FREQUENTLY ASKED QUESTIONS

How is the Gamma Knife different from radiation therapy?

The Gamma Knife is more accurate and takes less time to deliver than traditional radiation therapy.

Gamma Knife surgery is different from conventional radiation therapy of the brain because the radiation is precisely directed at the target and spares the surrounding normal brain tissue and other structures. Because of this, the radiation dose can be delivered to just the targeted tumor in one session. It is an 'overwhelming' dose that destroys the tumor.

Gamma Knife radiosurgery can be used in conjunction with whole brain radiation therapy with excellent results. In addition, it can also be used with conventional surgery as a treatment for tumors that cannot be totally removed or, in some cases, where the tumor is inoperable.

Do you use LINAC radiosurgery along with Gamma Knife?

Gamma Knife radiosurgery (single dose treatment) is different than traditional Linear Accelerator (LINAC) based radiation in that it is a single dose - one time, one day, and you're done, versus multiple treatments (fractionated). Because the Gamma Knife has 201 sources of radiation, healthy tissue gets only 1/200th of the dose delivered to the target. For that reason, the Gamma Knife can be used in a single-dose delivery, eliminating the need to fractionate (break up the total dose into smaller doses in order to preserve healthy brain tissue).

Because the Gamma Knife has a fixed isocenter and fixates the skull for delivery, its accuracy (and resulting minimal dosing to healthy tissue) is superior to that of the LINAC.

In addition, LINACs, used for stereotactic radiosurgery, usually take longer to treat than does the Gamma Knife (especially for multiple tumors). Bottom line? You wait less time with the Gamma Knife.

We have extensive experience with both technologies and we no longer use the LINAC for intracranial radiosurgery.

How is this different from the CyberKnife?

The Gamma Knife has been in operation for over 40 years and has been used to treat hundreds of thousands of patients. It is considered the 'gold standard' for intracranial tumor control. Because the Gamma Knife secures the skull with a lightweight frame and the radiation source is fixed (unmoving), its accuracy is within .3mm. The CyberKnife doesn't fix the patient's head and has moving delivery systems that do not offer the same level of accuracy as the Gamma Knife. This accuracy is significant when it comes to sparing healthy brain tissue during these very delicate procedures.

Also, the CyberKnife delivers between 2 to 6 times greater radiation dose to healthy tissue than does the Gamma Knife. This is significant in that it is healthy brain tissue that makes you, you. You want to keep that tissue safe.

I know I can't get whole brain radiation more than once. Can I get multiple Gamma Knife treatments?

Yes. In some cases, patients who have been treated and develop new tumors can come in for additional procedures. Because of the accuracy of the Gamma Knife, healthy tissue is not as compromised as it would be with conventional radiation therapy. In the case of trigeminal neuralgia, excellent results have been seen when the patient has follow-up procedures.

Who is an appropriate candidate for Gamma Knife?

Our treatment team reviews many factors to determine whether Gamma Knife is the best approach. In many cases, our team evaluates the patient's medical history, existing films and laboratory tests before seeing the patient in order to determine whether a physical consultation is necessary. For more information, call 1.800.927.5051.

Consultations include spending time with neurosurgeons Alex MacKay,MD , John Demakas MD, Jonathan Carlson MD, Benjamin Ling MD, or or for acoustic neuromas, Dr. Neil Giddings. In addition, one of our radiation oncologists, . Robert Fairbanks MD, Christopher Lee MD, Jason Call MD, or Wayne Lamoreaux MD will evaluate your entire radiation history and prescribe the appropriate dose for your condition.

What insurance does Gamma Knife of Spokane accept?

We accept Medicare, Medicaid and most private insurances. We will research your coverage and provide you with full information about costs and options. Call us at to discuss your needs at 800.927.5051.

What can be treated with the Gamma Knife?

The Gamma Knife is a dedicated radiation device exclusively for intracranial tumors and malformations. Conditions treated include:

1. Metastatic Brain Tumors
2. Primary Brain Tumors
3. Pituitary Tumors
4. Acoustic Neuromas
5. Trigeminal Neuralgia
6. AVMs (Arteriovenous Malformations)
7. Essential Tremor and Parkinson's Tremor

How does the Gamma Knife procedure compare to neurosurgery for a brain tumor?

Because Gamma Knife radiosurgery requires no incisions and no general anesthesia, the risks of complications, infection or other side effects are greatly reduced if not eliminated altogether. As an outpatient procedure for trigeminal neuralgia, the patient can in most cases, return home by dinner the same day of surgery and resume normal activity. For many tumors and tremors, the actual procedure takes less than 3-4 hours from the time the head frame is affixed to 'frame off'.

The vast majority of patients go home within hours of completing the procedure. It is this factor - the single-day treatment with minor complications - that separates a Gamma Knife procedure from traditional neurosurgery. Patients 'get on with living' much more quickly after a Gamma Knife procedure than they would if they underwent a surgical procedure.

What's my typical day look like with the Gamma Knife treatment?

1. Patient arrives and is given mild sedation.
2. Local anesthesia is applied to the head where the frame will be affixed.
3. A Plexiglas box (for targeting) is affixed to the frame and the patient goes to MRI, CT or Angiography to get scanned.
4. Patient rests while the neurosurgeon, radiation oncologist, neuro-otologist and the medical physicist use the state-of-the-art computer to plot and target the radiation (called a treatment plan).
5. Once the team approves the plan, the patient is taken into the Gamma Knife vault and lies down on the table.
6. The physicians place the head frame into the Automatic Positioning System apparatus and the machine is checked and calibrated for the treatment.
7. Upon treatment, the patient's table and affixed head frame/helmet all move as one into the machine so that just the head and shoulders enter the apparatus.
8. Depending on the extent of the disease and location of the targets, treatments can range from between 20 minutes and 4 hours during which the patient feels nothing.
9. Patients bring their own CD's and can listen to the music and talk to their loved ones via intercom during the entire treatment.
10. Upon completion of the treatment, the patient is moved out of the machine and back to the holding room where the head frame is removed.
11. Patient then has a light meal and is either released to go home or may be admitted overnight into the hospital for observation.

What does the patient feel during the Gamma Knife Treatment?

The patient may feel a stinging sensation when the surgeon administers the local anesthetic to the pin sites. They also may feel a temporary pressure when the head frame is affixed. While being treated, the patient does not feel any of the treatment procedure.

What can the patient expect after Gamma Knife treatment?

After treatment, the head frame is taken off and the pin sites are bandaged and the whole head is snugly wrapped, applying slight pressure to prevent bleeding from those sites. After a few hours, bandaids are applied to the pin sites.

How quickly will the Gamma Knife treatment work?

The effects of the Gamma Knife depend on the type of target--for most metastatic tumors, they respond within a few weeks or months. Some tumors that are slow growing, may take longer to respond. The overall goal of Gamma Knife radiosurgery is tumor control--using radiation to halt tumor growth by altering the DNA structure of the cancer cells and preventing these cells from reproducing. Consequently, the faster growing the tumor is, the more rapidly the tumor will respond to Gamma Knife treatment. Brain metastases shrink faster than meningiomas or acoustic neuromas.

How will I know that this procedure worked?

Our Gamma Knife Spokane doctors will follow up with you and do a repeat MRI within a month (sooner for some, later for others, depending on the tumor size and type).

What do I take with me after the procedure?

Upon the day of treatment, you, your referring physician and radiation oncologist will receive a photo of your treatment plan and a letter from the treatment team. With that photo may be a copy of the screen shot of your MRI.