Gamma Knife radiosurgery is a radiation tool known worldwide for its precise treatment of diseased areas of the brain. The Gamma Knife procedure is performed without incisions or the need for general anesthesia. The Gamma Knife Centre is located at the Toronto Western Hospital and works as a unique collaboration between the Neuroscience, Medical Imaging, and the Radiation Medicine Programs.
Read our guide to learn more about your gamma knife procedure, or click on the topic that matters most to you.
Usually
2 to 3 weeks before your procedure, you will have an appointment at
Toronto Western Hospital. This appointment could take
up to 6 hours, or sometimes longer. You can eat before your appointment (and you may want to bring a snack), unless your doctor has told you not to. Please wear clothes that you can easily remove and put back on for examinations and tests.
Gamma Knife Clinic
Toronto Western Hospital
McLaughlin Pavilion
TWH Maps & Directions
- Your health card (OHIP card), or another form of government-issued photo ID, such as a driver's license or passport.
- Any other insurance cards. You will need the policy number of your extended health insurance, if you have any.
- Your spouse/partner, a trusted friend or family member (to offer you support and be a second set of ears).
- All of your current medications in their original bottles or a list of all of your current medications.
- Name/address of your pharmacy.
- Name/address of your family doctor.
- A list of any questions you may have.
- The admitting clerk will register you.
- We will conduct blood work and, If ordered, we will take an
MRI.
- The nurse will ask about your health history and complete an in-depth assessment to help us manage your stay safely.
- You will see the pharmacist, who will record any medication you are currently taking.
- To get to know you better and to prepare for your operation, your health care team may ask you questions about:
- Your medical history
- Everyday activities you do
- What you normally eat
- Who you should call in case of emergency
- Details of your Power of Attorney for Personal Care or your Substitute Decision Maker or living will, if you have one.
If you are also having an angiogram, stop drinking at midnight on the night before your procedure. Your stomach needs to be empty. If you are not having an angiogram, you may have a light breakfast.
-
DO NOT wear makeup.
- Drink clear fluids, only, for the whole day. Examples of clear fluids you can drink:
- Apple juice
- Beef or chicken broth (no noodles or vegetables)
- Orange juice (without pulp)
- Grape juice
- Jell-O or popsicles
- Cranberry juice
- Pop (such as Ginger-ale, 7-Up, Coke)
- Lemonade
- Water
- Coffee or Tea
TIP: By drinking warm fluids such as tea or broth you may not feel as hungry.
- Pack a bag for the hospital, including important items such as:
Toiletries
- Medicines you need to take during the day. Bring them in their original containers.
- Toothpaste and toothbrush
- Activities to pass the time. You can bring books, crafts, DVDs or other items.
- Music to listen to during your procedure. You can bring an iPod or CD player.
- Deodorant
- Tissue
Clothing
- Loose-fitting clothes
- Loose non-slip footwear (such as Velcro runners)
- Underwear
Medication
- A list of current medications
Arrive
3 hours before your scheduled procedure time:
Medical Imaging Reception
Toronto Western Hospital
3rd Floor, East Wing, Room 448 - Go up the East elevators to the 3rd floor.
TWH Maps & Directions
All hospital entrances are open by 6 am. However, Bathurst St. and Leonard Ave. are easiest to access.
If there is no one at the reception desk, please have a seat and the nurse will come get you. DO NOT wait outside the Gamma Knife Clinic because no one is there at that time.
- Your health card (OHIP) card, or another piece of government issued photo ID, such as a passport or driver's license.
- Any other insurance cards. You will need the policy number of your extended health insurance, if you have any.
- Your spouse/partner, a trusted friend or family member (to offer you support and be a second set of ears).
- All of your current medications in their original bottles or a list of all of your current medications.
- Name/address of your pharmacy.
- Name/address of your family doctor.
- A list of any questions you may have.
- Activities to pass the time. You can bring books, crafts, DVDs or other items.
- Music to listen to during your procedure. You can bring an iPod or CD player.
- We will take your temperature, pulse, check your breathing, blood pressure, and do any other tests at this time.
- You will change into a hospital gown. Any belongings you do not need should be sent home with your family members.
- Your surgical team will interview you when you arrive in the surgical patient waiting area.
- Once in the operating room, we will put on your
head frame.
We will then take images of your head and brain. It will show the exact size, shape and position of the target in your brain. Your doctors may use Magnetic Resonance Imaging (MRI), Computerized Tomography (CT) or an Angiogram to do this.
If you are getting a CT or MRI
For these procedures, a dye may be injected into your veins. This will be done during the scan. It will help the doctors see your tumour(s) more clearly.
If you are getting an MRI, tell your doctor if you have:
- any implanted devices in your body (for example: a pacemaker.)
- ever worked with metal products
- any metal objects in your body
The staff will fill out a questionnaire with you before your MRI.
If you are having angiography
This is the test used if you have an Arteriovenous Malformation (AVM). For this scan, a dye will be injected into your veins. If you are allergic to the dye you must tell the doctor in the clinic before you are booked for treatment. You will be given a prescription for some special allergy medicine. A transparent box will be placed on your head over the frame during the scan. When the scan is done, the radiation therapist will take the box off. When your scans are done, you will go back to the Medical Imaging Day Unit. You will need to lay flat for 4 hours after the angiogram.
The radiation therapists will help you lie down on your back on the treatment bed. They will also help attach your frame to the treatment couch.
The radiation therapists will leave the treatment room during your treatment but they can see you on the video cameras. They can also talk to you if they need to. Before your treatment starts, the couch will move so that your head will be inside the treatment unit.
During treatment, you will not feel the radiation. There is also no noise from the treatment unit. The treatment can take several hours to finish.
You may move in and out of the treatment unit several times during your treatment. The radiation therapists may also have to adjust the position of your head frame.
You will need to stay still during your treatment. During this time you can listen to music in the room or you can bring your own iPod or CD player.
The stereotactic head frame is an important part of your treatment. It will be put on you the morning of your treatment. The head frame keeps your head very still during imaging and treatment. This helps make sure that the treatment only affects the target area in your brain. This frame stays on your head for the entire procedure.
A neurosurgeon will attach the lightweight titanium frame to your head. Before they put it on, you will get a local anesthetic injection. It will numb the areas on your head where the pins will be attached. The injection stings and burns for about 30 seconds. Then, when your medicine is working, the doctor will place the pins. They will use adjustable posts and pins. You will feel some pressure when the pins are placed. This feeling goes away in about 5 to 10 minutes. You will be moving around by wheelchair for the rest of the day. This is because it is not safe for you to walk with the head frame on. Someone will take you to the room for imaging.
After your procedure, the neurosurgeon or radiation oncologist will remove your head frame. You will then be taken back to the
Gamma Knife Clinic waiting room.
The pin sites on your forehead will be covered with small bandages. Do not get the pin areas wet for the next 24 hours. You may have some bleeding or discharge of fluid in the areas where the pins were placed. You may get a headache or minor swelling where the frame was attached.
You may have nausea and be sick to your stomach. The nurse will tell you to take deep breaths as this will help to decrease your nausea and fully expand your lungs.
We will monitor you for 1 hour after we remove your head frame. Then you may go home.
The neurosurgeon or radiation oncologist will remove your head frame. The pin sites on your forehead will be covered with small bandages. Do not get the pin areas wet for the next 24 hours. You may have some bleeding or discharge of fluid in the areas where the pins were placed. You may get a headache or minor swelling where the frame was attached.
You may feel numb or tingling on part of your head. You may notice this for the first few days after your procedure. It will get better in about 1 month.
You may have other side effects for about 1 week. You may:
- Feel tired
- Have headaches
- Lose some hair (very rare)
- Have nausea or vomiting
- Have some swelling or bruises over your eyes from the local anesthetic.
The nurse will give you a detailed list to follow when you get home. You can go back to your normal activities when you get home. Listen to your body. Rest if you need to. Start activities when you are ready.
Fatigue: Tiredness is a common side effect of radiation therapy. The day of your treatment will be a long day. It can be very tiring.
What you can do: Pace your activities and rest as needed. A well balanced diet and plenty of fluids may help.
Headaches: Many patients get headaches from wearing the frame.
What you can do: You may take Tylenol, Advil or a prescription pain medicine from your doctor if needed.
Swelling: You may notice swelling around your eyes. The local anesthetic can cause this.
What you can do: You can apply a cool compress to your eyes. This will ease the swelling.
Bleeding or discharge of fluid from pin sites: There may be some blood or fluid leaking from the pin sites for 2 or 3 days after treatment.
What you can do: This is not a sign of anything serious. For bleeding apply pressure with gauze for 5 minutes. The bleeding should stop. You may find spots of blood on the pillow for about 1 week. A little blood on the dressing or Band-Aids is normal. If the pin sites are leaking, clean the area with rubbing alcohol and cover with Band-Aids.
Nausea and Vomiting: You may feel nausea (wanting to throw up) and may vomit (throw up). But this does not happen to many people.
What you can do: Tell you doctor if you have an upset stomach. They can prescribe medicine to relieve the nausea and vomiting.
Hair Loss: Some patients experience hair loss in a small area of the scalp. But this does not happen to many people.
What you can do: You hair will grow back within a few months.
- Side effects that are severe
- Side effects that continue for more than 1 week
- Any signs of infection such as:
- Fever and/or chills
- Yellow pus and/or pin sites that are getting more red and tender
Call 911 to take you to the nearest emergency department if you:
- Have chest pain, tightness, or shortness of breath
- Have "the worst headache of your life" that does not go away by taking pain medication
Call your surgeon's office if you notice the following symptoms:
- Your incision is red, warm to the touch or has discharge or a bad smelling odour
- You have a fever (a temperature of 38°Celsius or higher for 2 days)
- You have pain that is not relieved by your pain medication
- You have a sharp pain or tenderness in the back of your calf or numbness and tingling to your foot
- Your surgeon's office is the first place to call with general post-operative questions.
Directory
To make or change appointments, call your surgeon's office.
-
Dr. Mark Bernstein
Phone: 416 603 6499 -
Dr. Fred Gentili
Phone: 416 603 5800 ext. 5250 -
Dr. Mojgan Hodaie
Phone: 416 603 6441 -
Dr. Suneil K. Kalia
Phone: 416 603 5866 -
Dr. Paul Kongkham
Phone: 416 603 5428 -
Dr. Andres Lozano
Phone: 416 603 6200 -
Dr. Ivan Radovanovic
Phone: 416 603-5800 ext. 620 -
Dr. Michael Tymianski
Phone: 416 603 5896 -
Dr. Gelareh Zadeh
Phone: 416 603 5679
Following up with all your doctors is important after the procedure. Before you leave the hospital we will talk about your follow-up appointment:
Directory
Dr. Mark Bernstein
Phone: 416 603 6499
Dr. Fred Gentili
Phone: 416 603 5800 ext. 5250
Dr. Mojgan Hodaie
Phone: 416 603 6441
Dr. Suneil K. Kalia
Phone: 416 603 5866
Dr. Paul Kongkham
Phone: 416 603 5428
Dr. Andres Lozano
Phone: 416 603 6200
Dr. Ivan Radovanovic
Phone: 4416 603 5800 ext. 620
Dr. Michael Tymianski
Phone: 416 603 5896
Dr. Gelareh Zadeh
Phone: 416 603 5679
When
Within the first week after your procedure. You are responsible for scheduling this appointment.
Where
Your surgeon’s office.
What to Expect
This appointment will let you doctor see how you are feeling. You may also have an MRI.
What to Bring
Your health card and a list of any medications you are taking.
Call this number from Monday to Friday, 8:30am to 4:30pm:
Gamma Knife Centre at Toronto Western Hospital
Phone: 416 603 5445
Call one of these numbers on evenings, weekend and holidays:
Neurosurgeon on-call (ask for the neurosurgeon on-call)
Phone: 416 340 3155
Radiation oncologist on-call (ask for the radiation oncologist on-call)
Phone: 416 946 2000
