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Stereotactic radiosurgery uses radiation to treat small vascular malformations, mainly AVMs with a nidus less than three centimetres across. Currently, there is insufficient evidence that it can be used to treat cavernous malformations. It involves a single treatment of invisible, high-energy X-ray radiation, delivered by a machine called a linear accelerator (linac) or gamma knife. It is designed to target a high dose of radiation at your vascular malformation, minimising the effect on the surrounding areas of your brain and other parts of your body. Despite its name, the treatment is not a surgical procedure and does not involve any incisions.

What happens before radiosurgery?

A team of health professionals from several different departments in the hospital will look after you. The main people involved will be a radiotherapist, a neuroradiologist, a radiographer, a physicist, and possibly a neurologist or neurosurgeon.

Careful planning is needed to aim the narrow X-ray beams precisely. For some forms of radiosurgery, you will need to be measured and fitted for a special frame that helps keep your head very still during the treatment. Staff will need to make an impression of your teeth and the back of your head well in advance to prepare for this. You might need to have a dental check-up.

You might also need to have some more scans before the treatment. These will provide detailed computer images of your brain which the radiotherapist and physicist will use to direct the X-ray beams accurately.

What happens during radiosurgery?

When you arrive for your treatment, your customised head frame will be fitted (if necessary). Its measurements will be checked again and X-ray pictures will be taken to confirm its exact position. You will then lie on a couch that supports your head and the frame. The radiographers will set up the positions of the couch and the X-ray machine.

The radiosurgery might last up to one hour. You will not feel any discomfort during the treatment but you will hear some noise from the X-ray machine.

What happens after radiosurgery?

After the treatment, it can take three or more years for the vascular malformation to seal up and disappear. During this time, you remain at risk of experiencing symptoms caused by your vascular malformation. After this time, your doctors might want to repeat an angiogram or MRI scan to see how effective the treatment has been. Sometimes, radiosurgery does not succeed in sealing up the AVM.

The advantages of radiosurgery are that it does not involve neurosurgery or a general anaesthetic and it can be used to treat some vascular malformations located deep in the brain which are otherwise hard to reach. However, it cannot usually be used to treat vascular malformations larger than three centimetres across and it does not always seal up the AVM. There is also a risk of the radiation damaging the surrounding brain tissue (radionecrosis).

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Last updated 20 December 2010