CyberKnife Treatment Care

Your doctor may do the following:

• Perform a neurological exam to see how well your nervous system is functioning
• Review your MRI scans, or other diagnostic test results
• Order additional tests if necessary

Your doctor may ask if you:

• Take medicine or insulin to control diabetes
• Are allergic to intravenous contrast material-an injected substance that can make a tumor or other abnormality easier to see
• Are allergic to iodine or shellfish (iodine is present in both shellfish and contrast material)
• Have a claustrophobia

Leading up to your procedure:

• Review your regular medicines with your doctor. You may be asked to stop taking some drugs.
• Arrange for someone to:
  • Drive you to the treatment facility
  • Drive you home afterward
  • Stay with you during treatment
  • Stay with you the following night
• If advised by your doctor, use a special shampoo.

The day before your procedure:

• Do not use any hair creams or hair spray.
• Do not eat or drink anything after midnight unless told otherwise by your doctor.

The day of your procedure:

• Bring your regular prescription medicines with you to the hospital.
• Do not wear jewelry, make-up, nail polish, a wig, or a hairpiece.
• Remove any contact lenses, eyeglasses, or dentures.
• An IV line will be inserted into your arm to deliver contrast material, medicines, and fluids.

• You will receive a mild sedative to help you relax.
• A local anesthetic may be injected to numb your scalp.

There are three types of stereotactic radiosurgery:

The procedure will be done using 201 beams of highly focused gamma rays. It is used to treat smaller brain tumors and functional brain disorders. The Gamma Knife is the most well-known machine used for this procedure.

There are four phases to this treatment:

• Head frame placement-Local anesthesia will be injected into the front and back of your head to numb your scalp. A box-shaped, aluminum frame will be attached to your skull with special pins. This will keep your head from moving during treatment.
• Imaging-You will have a CT scan and/or MRI to pinpoint the exact location of the tumor. If you are being treated for an AVM, you may have a test called an angiography to locate the abnormal veins.
• Computerized dose planning-You will relax for about an hour while your doctors plan your treatment. When they are finished, you will lie down on a special couch. Your doctor will talk to you about the number of treatments you will receive and how long they will take. Your head frame will then be attached to a helmet full of small holes. Each hole will allow a single ray of radiation to target a specific part of your brain.
• Radiation delivery-The doctors and nurses will leave the room. Your couch will move into the treatment area. You might hear a click as the helmet locks into place. Your doctor will be able to see and hear you during the entire procedure, and you will be able to talk to her. You will remain still during the procedure and so will the machinery around you. You will not be able to see, feel, or hear the treatment being done. When treatment is complete, the couch will move back to its original position.

This treatment utilizes one large, powerful radiation beam. It is used to treat small and large brain tumors. You will go through the same phases listed above. During radiation delivery, however, part of the machine will move around you. The treatment couch will also be repositioned. Some newer systems can also deliver radiation to tumors of the spinal cord.

CyberKnife treatment is given using a small linear accelerator mounted on a robotic arm. It is used to treat tumors and lesions of the brain and spine. No head frame is used.

There are three phases to treatment:

• Set-up-If you are being treated for a brain tumor, a special mask will be made to fit your head. No pins are needed to keep it in place. You will be given a CT scan, and possibly an MRI, with the mask in place. If you are being treated for a spinal tumor, a customized foam body cradle will be made, instead of a mask. You will most likely have some small metal markers, called fiducials, implanted near the tumor to help guide the radiation beams during treatment. The fiducials are implanted during a short outpatient procedure. After they are in place, you will be given a CT scan.
• Treatment planning-You may be allowed to go home while the doctors finalize your treatment plan. Actual treatment may take place that same day or several days after the set-up phase.
• Treatment delivery-You will be fitted with your mask or body cradle and then lie down on the treatment table. Before the treatment starts, x-rays will be taken to help the linear accelerator move into the proper position. Once treatment begins, the robotic arm will move around you and administer radiation beams from many different angles. Sometimes the arm will stop and more x-rays will be taken.

If you received Gamma Knife or LINAC-based treatment:

• The head frame and IV line will be removed.
• Your head will be wrapped in gauze, or small bandages will be placed at the pin sites, where the pins secured the frame to your head.

• Radiation delivery can take up to 2 hours for Gamma Knife and LINAC-based treatments. For CyberKnife treatments, it can take up to 3 hours.
• The total procedure usually takes 2-4 hours.

• Anesthesia prevents pain at the pin sites if a head frame is used during treatment.
• You will feel some pressure as the head frame is attached.
• The treatment itself causes no pain.
• You may experience headaches or nausea a few hours after treatment. Your doctor will give you medicine to relieve any discomfort.

When you return home after the procedure, do the following to help ensure a smooth recovery:

• You can typically return to your regular daily activities the day after the procedure.
• Resume your regular medicines, unless told otherwise by your doctor.
• Check with your doctor about performing any heavy lifting.
• For about a week, avoid scrubbing the pin sites when you wash your hair.
• Be sure to follow your doctor's instructions.