Neurosurgery – Gamma Knife
Gamma Knife radiosurgery replaces a surgeon's scalpel with a single dose of radiation. This is not a knife in the normal sense of the word. The physician makes no incision in your head. Instead, very precisely focused beams of radiation are directed to the treatment area of the brain. This procedure is simple, painless, and straight-forward.
Leksell Gamma Knife Icon Radiosurgery
What is Gamma Knife radiosurgery?
Penn State Neurosurgery’s new Gamma Knife Icon is the latest advance in stereotactic radiosurgery (SRS). Icon’s features allow for unprecedented accuracy and unlimited clinical and workflow flexibility. Gamma Knife Icon offers both frame-based and frameless immobilization. The frame-based option can be used for accurate localization and treatment. Patients for whom fixed frame stabilization is not appropriate can be treated using Icon’s Online Adaptive DoseControl™, which integrates several features to ensure precise and accurate dosing in each treatment.
Penn State Gamma Knife Radiosurgery: What it is and what to expect
What are the benefits of Gamma Knife radiosurgery?
Since no incision is made, the risk of surgical complications is low. The patient's head does not have to be shaved and side effects are few. Gamma Knife Icon offers both frame-based and frameless immobilization. The frame-based option can be used for accurate localization and treatment. Patients for whom fixed frame stabilization is not appropriate can be treated using Icon’s Online Adaptive DoseControl, which integrates several features to ensure precise and accurate dosing in each treatment. A mask based immobilization solution is personalized for each patient. Treatment is much shorter than conventional surgery and causes only minor discomfort. Benefits with Icon include faster set-up and treatment delivery to multiple tumors in a single session, and the potential to treat lesions in areas not able to be reached by older models, including tumors in the sinuses, orbits, and upper cervical spine. Icon allows treatment of a wider range of targets faster and more efficiently than ever before. The radiosurgery system's unique radiation-focusing device ensures superior radiation delivery and accuracy while reducing the dose to unintended areas.
Also, the patient can leave the day of the surgery or stay overnight for observation, compared with several weeks for traditional surgery. The treatment is complete in one session and seldom takes more than an hour or two. The full effects of Gamma Knife surgery may not be seen for several months following treatment.
What diseases can be treated with Gamma Knife?
- Benign or malignant tumor
- Trigeminal neuralgia
- Certain vascular malformations (AVM)
- Cavernous malformations
- Acoustic neuromas (schwannoma)
- Parkinson's disease and essential tremor
- Lesions causing epilepsy
Icon Gamma Knife treats many types of tumors found in the head. This includes tumors that came from somewhere else (metastatic from lung, breast, ovary, kidney or skin cancers including renal cell cancer and melanoma) that don't respond well to regular radiation treatments. Icon can treat many more tumors than previously possible, saving the patient from receiving whole brain radiation, a last resort. People that have already had whole brain radiation sometimes get regrowth or new brain tumors six months or a year later, and can NOT safely have more whole brain radiation. Often, these people can still have a focused Gamma Knife treatment that puts a high radiation dose into the tumor, but only a very small amount into the surrounding brain, giving them a new chance for longer survival.
Gamma Knife is very effective in stopping further growth and even shrinking slow-growing tumors deep in the head called meningioma, pituitary adenoma, and vestibular schwannoma (also known as acoustic neuroma). People that had open operations for these slow-growing tumors sometimes find several years later the tumor is coming back and getting bigger. Tumors that are growing back are often straight forward to treat with Icon Gamma Knife, without having to go through another open skull operation.
Icon treats more than cancer. A special type of face pain characterized by electric stabbing pain—called trigeminal neuralgia—is sometimes resistant to medications, or the medications cause serious side effects. Gamma Knife treatments can give relief to many people, with up to half completely pain free, with only a small risk of numbness.
Usually hand tremor from Parkinson's disease or a condition called essential tremor can be treated with medications or deep brain stimulation with implanted electrodes. In certain patients, Gamma Knife can be used to make a permanent lesion in part the brain to help control the tremor in one hand.
Certain blood vessel abnormalities inside the skull and brain can be treated with Gamma Knife. Sometimes it requires multiple treatments, including open neurosurgery and intravascular injections of coils and glue. Arteriovenous malformation (also called AVM) and dural arteriovenous fistula (or dural AV fistula) are two conditions that have been successfully treated with radiosurgery, sometimes with no other treatment, and sometimes as part of multiple approaches.
The above conditions, from tumors, trigeminal neuralgia, tremor, to vascular malformations, are all standard accepted and proven treatments with the Gamma Knife and are covered procedures paid for by government and private insurance like any other open neurosurgical operation.
Gamma Knife Radiosurgery Providers
- Akash Agarwal, MD, Neurosurgeon
- Sandra J. Brettler, MSN, RN, CCRN, CNRN, Nurse Coordinator
- Kevin Cockroft, MD, MSc, FACS, FAHA, Neurosurgeon
- Huseyin Isildak, MD, Otolaryngology- Head and Neck Surgery
- Heath Mackley, MD, Radiation Oncologist
- James McInerney, MD, Neurosurgeon
- Jennifer Rosenberg, MD, Radiation Oncologist
- Michael Sather, MD, Neurosurgeon
- Scott Simon, MD, Neurosurgeon
- Leonard Tuanquin, MD, Radiation Oncologist
- Brad Zacharia, MD, Neurosurgeon
During your clinic appointment with the neurosurgeon or radiation oncologist
Please let your provider’s nurse or medical assistant (MA) know if you are diabetic or on blood thinner medication (Coumadin, Aggrenox, aspirin or aspirin-containing products). While we don’t necessarily have to stop these medications, we may need to make additional arrangements for your care.
One Week before your procedure
Stop all aspirin or aspirin-containing products. You may continue to take acetaminophen (Tylenol) or ibuprofen (Advil) as needed.
Preparation for your procedure
- Nothing to eat or drink after midnight the night before your procedure. Take your medications the morning of the procedure with a sip of water or clear liquids. If you must take your medicine with food, please have something light (toast, muffin, bread). NO EGGS, MILK, OR SUGARY FOODS OF ANY KIND.
- Please wear comfortable clothing to your procedure. Sweats and a t-shirt are fine! No extra metal in your clothing (underwire bras and zippers in pants are fine, no zippered jackets or sweatshirts). You may wear wedding rings, but no other jewelry. The temperature in our facility is on the cooler side (68° - 70°), so please dress accordingly.
- You may bring any music you would like to listen to with you. We can play music from mp3 players, iPods, or CDs. We also have access to satellite radio.
- You will need a driver to come with you to take you home after your treatment. Please park your car in the South Garage. As you pull into the garage, there are reserved parking spaces on the left-hand side for Gamma Knife patients (directly across from the elevator). Please use these for the day; however, we request that you use only one space per patient. If you have other family coming for your treatment, they may park anywhere else in the garage.
- You will need to arrive for your treatment at 6 a.m. in the South Annex. Our front doors open at 5:30 a.m., and if needed, your family member may pull the car up to the front door to drop you off before parking the car. Your family may wait for you in the waiting area until we return from MRI, at which time the nurse or MA will bring them back to stay with you during the planning phase of the treatment.
- Once your treatment is completed, your family member will be asked to listen to the discharge instructions with you. You will leave with printed instructions on how to care for yourself, as well as your return appointments already scheduled.
If you have any questions, please contact the Gamma Knife Nurse at 717-531-8807, option 4.
How is the procedure billed?
The Gamma Knife coordinator will obtain pre-authorization for procedures. Visit these pages for more information on
How do I schedule my procedure?
After meeting with the neurosurgeon and radiation oncologist, the Gamma Knife coordinator will contact you to schedule your procedure. A tour of the facility will be provided at one of your appointments with the physicians. Neuropsychological testing may be required in some instances; this will be discussed with you at your appointment.
Where do I go on the day of my procedure?
Park in the south parking garage, and exit the garage to the South Annex (the door will be on your left immediately after exiting the elevator). Check in at the front desk at 6:00 a.m. unless otherwise scheduled by the Gamma Knife coordinator. Remember, you should have nothing to eat or drink after midnight, except for your medications. The only medications that should not be taken will be indicated by the Gamma Knife coordinator prior to your procedure. Also, please wear comfortable clothing with no metal (i.e. no belts, jewelry other than wedding rings, metal objects in your pockets, change or credit cards). Rings, underwire bras, blue jeans, and grommets in shoes/sneakers are allowed.
What should I bring to the procedure?
You may bring music to listen to during your treatment. We can accommodate iPods or CDs. As there is limited room, only one to two family members can be with you at a time prior to your treatment. Please keep all valuables at home.
Can I drive after the procedure?
No, you will need a driver to come with you to take you home after your treatment. As you pull into the south parking garage, there are reserved parking spaces on the left hand side for gamma knife patients directly across from the elevator. Please use these for the day; however we request that you use only one space per patient. If you have other family coming for your treatment, they may park anywhere else in the garage.