The Walton Centre. NHS Foundation Trust. Patient Information. Stereotactic Radiosurgery

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1 The Walton Centre NHS Foundation Trust Patient Information Stereotactic Radiosurgery

2 Stereotactic Radiosurgery (SRS) is a non-invasive treatment of brain tumours (benign and malignant), arteriovenous malformations (AVM) and Trigeminal Neuralgia. SRS delivers highly focused beams of radiation with high precision. By continuously shaping the treatment beam to match the size and shape of a patients abnormality from all angles, SRS ensures that the targeted area receives the full dose of radiation while protecting normal healthy tissue. SRS can be used to treat abnormalities within the brain that are otherwise inaccessible or inappropriate for invasive open surgery. SRS is a day case procedure. You will not have to be admitted to hospital for an overnight stay. Many patients return to their normal lifestyle without any discomfort following SRS as recovery from the procedure is minimal. SRS is an awake procedure, patients do not have to undergo a general anesthetic. Your Neurosurgeon/Neuro-Oncologist will have discussed the SRS procedure with you prior to signing your consent form in clinic. You will then have an appointment with the Clinical Nurse Specialist or the Specialist Radiographer for a pre admission check. Here you will be asked a series of questions about your general health, have a MRSA swab taken and be given your date for the treatment and any patient information. You will also have the chance to ask any questions. You will be informed at this point of the ward you will be admitted to. You will require a MRI scan prior to having the treatment, this may be on the same day as your pre admission appointment, or you may be given a future date to have your scan. This scan will take approximately one hour and may require an injection of contrast/dye to help see the abnormality in the brain in more detail. 1

3 On the day of your procedure you will be admitted to the ward at the Walton Centre. You will need to arrive by 0700 am. Please wear light comfortable clothing and ensure that any shirts/tops do not have bulky collars You will be reviewed by the Clinical Nurse Specialist and the Senior House Officer (SHO). You will be given a small amount of sedation called Lorazapam (2mgs), a dose of Dexamethasone (steroid) and medication to protect your stomach from the steroids as they can irritate the lining. You will also have a needle inserted into your hand/arm which will be used to inject contrast/dye prior to having your CT scan. You will then be taken to theatre recovery area to have the frame applied to your head. The Neurosurgeon will inject local anesthetic into four points around your head. Two on your forehead and two at the back. This will make the area numb. To attach the frame the neurosurgeon will put four very tiny pins into the numb areas. You should not be able to feel the sharpness of the pins, however you may feel some pressure or tightness. Please inform the Neurosurgeon if you can feel the sharpness of the pins when he/she is applying the frame. Once the frame is applied you will be given an infusion/drip which contains the contrast for the CT scan. You will then be taken to the radiology department and have a CT scan. This will require you to lie on a hard board with a lightweight box placed on top of the frame. This scan will take approximately 15 minutes. 2

4 You will then be transferred back to the ward to rest whilst the radiosurgery is planned. This may take a few hours and is a long wait, necessary to ensure that the dose of radiation and the area being treated is correct. There are magazines and televisions available on the day ward. You will be allowed to eat and drink and mobilise to the toilet. Please ask the nursing staff for assistance when using the bathroom as the frame is heavy and you may feel tired from the sedation Once the panning of your treatment is complete, you will transferred to the Clatterbridge Cancer Centre Liverpool with a nurse/radiotherapy support worker and a porter. You will meet a radiographer who will take you into the treatment room. You will be asked to lie on the table and the frame will be attached to a bracket on the end of the table. The radiographers will line up to the marks provided by the treatment planning system. Once you are in position a final CT scan is performed on the treatment machine to confirm that the treatment is aimed at the correct place The staff will leave the room. Once the machine is switched on you will hear a buzzing noise, which can be quite noisy. You may want to bring an ipod or personal stereo to listen to whilst having the treatment. The radiographers will be monitoring you throughout the treatment on a camera. If, for any reason, you require assistance please wave your hand and someone will assist you immediately. The treatment will be interrupted at regular intervals as the radiographers reposition the machine and check that you are ok. The machine will move around you but will not touch you. You will not feel anything during the treatment. The treatment takes approximately minutes. 3

5 There may be some oozing of blood stained fluid from the pin sites. This is called serous fluid and is fluid that comes from the tissues underneath the skin. This is normal and should stop oozing within 24 hours. Please keep the pin sites clean, if they start to look infected please let your GP or CNS know. Following the removal of the frame you will be able to go home. You may require a prescription of medication to take home with you however this will be discussed with you on the day. The clinical Nurse Specialist with see you prior to your discharge and answer any questions you may have. Please bring this booklet with you on the day of your treatment as we may need to include further contact details. Side effects of treatment SRS is very safe with minimal side effects. Things to be aware of are: Headache Nauseas / Vomiting If you have any of these feelings on the night that you go home from hospital you must contact the night sister at the Walton Centre. (see number overleaf). The areas where the pins have been may tingle for a few days, this is normal and is because the skin is healing. Please do not hesitate to contact your CNS/Specialist radiographer/ Consultant if you are worried about anything else 4

6 Frequently asked questions What do we mean by abnormality in the brain? Abnormality means something that is not normal in the brain or something that should not be there. This can cover a wide range of diagnoses including: A. Brain tumours (both benign and malignant) B. Vascular lesions such as Arteriovenous Malformations (AVM) C. Trigeminal neuralgia Why is the abnormality in my brain inaccessible? The brain has many vital structures including, major blood vessels, important nerve structures and structures that allow us to see, speak and move. The abnormality in your brain may be close to one of these vital structures and therefore an invasive procedure may cause damage to this area. What are the benefits of Stereotactic radio surgery (SRS)? SRS is a relatively pain free procedure and is non-invasive. It has less risks associated than invasive surgery, such as post operative complications i.e. haemorrhage and infection. It is also a day case procedure and the recovery time is minimal so patients can carry on with their normal life style as soon as possible. I ve Heard of Gamma Knife and Cyber Knife what is the difference with SRS? Gamma and Cyber Knife treatments are the names of the machine used to carryout the SRS. The machine you will be treated with is called the Novalis Tx and is state of the art equipment. Will I have the opportunity to ask questions after signing my consent form? Yes. You can ask questions at any point throughout your treatment. You will be given contact numbers for the Clinical Nurse Specialist and the Specialist Radiographer so that you can contact them any time prior to and after your treatment. You can also contact your appropriate consultant via their secretary. Please see numbers overleaf. 5

7 Why do I have to have a MRSA swab? All hospitals screen all admissions to their trust for MRSA as up to 1 in 4 patients can colonise the bug in their nose whilst in the community. This does not mean that you will contract MRSA. It is a precautionary measure. If your swab comes back positive you will be given a cream to apply to your nose which will treat the bug. Neurosurgeon Contact Telephone Numbers.. Neuro-Oncologist Clinical Nurse Specialist Specialist Radiographer Night Sister at the Walton Centre (switch board) and ask for bleep 4556 Customer Care including Pals Neurosupport, Norton Street, Liverpool

8 The Walton Centre NHS Foundation Trust Lower Lane, Fazakerley Liverpool L9 7JL Tel: Fax: The Walton Centre for Neurology & Neurosurgery NHS Trust. All rights reserved. No reproduction by or for commercial organisations is allowed without the express written permission of the Walton Centre For practical advice our Customer Care Team provide a (PALS) service. Contact Customer Care Service Manager, Fran Seagreaves or a member of the Customer Care Team on , Francis.Seagreaves@ thewaltoncentre.nhs.uk or Alternatively, log on to: or call for advice and information for people with neurological conditions and their carers. Title: Stereotactic Radiosurgery Author: Anna Crofton Version No: 1 Date of Approval: August 2011

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