A stereotactic targeting system is attached to the head under general anesthetic. After intraoperative stereotactic CT and fusion of the MRI examination carried out preoperatively, the operation is planned. In a first step the radiation therapy is simulated on the computer screen, thereby determining the number and intensity of the radiation sources and their optimum positions. For the procedure the skull is partially shaved, a 3cm to 4cm skin incision is made and a small (diameter about 8mm) hole burred through the bone of the skull. After the thin teflon catheters containing the seeds have been implanted, the catheters are anchored directly above the burr hole with a small metal clip and bone cement. This cement also closes off the burr hole. And finally the skin is closed with sutures. Depending on the number of seeds and teflon catheters needed for implantation, the total procedure may take several hours (from stereotactice frame attachment to closure of the skin).

In certain types of tumor, brachytherapy is supplemented by conventional radiation therapy in the first week after seed implantation. In some patients the radiation sources are left for at least 9 months, while in others they remain in the tumor for just a few weeks. Please discuss these aspects in person with your healthcare professionals in the Department of Stereotactic Neurosurgery.