EMERGENCY:For new or worsening neurological deficit, severe headache unresponsive to paracetamol, or seizure after Gamma Knife — call the KIMS emergency line —call040-46324365immediately — 24 hours, 7 days— 24/7
Gamma Knife Radiosurgery — Step-by-Step: What Happens on Your Treatment Day at KIMS Hyderabad
Arrival, frame fitting, MRI and CT imaging, multidisciplinary treatment planning, radiation delivery, recovery, and follow-up — the complete Gamma Knife day at KIMS Neuroscience, in the order it happens.
- The treatment day timeline — 4–6 hours in total
- Arrival: 30 min (check-in, IV cannula, consent review, pre-medication). Frame/mask: 20–30 min (Leksell stereotactic frame fitted at 4 scalp points under local anaesthetic, or thermoplastic mask for Esprit frameless). MRI and CT: 30–60 min (high-resolution 1 mm T1 with gadolinium, with the frame in place). Treatment planning: 60–120 min (joint session between neurosurgeon, radiation oncologist, and medical physicist on Leksell GammaPlan). Radiation delivery: 15–120 min (depending on tumour size, isocenters, dose rate). Frame removal and discharge: 60 min.
- What to expect during radiation delivery — the most reassuring fact
- The patient lies inside the Gamma Knife unit with the frame locked into the machine. The 192 beams are delivered automatically — the patient experiences no sound, no vibration, no heat, no visible light, no sensation of any kind. The patient can listen to music, rest, or simply wait. Delivery may take 15 minutes for a small single target or up to 120 minutes for large or complex cases. Continuous monitoring via intercom and camera; the treatment can be stopped at any time. Most patients find it much easier than anticipated.
- The Leksell stereotactic frame — what frame fitting involves
- The frame is fitted at four points: two above the forehead and two at the back of the skull. Local anaesthetic is injected at each pin site; the pins are then tightened against the outer table of the skull — they do not penetrate it. The sensation: firm pressure at the four sites, brief stinging of the local anaesthetic, then no pain for the remainder of the day. The most common patient feedback: 'it was not as bad as I expected.'
- Pre-procedure preparation — the day-before checklist
- Day before: take regular medications as usual unless told otherwise; wash hair the night before (harder to wash for 24–48 hours after the frame); no hair products (gels, oils, sprays) on the day. Treatment day: A light breakfast is permitted on the morning of the procedure. Bring a companion who can drive you home and stay the first night; bring all prior MRI films and reports and your medication list. The KIMS Gamma Knife team sends a written checklist at the pre-procedure consultation.
- Post-procedure — what happens and what to watch for
- After the frame is removed, the patient has a light meal, vital signs are checked, and the neurosurgeon reviews the case. Patients go home the same afternoon. In the days after: mild pin-site headache (paracetamol) and fatigue for 1–2 days. The tumour does not disappear immediately — the treatment works over days to months. Follow-up MRI at KIMS: 3 months, 6 months, then annually. Remote MRI follow-up is available for out-of-Hyderabad patients.
- Post-procedure emergency
- Emergency contact: 040-46324365
| Fact | Details |
|---|---|
| Timeline | 4–6 hours total: arrival (30m) + frame (20–30m) + imaging (30–60m) + planning (60–120m) + delivery (15–120m) + discharge (60m) |
| Planning | Joint: neurosurgeon + radiation oncologist + medical physicist · Leksell GammaPlan software · Target outlined · Critical structure dose constraints set · 60–120 minutes |
| Delivery | No sound, sensation, heat, or visible light · Patient listens to music or rests · Continuous monitoring via intercom and camera · Patient can request stop at any time |
| Frame fitting | 4 skull pins at local anaesthetic sites · Mild pressure, not penetrating the skull · Most patients: 'not as bad as expected' · Removed at end of procedure (5 min, painless) |
| Post-procedure | Same-day discharge · Mild headache (pin sites) + fatigue for 1–2 days · No immediate tumour change · Follow-up MRI: 3 months, 6 months, annually |
| Post-procedure emergency | Emergency contact: 040-46324365 |
| Out-of-Hyderabad | Remote MRI follow-up available (images sent to KIMS) · 040-44885000 · neuroscience@kimshospitals.com |
A Precisely Choreographed Day — Step by Step, In the Order It Happens
The Gamma Knife treatment day is a precisely choreographed sequence of steps, each of which builds on the last to produce the final treatment. Understanding what happens at each stage — and why — transforms what could be a frightening experience into a manageable one. This page describes the complete Gamma Knife day at KIMS, from the moment you arrive to the moment you go home, in the order it happens.
Book a Consultation
Speak directly with the KIMS Gamma Knife team for a pre-procedure consultation that walks you through every step.
040-44885000Emergency line: 040-463243654–6 Hours from Arrival to Discharge
A typical Gamma Knife treatment at KIMS takes 4–6 hours from arrival to discharge: approximately 30 minutes for frame fitting, 30–60 minutes for MRI and CT imaging, 1–2 hours for treatment planning by the physics and neurosurgery team, 15–120 minutes for the actual radiation delivery (depending on tumour size and complexity), and 1 hour of post-treatment observation before discharge.
The Full Day at a Glance — Stage, What Happens, Duration
The comparison matrix below summarises the entire Gamma Knife treatment day in sequence, including what happens at each stage and the approximate duration.
Stage
What Happens
Duration
Arrival and preparation
Check-in · IV cannula · Consent review · Pre-medication
Frame or mask application
Stereotactic frame or thermoplastic mask fitted under local anaesthetic
MRI and CT imaging
High-resolution MRI (and sometimes CT) with frame/mask in place
Treatment planning
Neurosurgeon + radiation oncologist + physicist design dose plan
Radiation delivery
Patient positioned in Gamma Knife unit · Treatment delivered
Frame removal and observation
Frame removed · Post-procedure monitoring · Light meal
Discharge
Review by neurosurgeon · Discharge instructions · Follow-up MRI scheduled
Total
Arrival to discharge
The Gamma Knife Procedure Stack at KIMS
The six main treatment-day steps — followed by the full clinical detail of each in the sections below.
Step 1: Arrival and Preparation
Morning arrival · A light breakfast is permitted on the morning of the procedure · IV cannula placed · Consent reviewed · Pre-medication (dexamethasone, antiemetic, optional anxiolytic) administered.
Step 2: Frame or Mask Application
Leksell stereotactic frame fitted at four pin sites under local anaesthetic — or thermoplastic mask for hypofractionated Esprit treatments. The frame is the basis of sub-millimetre targeting.
Step 3: MRI and CT Imaging
High-resolution 1 mm isotropic T1 + gadolinium with the frame in place — the relationship between the tumour and the frame's coordinate system gives the exact physical target inside the Gamma Knife.
Step 4: Treatment Planning
Joint planning by neurosurgeon, radiation oncologist, and medical physicist on the Leksell GammaPlan system. Target and critical structures outlined; dose distribution optimised.
Step 5: Radiation Delivery
Patient docked in the Gamma Knife unit; planned isocenters delivered automatically. No sound, sensation, heat, or visible light — patient rests, listens to music, or simply waits.
Step 6: Frame Removal and Discharge
Frame removed (5 min, painless) · vital signs monitored · light meal · neurosurgeon reviews · written discharge instructions issued. Patients go home the same day.
Arrival and Pre-Procedure Preparation
What happens when you arrive
You arrive at KIMS Neuroscience in the morning (typically 8–9 am). A light breakfast is permitted on the morning of the procedure. An IV cannula is placed in your arm for medication delivery during the procedure. Your neurosurgeon or the Gamma Knife team reviews your consent and answers any last questions. Medications given at this stage include: dexamethasone (a steroid to reduce any peri-tumoural swelling that can be transiently exacerbated by radiation) · An antiemetic (to prevent nausea) · A mild anxiolytic (if requested by the patient · most patients tolerate the procedure without sedation, but oral lorazepam or diazepam is available for those who feel anxious). Blood pressure is measured. For patients with trigeminal neuralgia, antiepileptic medication is usually continued until the day of the procedure.
What to bring and what to do the day before
The day before your Gamma Knife: take your regular medications as usual unless specifically told otherwise · Wash your hair the night before (you will not be able to wash it easily for 24–48 hours after the frame) · Do not apply hair products on the day of the procedure. A light breakfast is permitted on the morning of the procedure. On the day: bring a family member or friend who can accompany you home and stay with you the first night · Bring all previous MRI films and reports · Bring your medication list.
Stereotactic Frame Application (or Mask Fitting)
The Leksell stereotactic frame — what happens
The stereotactic frame (Leksell coordinate frame) is the device that ensures sub-millimetre targeting precision. KIMS currently uses the Leksell Vantage Frame — a resin-based ring that surrounds your head. It is significantly lighter than the traditional metal G Frame, which makes it more comfortable to wear, and it keeps the same submillimetre accuracy. It is attached at four points: two on your forehead and two at the back of your head, using small titanium pins. Before the pins are placed, the scalp at each pin site is cleaned and injected with local anaesthetic (the same type used by dentists for tooth extractions). The local anaesthetic stings briefly during injection; after that, the pin placement is painless. Each pin penetrates only 1–2 mm into the outer table of the skull — not deep into the brain. The frame is secure but not painful once in place; most patients describe it as a feeling of mild pressure or weight on the head.
How long the frame is on
The frame is fitted at the beginning of the day and remains on throughout the imaging and treatment phases. It is removed at the end of the procedure — typically after 4–6 hours. The removal takes about 5 minutes and is painless. Small marks remain at the four pin sites, which heal within 1–2 weeks.
Frameless mask-based alternative — for multi-session treatment
For patients undergoing hypofractionated Gamma Knife (2–5 sessions), the thermoplastic mask system (Leksell Esprit) is used instead of the rigid frame. A personalised thermoplastic mask is fitted around the head and face — similar to those used in conventional radiotherapy. The mask is made by heating a perforated plastic sheet and moulding it to the face while it is warm and pliable, then allowing it to cool and harden. This takes approximately 15 minutes. The mask is not claustrophobic for most patients; for those with significant claustrophobia, an anxiolytic is given beforehand. During each treatment session, real-time cone-beam CT (CBCT) imaging verifies head position within the mask and compensates for any small movements.
Imaging — MRI and CT
Why imaging is repeated on the day of treatment
You have already had MRI scans in the days or weeks before your Gamma Knife day, used to confirm the diagnosis and plan the approach. The MRI performed on the day of Gamma Knife is different: it is acquired with the stereotactic frame in place and is used specifically for treatment planning. The relationship between the tumour (on MRI) and the frame coordinate system (measured precisely) is used to calculate the exact physical coordinates of the target within the Gamma Knife machine. The same tumour on a scan without a frame cannot be used for this calculation.
MRI protocol for Gamma Knife planning
High-resolution 1 mm isotropic T1 with gadolinium contrast (for tumours) · T2 FLAIR for oedema and anatomy · Specific sequences depending on the condition: T2 for AVM nidus delineation · CISS or FIESTA for trigeminal nerve visualisation · Pituitary dynamic contrast enhancement for adenomas. CT scanning is added in some cases to provide bony anatomy detail and for patients in whom MRI is contraindicated. The imaging takes 30–60 minutes in total.
Treatment Planning
Who designs the treatment plan
The treatment plan is designed jointly by the neurosurgeon, the radiation oncologist, and the medical physicist. This is a team process — not a single specialist's decision. The physicist provides the technical dose calculation expertise; the radiation oncologist advises on dose-fractionation and tumour biology; the neurosurgeon provides the anatomical expertise and final target definition. The process: (1) The imaging is loaded into the Leksell GammaPlan treatment planning system. (2) The target (tumour, AVM nidus, or nerve) and critical structures (optic nerves, brainstem, cochlea) are outlined on the imaging. (3) The planning software calculates the dose distribution for proposed isocenters, beam configurations, and dose levels. (4) The plan is optimised until the prescribed dose covers the target and all critical structure dose constraints are satisfied. (5) The plan is reviewed and approved by all three team members.
How long planning takes
Treatment planning takes 60–120 minutes, depending on the complexity of the case. A simple single brain metastasis with one isocenter may take 45–60 minutes. A complex multi-target plan (multiple brain metastases or a large, irregularly shaped meningioma) requiring multiple isocenters may take 90–120 minutes. During this time, the patient rests comfortably in a private room with the frame in place, accompanied by family or a nurse.
Radiation Delivery
Positioning in the Gamma Knife unit
The Gamma Knife unit at KIMS is a large, cylindrical device in a radiation-shielded room. The patient lies on a motorised treatment couch that slides into the centre of the unit, with the stereotactic frame mechanically docked to the unit's coordinate system. Once docked, the patient's head is precisely positioned so that the planned isocenter coincides exactly with the Gamma Knife's convergence point. A helmet-like structure surrounds the head but does not touch it. The patient cannot see into the beam channels but is visible on a CCTV monitor and can communicate with the team throughout treatment via an intercom.
What happens during radiation delivery — the patient experience
Nothing happens that the patient can perceive. Gamma radiation is completely undetectable — there is no sound, no sensation, no heat, and no visible light from the radiation itself. The machine makes gentle mechanical sounds as the sectors adjust their positions between isocenters. The duration of radiation delivery depends on the plan: a small acoustic neuroma may take 15–25 minutes · A complex multi-target brain metastasis case may take 60–90 minutes. The patient can request a brief pause at any time via the intercom and can be quickly withdrawn from the unit if needed. Most patients rest quietly, listen to music through headphones, or simply wait during treatment.
How many isocenters and how many shots
Each “shot” positions the patient so that the isocenter is at a specific target point. For a single small tumour, 1–3 isocenters (shots) may be sufficient. For a larger or irregularly shaped tumour, 10–20 or more shots may be planned. The Leksell Gamma Knife Perfexion delivers each shot automatically, repositioning between shots without any manual adjustment. The total treatment time is the sum of all individual shot times plus repositioning time.
Frame Removal and Post-Procedure Care
Frame removal and pin site care
After treatment is complete, the frame is removed by loosening the four pins. The pin sites are cleaned and a small dressing is applied to each. No stitches are needed. Patients are advised to clean the pin sites gently with saline or antiseptic wipe twice daily for 3–5 days.
Post-procedure observation and discharge
The patient rests for 30–60 minutes after the frame is removed. Vital signs are monitored. A light meal is provided. The neurosurgeon reviews the patient before discharge and provides written discharge instructions. Patients feel well enough to travel home by private car on the day of the procedure. Driving is not permitted on the day of the treatment (due to pre-procedure sedation). For patients who have travelled from outside Hyderabad, staying overnight in the hospital or a nearby hotel and travelling home the next morning is recommended.
The Days and Weeks That Follow
Immediate (day 1–3) — what is normal
Mild headache (from the frame sites and the procedure): managed with paracetamol · Fatigue: patients feel tired for 1–3 days and should rest · Dexamethasone: continued for 3–5 days post-procedure (to manage any radiation-induced oedema) and then tapered · Nausea: uncommon but managed with antiemetics if present. Alert symptoms requiring urgent review: new or worsening neurological deficit (weakness, speech difficulty) · Severe headache unresponsive to paracetamol · Seizure. Call 040-46324365 if any alert symptom occurs.
Weeks 1–8 — the latency period
Gamma Knife does not destroy tumours instantly. The radiation causes DNA damage that leads to cell death over weeks to months. During the first 4–12 weeks: the tumour may appear unchanged on MRI · Some tumours temporarily swell (pseudo-progression or radiation necrosis) before shrinking, causing a transient increase in symptoms · Steroids (dexamethasone) are used during this phase if symptoms worsen. For trigeminal neuralgia patients: pain relief typically begins 4–12 weeks after treatment; analgesic medication is continued throughout this period.
Follow-up MRI schedule — how we monitor the response
The follow-up imaging schedule depends on the condition treated: Brain metastases: MRI at 6–8 weeks, then every 2–3 months for 1 year, then every 3–6 months · Acoustic neuroma and meningioma: MRI at 6 months, 1 year, then annually · AVM: MRI + MRA at 6 months, 1 year, 2 years; catheter angiography at 3 years to confirm obliteration · Trigeminal neuralgia: clinical follow-up at 4–6 weeks, 3 months, 6 months, 1 year · Pituitary adenoma: MRI at 6 months, 1 year; hormonal studies at 6 months, 1 year, then annually. Follow-up MRI can be performed at any hospital; the images and reports are sent to KIMS for review.
What Patients Should Know
The Gamma Knife treatment day at KIMS is a precisely choreographed sequence of steps. The points below summarise the most clinically significant facts patients and families deserve to know before treatment.
Total time from arrival to discharge: 4–6 hours — a single-day procedure with no hospital admission for patients
Frame pins penetrate only 1–2 mm into the outer table of the skull — not deep into the brain — and the four sites heal within 1–2 weeks
Gamma radiation is completely undetectable to the patient — no sound, sensation, heat, or visible light during delivery
Treatment planning is a joint process between the neurosurgeon, radiation oncologist, and medical physicist on the Leksell GammaPlan system
Each Gamma Knife shot is delivered automatically by the Leksell Perfexion — repositioning between isocenters requires no manual adjustment
Dexamethasone is continued for 3–5 days post-procedure to manage any radiation-induced oedema, then tapered
Pain relief from Gamma Knife for trigeminal neuralgia typically begins 4–12 weeks after treatment — analgesics continue through the latency
Out-of-Hyderabad patients can have follow-up MRI performed locally and DICOM images sent to KIMS at neuroscience@kimshospitals.com for remote review
Related Treatments
Explore related Gamma Knife and neurosurgical pages at KIMS Neuroscience:
Frequently Asked Questions
Knowing Exactly What Will Happen Makes the Day Significantly Less Frightening — Gamma Knife at KIMS Hyderabad.
Knowing exactly what will happen on the day makes the Gamma Knife experience significantly less frightening. At KIMS Hyderabad, the Gamma Knife team provides a detailed pre-procedure consultation that walks you through every step, answers every question, and ensures you arrive on the day prepared and calm. Call 040-44885000.
International enquiries: info@kimsneurosciences.com