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sooner."},"fly_home_after_days":{"min":1,"max":3,"unit":"days","qualifier":"Flight usually allowed the day after treatment if headache, nausea or neurological symptoms are absent and pin sites are fine."},"follow_up_visits":[{"purpose":"assessment","requirement":"routine","after":{"min":90,"max":180,"unit":"days","qualifier":"First clinical and MRI review commonly at about 3-6 months; subsequent schedule depends on indication."}}],"indications":["Brain metastases (limited number, small to moderate size)","Vestibular schwannoma and meningioma","Arteriovenous malformations","Trigeminal neuralgia","Pituitary adenoma and other small skull-base tumors","Selected functional disorders (e.g., tremor, obsessive-compulsive disorder) in specialist centers","Residual or recurrent small intracranial lesions after surgery"],"main_risks":["Transient headache, nausea, fatigue","Pin-site soreness or bleeding with frame-based systems","Radiation-related brain edema, sometimes needing steroids","Delayed radionecrosis","Seizure","New or worse neurological deficit, e.g., hearing loss, facial numbness","Hair loss at beam entry sites (usually minor)","Pituitary hormone deficiency after sellar treatment"],"pain":"Radiation delivery is painless; discomfort mainly comes from local-anesthetic injection and frame pins, with mild headache afterwards.","preparation":["Recent MRI (and sometimes CT or angiography) for target definition","Multidisciplinary review of indication and dose plan","Review of medical history, implants and pregnancy status","Fasting or medication guidance per center protocol","Arrange an accompanying adult for the day of treatment"],"recovery_timeline":[{"phase":"Day of treatment","description":"Frame removal after beam delivery, observation for a short period, then discharge home.","restrictions":["Avoid driving on treatment day","Rest"]},{"phase":"First days to 2 weeks","description":"Possible mild headache, fatigue and pin-site tenderness; most people resume light activity quickly.","restrictions":["Avoid strenuous exertion initially"]},{"phase":"Months after","description":"Imaging and clinical follow-up to assess lesion response and delayed effects.","restrictions":[]}],"rehabilitation_days":{"min":1,"max":3,"unit":"days","qualifier":"Ordinary functional recovery after a single-session outpatient treatment; excludes any deficits from the underlying disease."},"result_longevity":"Local tumor control is durable, often many years for benign lesions such as schwannoma and meningioma. Trigeminal neuralgia relief may recur over years; metastases need ongoing surveillance for new lesions.","revision_rate_pct":{"min":5,"max":20,"unit":"percent","qualifier":"Repeat radiosurgery, surgery or other salvage treatment for local progression or incomplete response within several years."},"scars":"No incision; tiny temporary pin-site marks may occur with a head frame.","sessions_or_stages":{"sessions":{"min":1,"max":1,"unit":"visits","qualifier":"Single-fraction frame-based radiosurgery; multi-fraction stereotactic radiotherapy is a separate protocol."},"stages":[{"code":"radiosurgery_session","label":"Frame or mask fixation, planning imaging, dose planning and radiation delivery in one day","after":{"min":0,"max":0,"unit":"days","qualifier":"Same day as the first treatment visit."}}],"qualifier":"Follow-up imaging visits are not counted as treatment sessions."},"success":{"metric":"Local tumor control after radiosurgery","value":90,"unit":"percent","horizon":"1-5 years","population":"Adults with small brain metastases, schwannoma or meningioma treated with single-session radiosurgery","evidence_status":"limited"},"techniques":[{"name":"Gamma Knife (cobalt-60) frame-based radiosurgery","suits_whom":"Small to moderate intracranial targets, e.g., metastases, schwannoma, AVM, trigeminal neuralgia.","recovery":"Same-day discharge; light activity within days."},{"name":"Linear accelerator (LINAC)-based radiosurgery (e.g., CyberKnife, Novalis)","suits_whom":"Patients preferring frameless or mask fixation for intracranial targets.","recovery":"Outpatient with a short recovery; frameless setups avoid pin-site discomfort."}],"treatment_conditions":["outpatient"],"treatment_duration_hours":{"min":2,"max":5,"unit":"hours","qualifier":"Whole treatment day for single-session frame-based radiosurgery: fixation, imaging, planning, delivery; beam time is shorter."},"initial_assessment_documents":["Brain MRI with contrast, DICOM files","Radiology reports of recent imaging","Biopsy or pathology report (if available)","Previous radiotherapy or radiosurgery records (if available)","Recent neurosurgery or oncology consultation letter"],"travel_trips":{"min":1,"max":1,"one_trip_possible":true,"qualifier":"Single-day outpatient treatment; stay 2-4 days including pre-treatment checks. Follow-up MRI at 3-6 months is usually done at home."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Confirm the surgeon is trained and experienced in the exact procedure you are considering, not just in surgery generally","scope":"treatment_abroad","source":{"url":"https://www.isaps.org/discover/patients-home/considering-your-procedure-abroad/finding-a-surgeon-abroad/","host":"isaps.org","quote":"Verify that the surgeon is trained and experienced in performing the procedure you are considering.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C2","text":"Ask for certification information and the name of the body that certified the surgical setting","scope":"treatment_abroad","source":{"url":"https://www.isaps.org/discover/patients-home/considering-your-procedure-abroad/finding-a-surgeon-abroad/","host":"isaps.org","quote":"Ask for certification information and the name of the certifying body when assessing a surgical setting.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C3","text":"Check that the surgeon who consults with you is the same person who will carry out the procedure","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Check that the surgeon you consult with, will be the same person carrying out the procedure.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C4","text":"Ask whether a doctor is always present in the clinic and whether a high dependency or intensive care unit exists","scope":"treatment_abroad","source":{"url":"https://www.bapras.org.uk/public/patient-information/cosmetic-surgery/cosmetic-surgery-abroad","host":"bapras.org.uk","quote":"Is there always a doctor in the clinic and is there a high dependency or intensive care unit?","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C5","text":"Ask whether the surgeon and the facility use a surgical safety checklist, which can reduce complications","scope":"treatment_abroad","source":{"url":"https://www.isaps.org/discover/patients-home/considering-your-procedure-abroad/finding-a-surgeon-abroad/","host":"isaps.org","quote":"Do the surgeon and his/her facility use a safety checklist?","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"red_flags":{"status":"ok","items":[{"id":"F1","text":"An advert or information that guarantees complete success should raise concerns","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Any advert or information that guarantees complete success should raise concerns.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F2","text":"Forceful persuasion or cheap, time-limited offers pushing you into a quick decision","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Don’t be pressured into quick decisions either through forceful persuasion or cheap, time limited offers.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F3","text":"A price that sounds too good to be true probably is","scope":"treatment_abroad","source":{"url":"https://www.plasticsurgery.org/news/articles/will-economic-uncertainty-drive-more-patients-overseas-for-plastic-surgery-what-to-consider-and-how-to-stretch-your-dollar-back-home","host":"plasticsurgery.org","quote":"If the price sounds too good to be true, it probably is.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"warning_signs":{"status":"missing","reason":"no_official_source","checked_at":"2026-11-13","next_check_at":"2027-02-11"},"take_home":{"status":"ok","items":[{"id":"T1","text":"Home doctor needs the clinic's follow-up recommendations in a written discharge summary","document":"discharge summary","source":{"url":"https://sbuhb.nhs.wales/about-us/individual-patient-commissioning/ipc-folder/advice-on-accessing-treatment-abroad","host":"sbuhb.nhs.wales","quote":"When you have treatment abroad, you must ask the treatment provider for their follow-up recommendations documented within a written discharge summary in English.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T2","text":"Ask for copies of all prescriptions before you leave","document":"prescription copies","source":{"url":"https://travelhealthpro.org.uk/news/699/travelling-abroad-for-treatment","host":"travelhealthpro.org.uk","quote":"Remember to ask for copies of all your treatment records, including prescriptions, scans and x-rays before you leave.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T3","text":"Home doctor needs the dates for required blood tests and follow-up appointments","document":"written aftercare plan","source":{"url":"https://sbuhb.nhs.wales/about-us/individual-patient-commissioning/ipc-folder/advice-on-accessing-treatment-abroad","host":"sbuhb.nhs.wales","quote":"This should include any medication and doses, as well as any dates that blood tests and follow-up appointments must be carried out.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"alternatives":{"status":"missing","reason":"no_official_source","checked_at":"2026-11-13","next_check_at":"2027-02-11"},"technique_details":{"status":"ok","items":[{"id":"gamma-knife-frame-based","name":"Gamma Knife (cobalt-60) frame-based radiosurgery","how_it_works":{"text":"Radiation beams are sent toward the tumor from a treatment unit","source":{"url":"https://my.clevelandclinic.org/health/procedures/stereotactic-radiosurgery","host":"my.clevelandclinic.org","quote":"Then, the unit will send the radiation beams toward the tumor.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},"recovery_daily":{"event":"back_to_daily_activities","min":1,"max":2,"unit":"days","label":"1–2 days","source":{"url":"https://braintumorcenter.ucsf.edu/about-brain-tumors/treatment/radiation-therapy/gamma-knife-faq","host":"braintumorcenter.ucsf.edu","quote":"Most patients resume normal activities within a day or two, and you can eat and drink as you feel able.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}}},{"id":"linear-accelerator-based","name":"Linear accelerator (LINAC)-based radiosurgery (e.g., CyberKnife, Novalis)","how_it_works":{"text":"X-rays are sent toward the tumor as an arm moves","source":{"url":"https://my.clevelandclinic.org/health/procedures/stereotactic-radiosurgery","host":"my.clevelandclinic.org","quote":"As it moves, it sends X-rays toward the 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