Gamma Knife Radiosurgery

Gamma Knife radiosurgery delivers focused beams of radiation to treat brain conditions without an incision. This outpatient procedure directs multiple radiation beams that converge at a specific target within the brain while limiting exposure to surrounding healthy tissue. It is used to treat various neurological conditions, including tumours, vascular malformations, and certain functional disorders.

Dr. Teo Kejia

Senior Consultant Neurosurgeon

MBBS (Singapore) | MRCS (Edinburgh) | FAMS (Neuro.Surg) | FRCS Ed (Neuro.Surg) | IFAANS

Indications Benefits Techniques Preparation Procedure Recovery Risks FAQ

Indications for Gamma Knife Radiosurgery

Gamma Knife radiosurgery treats neurological conditions requiring targeted radiation, especially when surgery is not an option. These include:

Brain Tumours: Treats benign and malignant tumours, including metastases, meningiomas, and acoustic neuromas. Effective for hard-to-reach tumours, it slows or stops growth while preserving healthy tissue.
Arteriovenous Malformations (AVMs): Targets abnormal blood vessel tangles that increase bleeding risk. Radiation gradually closes them off, reducing haemorrhage risk without surgery.
Trigeminal Neuralgia: Relieves severe facial pain by disrupting pain signals in the trigeminal nerve. Suitable for patients unresponsive to medication.
Brain Metastases: Treats cancer that has spread to the brain, allowing multiple lesions to be targeted in one session. A focused alternative to whole-brain radiation.

Benefits of Gamma Knife Radiosurgery

Compared to traditional brain surgery, Gamma Knife radiosurgery offers several advantages:

Non-invasive

With no incisions, stitches, or open wounds, the procedure eliminates infection risks and avoids the trauma and lengthy recovery time associated with open surgery.
Targeted Radiation

Multiple beams converge precisely on the affected area, treating the condition while limiting exposure to surrounding healthy brain tissue.
Single-day Treatment

Most procedures are completed in one session, allowing patients to return home the same day without requiring a hospital stay.
Quick Recovery

With no surgical wounds, most patients experience minimal discomfort and can resume normal activities within a few days.

Surgical Techniques

Single-shot Technique

Used for small, well-defined targets such as trigeminal neuralgia, this method delivers radiation to a single point, ensuring a high dose concentration within a short treatment time.

Dynamic Shaping Technique

Designed for irregularly shaped targets, including complex tumours, this approach adjusts the beam shape and intensity to match the contours of the target, using multiple radiation shots to create a customised treatment field.

Fractionated Treatment

Suitable for larger targets or sensitive areas, this technique delivers radiation in multiple sessions, allowing healthy tissue to recover between treatments while maintaining effectiveness against the target.

Preparing for Surgery

Medical Evaluation: Brain scans (MRI and/or CT) provide detailed images of the treatment area, while the surgeon reviews medical history, current medications, and conducts a physical examination to tailor the treatment plan.
Frame Fitting: A lightweight head frame is secured to the skull with four small pins under local anaesthesia, ensuring precise positioning and preventing movement during treatment.
Imaging: Additional scans are performed with the frame in place to map the exact target location, which is then combined with previous imaging to create a detailed three-dimensional treatment plan.
Treatment Planning: Specialised software determines the number, intensity, and placement of radiation beams to deliver an effective dose while minimising exposure to surrounding healthy tissue.

Step-by-Step Procedure

Patient Positioning and Setup

The patient lies on the treatment table with the head frame securely attached to the Gamma Knife machine. Our surgeon ensures proper positioning to align with the treatment plan.

Final Verification

Our surgeon reviews the treatment plan, confirms target coordinates, and performs final safety checks. The system verifies that all parameters align with the predetermined protocol before treatment begins.

Radiation Delivery

The Gamma Knife machine directs multiple focused radiation beams to the target area as planned. Treatment duration varies from less than an hour to several hours, depending on the size, location, and number of targets.

Real-Time Monitoring

Our surgeon continuously monitors the patient using video and audio systems throughout the procedure. The patient remains awake and can communicate with the surgeon at any time.

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Post-Surgical Care and Recovery

Immediate Care

The head frame is removed after treatment, and small bandages are placed over the pin sites, which heal within days. Most patients leave the hospital within a few hours.

Recovery Process

Normal activities usually resume within 24 to 48 hours. Some patients experience mild headaches or scalp numbness at the pin sites, which resolve within a few days.

Follow-up Care

An initial follow-up is scheduled within the first week to check the pin sites and address concerns. Subsequent imaging monitors the treatment response at intervals based on the specific condition.

Potential Risks and Complications

Temporary side effects may include scalp numbness or headaches at the frame pin sites. Radiation-related effects may develop months after treatment, such as localised swelling in the treated area or a temporary worsening of existing symptoms. Less common complications involve radiation injury to nearby healthy tissue, which could result in brain swelling or loss of function in the affected area.

Frequently Asked Questions (FAQ)

Does the radiation remain in the body after treatment?

No, the radiation does not remain in the body. It continues to affect the target tissue for weeks to months, but patients can safely interact with others immediately after treatment.

When do treatment effects become noticeable?

This varies by condition. Some patients with trigeminal neuralgia notice pain relief within days, while tumour responses may take several months. Our surgeon will provide an expected timeline based on your condition.

Will I need multiple treatments?

Most patients need only one session, but for larger or sensitive targets, radiation may be delivered over multiple sessions to protect healthy tissue. Our surgeon will advise on the best approach for your condition.

Dr. Teo Kejia

Senior Consultant Neurosurgeon

MBBS (Singapore)|MRCS (Edinburgh)|FAMS (Neuro.Surg)|FRCS Ed (Neuro.Surg)|IFAANS

Dr. Teo’s expertise lies in complex brain tumour surgeries employing advanced techniques like brain mapping and awake brain surgery. He also manages neurovascular conditions, traumatic head injuries and spinal disorders.

Dr. Teo graduated from the National University of Singapore with a Bachelor of Medicine and Bachelor of Surgery in 2006. He completed his general surgery training and advanced neurosurgery training at the National University Hospital Singapore. He furthered his education in the United Kingdom, obtaining advanced certifications and completing specialist training in various neurosurgical disciplines.
Dr. Teo’s AMDA award facilitated his training at Queen’s Hospital in London, where he specialized in functional neurosurgery, neuro-oncology, neurovascular, skull base, and spinal surgery. He also underwent fellowship training in brain mapping and awake brain surgery at renowned institutions in Italy and France, working with leading experts in the field.

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