroy the tumor or lesion. Depending on your condition, you may or may not need additional Gamma Knife treatment or traditional now-more-manageable surgery. You will have follow-up CT and/or MRI scans to check on treatment progress.

It may take weeks, months, a year to see the full effects of treatment. For example, pain relief if you have trigeminal neuralgia can occur anytime between one day and six months, with most people improving within one month. Cancerous tumors typically become stable or get smaller over a period of weeks to months. Many noncancerous tumors stop growing immediately , but may not get smaller in size. Arteriovenous malformations may take two to three years to resolve after treatment.

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Delayed Side Effects Of Gamma Knife Treatment

Its possible, although rare, to experience side effects from treatment with Gamma Knife well after the procedure. Delayed side effects can include:

  • Swelling in the brain
  • Hair loss near the treated area, if close to the scalp. It will regrow on its own.
  • Radiation necrosis, which is the death of brain tissue at or near the treatment site. It can occur months or years after radiosurgery and is usually treated with steroids.

What Is The Outcome Of Gamma Knife Surgery

Gamma Knife® Icon: What Happens During Treatment?

Gamma Knife surgery is often successful. The goal of the procedure is typically to shrink, stabilize, or destroy a brain tumor or lesion.

However, Gamma Knife surgerys outcome or success rate depends on the condition. In the case of a brain tumor, the size of the tumor and its location can affect the outcome.

In one study, 91.75% of patients with trigeminal neuralgia were pain-free in a median period of only 10 days. Three years after the Gamma Knife surgery, 71.8% of them remained pain-free.

After the procedure, you can expect to have follow-up CT or MRI scans regularly. Youll likely continue to meet with your oncology team or neurologist regularly. It may take several weeks or longer to see the full impact of the treatment.

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When To Call The Doctor About Side Effects

Complications arising from Gamma Knife Radiosurgery are rare, but call your Rocky Mountain Gamma Knife Center doctor if you have:

  • Pain at the points where the head frame was attached that does not improve or gets worse
  • A fever of 100.5 or greater
  • Severe headache or any headache that does not improve within 48 hours
  • Balance problems
  • Weakness in your arms or legs
  • Cognitive changes, such as confusion or disorientation
  • Excessive fatigue
  • Nausea and vomiting that does not go away
  • Prolonged numbness

What Are The Side Effects Of Gamma Knife Surgery

Because no incisions are required, the radiosurgery used at Rocky Mountain Gamma Knife Center comes with much less risk than traditional brain surgery. Although uncommon, traditional brain tumor surgery can lead to bleeding, infection and adverse reactions to general anesthesia. These are not risks associated with Gamma Knife Radiosurgery. Gamma Knife Radiosurgery does have some side effects youll want to be aware of so you know what to expect and can alert your physician to anything out of the ordinary.

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Sellar And Parasellar Meningiomas

Due to their involvement of neurovascular and endocrine structures, complete resection of parasellar and sellar meningiomas can be associated with significant morbidity and incomplete resections are common. A multicentre study of ten centres of the North American Gamma Knife Consortium of patients identified 763 patients with benign sellar and parasellar meningiomas with median follow-up of 66.7 months. At the last follow-up, tumour volumes remained stable or decreased in 90.2% of patients with 88% actuarial progression-free survival rate at 8 years with new or worsening cranial nerve deficits occurring in 9.6% and additional 4.2% of patients experiencing other forms of symptom progression .

When Should I Call The Doctor After Having The Gamma Knife Procedure

  • The pin sites feel hot to the touch .
  • A cloudy or foul smelling drainage is coming from the pin sites.
  • You have a fever of 101 degrees F or higher.

If you experience nausea, vomiting, severe headache, visual changes, difficulty speaking, a seizure, or any other symptom unusual for you, contact your physician immediately or go to the nearest emergency room.

A note from Cleveland Clinic

Gamma knife is a highly effective treatment with minimal or no associated adverse effects. Because of its ability to stabilize or reduce the size of a tumor or lesion, often only one treatment is required however, occasionally gamma knife can be repeated safely and successfully.

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Definition Of Types Of Recurrences

The radiation field was defined as the tumour volume contained within the prescription dose. Tumour recurrence was defined as a progression of tumour volume within the initial radiation field, i.e. within the prescription dose. Out-of-field recurrence was defined as tumour progression immediately adjacent to the radiation field and hence outside the initial prescription isodose. The occurrence of a new meningioma was defined as a distant tumour unrelated to the radiation field.

Radiation Techniques For Postsurgical Residual Or Recurrent Nfpas

Radiation techniques have developed from 3D conformal radiotherapy to stereotactic radiosurgery or fractionated stereotactic radiotherapy . In previous studies of postsurgical conventional radiotherapy for NFPAs, tumor control rates were 80-90% at 10 years and 75-90% at 20 years with doses ranging from 45 to 55 Gy at 1.8-2.0 Gy per fraction . The hypopituitarism occurred in 20% to 30% at 5 years after conventional radiotherapy. SRS or FSRT which has advantages of precise tumor localization and a better dose conformity than conventional radiotherapy is the most commonly used radiation techniques and essential part in the treatment of pituitary adenomas. As GKRS is still considered the gold standard of SRS, GKRS is the most reported in literatures. For FSRT, tumor control rate was around 95% at 5 years and new hypopituitarism was reported in 10% to 48% in NFPA patients with doses ranging from 45-54 Gy at 1.8-2.0 Gy per fraction . GKRS has been proved to offer a high tumor control rate of 83%-92% and a low rate of 9%-32% of new hypopituitarism for pituitary adenomas . Tumor local control and complications were similar between GKRS and FSRT. However, the superiority of GKRS over FSRT for NFPA patients according to tumor control and complications has yet to be defined.

Figure 4

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What Is Gamma Knife Radiosurgery

Radiosurgery is a technique that combines the precision of brain surgery with the effectiveness of high-dose radiation. It creates a noninvasive treatment for brain tumors that allows physicians to preserve most of the patients healthy brain tissue. This procedure has been used for decades to treat functional disorders such as tremors related to Parkinsons disease, as well as benign brain lesions such as meningiomas, pituitary adenomas, and arteriovenous malformations.

In the past decade, however, the use of radiosurgery has become much more commonplace because of its newly recognized benefit in the treatment of metastatic brain tumors. These tumors develop in the brain due to cancer having spread from other parts of the body.

Causes And Risk Factors

Gamma Knife offers patients an excellent, short-term radiation treatment option for brain tumors

Radiation therapy works by damaging DNA in cells. This damage isn’t isolated to cancer cells, though normal cells can be damaged as well. While radiation therapy has improved significantly such that less damage occurs to healthy cells than in the past, some healthy tissues are inevitably exposed.

Several variables can increase or decrease your risk of developing long-term side effects of radiotherapy. Some of these are:

  • Your age at the time of radiation
  • The dose of radiation you receive
  • The number of treatment sessions
  • The type of cancer treated
  • The area of the body that receives radiation
  • Other cancer treatments, such as chemotherapy
  • Other health conditions, such as heart disease or diabetes

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Metastatic Tumors To The Brain

Solitary or multiple metastatic lesions less than 3 cm can be treated in one session. Lesions in the brainstem or other eloquent areas can be safely treated, providing superior long term control. Treatment of multiple lesions is also feasible with a local control of tumor and survival similar to that of patients with fewer lesions.1

Discover the benefits of Gamma Knife Perfexion as a Metastatic Tumors to the Brain Treatment.

Cavernous Sinus And Skull Base Meningiomas

In a large series of 255 patients with skull base meningiomas treated with Gamma Knife, the actuarial progression-free survival at 5 and 10 years was 96% and 79%, respectively , while Igaki documented actuarial local tumour control rates of 86.9% and 78.9% at 5 and 10 years, respectively . Higher local control was seen in smaller tumours and in meningiomas treated with prescription doses above 14 Gy . New cranial neuropathies occurred or worsened in 8.6% and decline in cognition or memory or cerebellar deficits, etc. in 2%, with petrous or clival location being predictive factors for side effects versus parasellar, petroclival and cerebello-pontine angle location . In cavernous sinus, meningiomas local tumour control rates were 99% at 5 years and 90.4% at a mean follow-up of 82.0 months with a resulting 10-year actuarial tumour growth control rate of 83.8% . The complication rate of 6% included optic neuropathy, worsened diplopia or pituitary dysfunction while 21.0% of patients experienced improvement of symptoms .

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How To Lower Your Risk

You can do a number of things in addition to the precautions your healthcare provider takes to reduce your risk of long term complications related to radiation therapy.

  • Don’t smoke, as smoking increases the risk of lung cancer after chest radiation.
  • Talk to your practitioner about any new respiratory symptoms that may suggest radiation pneumonitis.
  • Ask about clinical trials designed to reduce the risk of late effects of radiation.
  • If you will be having chest radiation, ask if respiratory gating is available.
  • Ask your healthcare provider about physical therapy if your movements are restricted. Physical therapy can’t rid your body of permanent scarring but can often improve flexibility and mobility.

Permanent Hearing Loss A Reasonable Price To Pay


An acoustic neuroma is also called a vestibular Schwannoma. Gamma Knife treatment may be delivered as a single event or in multiple smaller events .

Gamma Knife works by stopping tumor growth, and in some cases it even shrinks over time.

Why would you want to undergo Gamma Knife surgery for acoustic neuroma treatment if a common side effect is permanent hearing loss? Some benefits:

Facial and trigeminal nerve function can be preserved for most patients.

No post-operative pain no post-operative rehabilitation. Patients can immediately resume activities.

No hair is shaved.

Eliminates risk of infection, blood clots, hemorrhaging, brain swelling, prolonged facial weakness/paralysis and permanent facial weakness/paralysis.

The cost is often 20% to 35% less than conventional neurosurgery.

The downside is as follows:

Slight risk of tumor regrowth, requiring periodic MRI surveillance.

Non-successful treatment usually means a micro-surgical removal rather than more Gamma Knife attempts.

Very low to non-existent risk of malignant transformation triggered by the treatment.

Good chance of permanent hearing loss.

Before you begin panicking that Gamma Knife for your acoustic neuroma will cause permanent hearing loss, you should know that micro-surgery as well can yield this side effect. Its actually the most common complication.

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What Are The Benefits Of The Gamma Knife Procedure Compare With Traditional Surgery

There are many benefits of Gamma Knife surgery over traditional surgery. Gamma Knife surgery:

  • Doesnt require incisions or general anesthesia.
  • Can target tumors/lesions deep in the brain that cant be safely reached by traditional surgery.
  • Can target multiple tumors/lesions at the same time.
  • Avoids other risks and complications of surgery .
  • Limits damage to the surrounding healthy tissue.
  • Results in little to no post-treatment discomfort or pain.
  • Is usually performed as an outpatient procedure .
  • Allows return to usual activities in a day or two.
  • Usually doesnt require physical therapy or other rehabilitation.

Its covered by most insurance and Medicare .

Does Radiation Cause Hair Thinning

Radiation therapy can also cause hair loss on the part of the body that is being treated. Hair loss is called alopecia. Talk with your health care team to learn if the cancer treatment you will be receiving causes hair loss. Your doctor or nurse will share strategies that have help others, including those listed below.

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What Is Gamma Knife Surgery

Gamma Knife® surgery is a treatment method that uses radiation and computer-guided planning to treat brain tumors, vascular malformations and other abnormalities in the brain. Despite its name, this procedure does not involve any incisions, not even a skin incision. The Gamma knife is actually a treatment that delivers beams of highly focused radiation. Some 192 “beamlets” of radiation converge and are precisely focused on the targeted area of brain, specifically in the shape of the tumor or lesion, while sparing the surrounding normal tissue.

Gamma Knife surgery is also known as stereotactic radiosurgery, Gamma Knife radiosurgery and Gamma Knife radiation.

How Do You Prepare For Gamma Knife Surgery

Mayo Clinic Minute: How gamma knife surgery treats brain tumors

To reduce the likelihood of getting an upset stomach, dont eat or drink anything after midnight. Go to bed at a reasonable hour the night before the intervention so youll feel well rested in the morning. Youll also need to arrange ahead of time for a family member to accompany you and stay throughout the treatment.

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