A Patient Guide
This handout tells you what to expect
before, during and after stereotactic
radiosurgery. While reading it, highlight any
parts that do not make sense to you. Make a
list of any questions you may have. Bring
this handout when you come for your clinic
visit or your treatment. Your doctor or nurse
will go over it with you.
What is stereotactic radiosurgery?
Stereotactic radiosurgery is used to treat
many types of lesions or tumors in the brain.
This includes: brain tumors, meningiomas,
vestibular schwannomas, trigeminal
neuralgia and arteriovenous malformations
(AVM). High doses of radiation are given
to a small area in your brain. In most cases it
is done in one treatment. The radiation can
be given to the abnormal area while the
normal brain tissue around it gets only a
small dose of radiation. Because this
treatment is so precise, a special frame is
used to keep your head perfectly still.
Before the Procedure
1. Arrange to have someone drive you
home after the treatment. Family
members or a friend may come and be
with you during the day.
2. You will have a special MRI scan done.
This is called a stealth MRI. This MRI
will be used to plan your radiation
treatment. It will feel no different than
other MRIs you may have had. If you
have never had an MRI, please let your
nurse know. You will be given a
handout that describes it in detail.
Please let the doctor or nurse know if you
ξ Brain aneurysm clips
ξ Implanted pumps
ξ Chemotherapy ports
ξ A pacemaker
ξ An artificial heart valve
ξ A defibrillator
ξ Eye or ear implants
ξ Stents, coils or filters
ξ If you are allergic to IV (intravenous)
contrast dye, shellfish or iodine.
ξ Claustrophobia (fear of being in closed
3. If you have diabetes and are taking oral
medicines or insulin, please let your
nurse or doctor know. These medicines
may need to be held or adjusted for the
4. The night before the treatment, do not
eat or drink anything after midnight. If
you have prescribed oral medicines, take
them with a small sip of water only, or
5. If you are taking aspirin, ibuprofen
(Motrin®) or warfarin (Coumadin®),
please let your nurse or doctor know.
These medicines may need to be
adjusted prior to the radiation treatment.
6. Bring all medicines with you on the day
of the procedure.
7. Expect to be at the hospital for about 10
to 14 hours.
The day of the treatment
1. You will change into a hospital gown. A
nurse will place a small needle (IV) in
your hand or arm to give medicines
during the frame placement, if needed.
It will also be used for IV contrast dye.
2. A head frame is applied to your head by
a neurosurgeon. The frame placement
can cause some pain and discomfort. A
local anesthetic is used to numb 4 sites
on your scalp (2 on the forehead and 2 in
the back of your head) before the frame
placement. This takes about 15-20
3. After the frame is placed, a CT scan is
done. This is done to pinpoint the exact
place and size of the abnormal area. It is
also used for treatment planning. After
the CT, you will wait in a comfortable
area for the treatment. A television is
available for your use.
If you have never had a CT scan, please let
the nurse know. You will be given a handout
that describes it in detail.
4. After the CT scan, you will be able to eat
and drink. Please drink extra fluids the
day of the procedure (we recommend an
extra 1-2 quarts). This will flush the dye
from your system. You will be given a
meal after the CT scan is done.
5. Your doctors (a neurosurgeon, radiation
oncologist and physicists) do treatment
planning. This takes about 3 to 4 hours.
6. Late in the afternoon, after the planning
is done, you will be brought into the
You lie on the treatment table with the
frame locked into a special holder. The
treatment machine rotates around your
head as the radiation is given. This is
called an arc. The length of the treatment
will vary. It depends on the number of
arcs you receive.
Radiation treatments are a lot like having x-
rays. You will not be able to see, feel, or
hear the radiation. There is no pain or
discomfort with the treatment. If you are in
pain for other reasons, such as back pain or
discomfort from the head frame, please let
the doctor or nurse know.
Your doctors, a nurse, a therapist who
operates the treatment machine, and the
physicist(s) who did the treatment planning
will be present during your treatment.
Once you are in place on the treatment table,
all staff must leave the room while the
machine is on. You will be watched on a
television screen. You will be able to talk
with the staff through a speaker. You can
also wave your hand as a signal that you
need help right away. If this happens, the
treatment will be stopped and the staff will
come into the room to help you.
What are the risks?
Your doctor will talk with you about the
short and long-term risks of this treatment.
The risks vary from patient to patient. They
depend on your diagnosis, the size and
location of the lesion, underlying medical
problems, the dose of radiation used, and the
amount of normal tissue treated. Most of
the time, there are few immediate side
The most common side effect can be brain
swelling, which is treated with steroids
(dexamethasone). Nausea is rare and is
controlled with medicine. Seizures are even
more rare. They can also be controlled with
medicines. In most people, there is little
hair loss as a result of the treatment.
There is some concern that, in a very few
patients, long-term side effects could occur.
At worst, these side effects could include the
damage of normal brain tissue leading to the
loss of some brain function. This could
include changes in vision, speech, or
paralysis. Although serious, these side
effects are quite rare. A very few patients
have severe brain swelling and may need
steroids for a long time. These risks will be
discussed in detail with you.
After the treatment
You will be taken to an exam room to have
the head frame removed. After it is
removed, we will clean the pin sites and
apply antibiotic ointment to these sites. You
will be sent home shortly after that with
You will need to have someone to take you
home after the procedure. You will not be
allowed to drive yourself home.
The day of the procedure and the day
afterward, please drink extra fluids to flush
the IV contrast from your system
You may have some short-term swelling
around both eyes. This is caused by the
numbing medicine placed at the pin sites.
This begins about 2-3 days after the
treatment. It may last from days to weeks.
This is normal and should go away by itself.
Starting the day after radiation you can place
cold cloths on your eyes to help reduce the
swelling. Put the cloths on for about 20
minutes at a time, 3-4 times a day. Continue
using the cold cloths for about 4 days after
the radiation procedure.
You may have some pain, tenderness or
numbness around the pin site areas for up to
a few weeks. This is normal and should go
away by itself.
You may feel a little tired for a day or two.
You can be as active as you wish.
Keep the pin sites clean. You will be given
antibiotic ointment. Put it on the pin sites
for the first 2-3 days.
You cannot wash your hair for a minimum
of 2-3 days after the procedure or until the
pin sites have healed.
If you are taking diabetes and/or anti-platelet
medicines you will be given special
instructions about when they can be
If you are taking anti-platelet medicines, you
may have bleeding from a pin site. If this
occurs, place clean gauze on the pin site and
hold pressure. If you can’t get the bleeding
to stop after 5-10 minutes of pressure, call
the doctor on call, or go to urgent care or an
When to call the doctor
ξ Increasing or severe headaches that
are not relieved by Tylenol
ξ Headaches that occur daily or several
times a day, even if relieved by
ξ Headaches associated with nausea and
ξ Nausea or vomiting. Any change in
strength or sensation (numbness or
ξ Clumsiness or difficulty moving a
hand or leg
ξ Vision, hearing or speech changes or
ξ Balance or walking difficulties or
ξ New onset of confusion
ξ New seizures or worsening seizures
If you have any questions or problems once
home, call the Radiotherapy Clinic at
(608) 263-8500. If the clinic is closed, your
call will be transferred to the hospital
answering service. Ask the operator for
the radiotherapy doctor on call. Give
your name and phone number with the area
code. The doctor will call you back.
If you live outside of the area, call toll-free by
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 11/2017. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5218