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Frequently Asked Questions Regarding Radiation for Acoustic Neuromas and Glomus Tumors

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  • What are the Gamma Knife and CyberKnife used to treat?

    The Ear Institute of Chicago uses Gamma Knife and CyberKnife radiation treatments to treat two main types of tumors: acoustic neuroma and glomus jugulare tumors. Each of these tumors are benign, slow-growing tumors that grow in and around the deep structures of the ear. Since these tumors are slow-growing, there are three broad treatment options for each of these tumors: observation, traditional open surgery (microsurgery) and radiation treatment. There are a set of complex pros and cons that must be considered when choosing any of these options. Please consult Dr. Battista of the Ear Institute of Chicago to discuss these options in detail.

  • Are the Gamma Knife and CyberKnife approved by the Food and Drug Administration (FDA)?

    Yes, the Gamma Knife procedure was approved by the FDA in 1988 and has since been used to treat hundreds of thousands of patients around the world. The CyberKnife procedure was approved by the FDA in 1999 to treat tumors in the head and neck, and has also been used to treat of thousands of patients around the world.

  • What will happen the day of Gamma Knife treatment?

    After patients arrive at the Gamma Knife Center they are given a mild sedative (children are often completely anesthetized). Shortly after that time, a box-shaped head frame is attached to the head with four screws (two in front and two in back). The key to the gamma-knife's precision lies in this box-shaped frame. The frame serves two purposes: 1. It holds the patient's head perfectly still when radiation is given. 2. The frame acts as a reference point in determining exactly where the beams of radiation should converge.

    The four spots on the scalp where the screws enter are numbed first with injections containing an anesthetic similar to that used by dentists. Hair will not be shaved, but it may be tied back into a ponytail if it is long. The head-frame is lightweight, so patients are able to move their head around after the frame is attached to the skull.

    Once the head-frame is attached, an imaging scan (MRI or CT) is performed to locate the exact area inside the skull that needs treatment. Even though a scan may have been done before, these scans must be repeated with the head-frame in place.
    A transparent plastic box is attached to the head-frame for the imaging scans. This box has special material in it that acts as localizer when the physicians plan the necessary radiation configuration used for treatment.

    After the imaging scans are taken, it may take an hour or more for the targeting plan to be computed. During this waiting period, patients are taken to an area in the Gamma Knife Center where they can relax.

    When it is time for the treatment, the patient is asked to lie down in the radiation machine so that the patient's head is put into a helmet. The helmet attaches to the head-frame, which keeps the head perfectly still. This type of setup ensures that there is no head movement. The lack of head movement allows the radiation beams to converge on the target and not on the healthy tissue surrounding the target area(s).

    The helmet does not cover the face and the radiation is not felt by the patient. There is no noise during the treatment.

    The number of minutes that each radiation dose lasts is determined during the dose planning. Treatment may include multiple doses. Sometimes, more than one type of helmet and head position is used to deliver the radiation.

    The head-frame stays on the head through the entire procedure. When the frame is removed, the places on the scalp where the screws entered may be a little tender, but the pin sites typically do not scar. Some patients may have a headache or feel nauseated for a few hours after the procedure.

  • Will I be sedated?

    For Gamma Knife radiosurgery, adult patients will be given a pill to take prior to placement of the head frame. The pill causes a sensation of relaxation, but patients are still awake. The scalp is numbed (anesthetized) with an anesthetic similar to that used by dentists. Young children are given a general anesthetic for the entire procedure including placement of the head frame.
    For CyberKnife radiotherapy, no type of sedation is given.

  • How long does the procedure take?

    For Gamma Knife treatment, patients are asked to come to the Gamma Knife Center early in the morning. The head frame is typically placed shortly after 6:30 am. After the head frame is placed, a CT and MRI are performed with the head frame in place. The actual time of radiation varies depending on the size and location of the area to be treated. Most patients go home before Noon on the day of the procedure.

    For CyberKnife treatment, the actual time of radiation also varies depending on the size and location of the area to be treated. The number of treatments varies between three to five sessions. These session occur on separate days, sometimes with treatments occurring on back-to-back days.

  • Who is involved with the treatment plan for Gamma Knife and CyberKnife radiation treatments?

    Dr. Battista, a radiation oncologist and a physicist are the three team members that are involved with designing the treatment plan on the day of the procedure for Gamma Knife radiation, and a few days prior to start of treatment for CyberKnife radiation. Each of these three different team members has expertise in specific areas related to the treatment. Dr. Battista has special expertise in the anatomy and physiology of the anatomical area to be treated. The radiation oncologist has expertise in the amount of radiation to be used and a knowledge of the side effects of radiation. Finally, the physicist is an expert in radiation biology and the equipment used to deliver the radiation.

  • How quickly will the treatment work?

    The effect of a Gamma Knife and CyberKnife treatments can be seen in weeks to months, not immediately, as with traditional, open surgery.

  • What are the side effects?

    Headache and nausea my occur within the first 24 hours after treatment. These side effects are often short term, uncommon, and often effectively treated if brought to the attention of the physician or nurse.

    Long term side effects are related to both the type of tumor that is treated, as well as the size of the tumor. For a detailed discussion of long term risks of the Gamma Knife or CyberKnife treatments, please consult your doctor.

  • How is Gamma Knife and CyberKnife radiation different than exernal beam radiation?

    With standard external beam radiation therapy, tumors and much or all of the surrounding brain are treated with the same dose of radiation. Standard external beam radiation is given in small increments over several weeks to allow normal brain tissue to recover from the harmful effects of the external beam radiation. The brain can only absorb a certain dose of radiation, beyond which no further treatment is advisable.

    Gamma Knife and CyberKnife radiation, on the other hand, allows radiation to be largely confined to the target (e.g. a brain tumor) itself and little radiation reaches the surrounding brain. The treatment is given in one session or up to five sessions (for CyberKnife), not over a period of weeks, as is the case for external beam radiation.

  • What is meant by a “cure” in Gamma Knife and CyberKnife treatment?

    The cure of a brain tumor by Gamma Knife and CyberKnife radiation treatment means that the tumor loses its ability to grow and the tumor remains the same size, never growing again. The intensely focused radiation of Gamma Knife and CyberKnife destroy the ability of the cells to divide. Sometimes benign tumors actually shrink over time and malignant tumors may disappear completely. This curative process occurs over months to years.

  • Are Gamma Knife and CyberKnife treatments covered by insurance?

    Yes, most insurance plans cover Gamma Knife and CyberKnife treatments. Gamma Knife and CyberKnife treatments have been proven safe and effective over the long term.