Stereotactic radiosurgery

What is stereotactic radiosurgery?

Stereotactic radiosurgery (STRS) is a technique that uses lots of narrow beams of special X-rays to accurately treat an area within the brain using a machine called a ‘gamma knife’. It allows high doses of radiation to be given to the abnormal area, without damaging the nearby healthy brain tissue. The use of the gamma knife means that no surgical incision needs to be made.

What can it treat?

This technique is used to treat a number of problems within the brain including:

• arterio-venous malformation (AVM)
• tumours
• movement disorders

What will happen when we are in hospital?

The treatment itself takes place at the Royal Hallamshire Hospital, but your child’s treatment before and after the procedure will take place at Sheffield Children’s hospital. The treatment can be done awake or under general anaesthetic.

Arriving the day before

You will be asked to arrive at Sheffield Children’s for 2pm the day before the procedure, usually to Ward 5. You will meet the nurses and doctors from the team at Sheffield Children’s and you will also meet members of the stereotactic radiosurgery team from the Royal Hallamshire Hospital.

The team will need to check your child’s details, medical history and may need to take a small blood sample.

Your child will be started on a steroid (Dexamethasone) to help protect against inflammation, and a stomach protector (Ranitidine) to prevent any side effects of the steroid. These medications will continue until your child is discharged.

If your child is having a general anaesthetic for the treatment they will not be able to have any breakfast on the morning of their STRS but will be able to have a drink of water early that morning.

Your child will need to stay in overnight the day before and day of treatment. There will be space for one parent or carer to stay at the bedside.

On the day of treatment

A nurse will escort you and your child to Royal Hallamshire Hospital in a taxi or ambulance. If your child is having a general anaesthetic, at this point they will be anaesthetised and the frame will be fitted.

If your child is staying awake you will be asked to leave so that the team can get your child ready to start the treatment. Throughout the day a dedicated children’s nurse will be with your child.

 What happens during the treatment?

Your child will be a special frame fitted to their head. This frame make sure the gamma rays are directed to the exact required position.

They will also have an MRI scan to plan the treatment and the gamma knife treatment.

Your child may also need an angiogram which maps the blood vessels in your child’s head.

Once the treatment is complete the team will call you so you can come and see your child. The frame will be removed from your child’s head and they can begin to wake up.

Once your child is ready, they will be brought back by ambulance to the ward at Sheffield Children’s hospital to rest.

After the treatment

Your child will be monitored overnight. The medications started before treatment will continue till you are discharged, pain relief will also be given as needed.

Your child will have 4 small marks on their skin. These are 2 on the forehead and 2 at the back of the head. These can sometimes ooze a small amount of blood. The nurse will show you how to care for these.

If your child has had an angiogram, they will need bed rest for a few hours afterwards. The nurse will let you know when your child can sit up and start to walk around again. There will be a small wound in the groin covered by a dressing. Please keep the dressing in place for 48 hours.

Most children are ready to go home the morning after treatment.

At home

It is a good idea to have some paracetamol ready at home if your child needs any pain relief after discharge. The team at Royal Hallamshire Hospital will work with your local team to coordinate your child’s follow up.

Glossary

Anaesthetist

The doctor who puts your child to sleep using a general anaesthetic.

Angiogram

A procedure where X-rays are used to examine your child’s arteries and veins. A special dye is used so that so that the blood vessels show up on X-ray pictures.

Arterio-venous malformation

A collection of abnormal blood vessels within the brain.

Frame fitting

A lightweight aluminium frame that is fitted to your child’s head so that treatment can be given accurately.

General anaesthetic

Medicine used to put your child to sleep so they can not hear or feel anything. The drug can be inhaled from a mask or injected into a vein.

MRI (Magnetic resonance imaging)

A scanning machine that gives detailed pictures of your child’s brain.

Radiographer

A technician trained to take pictures using X-ray, CT scanners and MRI scanners.