Dan asks:
My mother is 78 years old and was just
diagnosed yesterday with meningiomas.
She is going to get another MRI of her
spine to see if there are meningiomas
there, too. Is she a proper candidate
for Gamma Knife radiosurgery? I am very
concerned about having my mother cut
open with brain
surgery due to her age
and if there is a nonsurgical alternative
for her, I would like to explore it.
Dr. Lee responds:
Absolutely, your mother would be
an excellent candidate for Gamma
Knife radiosurgery. It is less
invasive than traditional cranial
surgery, and is therefore often a
better alternative for elderly patients. |
Mireille asks:
I had breast
cancer five years ago. About
a year ago the cancer came back to the
lungs and
later to the brain.
In February of this year I had five lesions
removed with the Gamma Knife.
My latest MRI,
done in July, showed 10 new tumors. My
doctor is strongly recommending
whole brain radiation. I'm very uncomfortable
with this decision but also worried about
time.
Dr. Lee responds:
Whole brain radiation therapy remains
a good option with this number of
brain metastases. |
Nancy asks:
I have seen mentioned in literature that
possibility of benign tumors turning
malignant after radiation, like Gamma
Knife. What do you feel the chance is
of this occurring for acoustic
neuromas?
Mine is 13mm, but I am considering treatment
to curb hearing loss.
Dr. Lee responds:
This is an extremely rare and reportable
occurrence. Studies have attempted
to quantify this risk, but because
it is so rare, it is hard to study.
Gamma Knife radiosurgery remains
the best treatment for small to medium
sized acoustic neuromas. |
Stacey asks:
I have been diagnosed with trigeminal
neuralgia. CT and MRI show no tumors,
cysts or anything pinching the nerve.
Are there treatment options other than
medication when the cause is unknown?
Dr. Lee responds:
Yes, I perform microvascular decompression,
percutaneous glycerol rhizotomy,
and Gamma Knife radiosurgery as options.
I would be happy to see you and
discuss these treatment options.
If you would like to schedule an appointment,
please call us at 800-789-PENN. You
can also request
an appointment online. |
Jess asks:
Which do you think is safer to remove
a cerebral cavernous malformation: surgically
or with the Gamma Knife?
Dr. Lee responds:
Surgical resection is the preferred
management for this specific type
of cavernous malformation. However,
if the risks of surgery are high,
Gamma Knife radiosurgery may be an
alternative. |
Daniel asks:
In 2003, I had an acoustic
neuroma removed
surgically because it was too large (3.5cm)
to be treated with a Gamma Knife. When
the surgeon removed the tumor he
left a 2mm piece so as to not permanently
damage my facial nerve. Unfortunately,
the tumor grew back and I had Gamma Knife
radiosurgery in October 2006. Again,
unfortunately, this did not completely
kill the tumor and my most recent two
MRIs show
that the tumor continues to grow.
I
have heard that Gamma Knife radiosurgery
can only be done once because they
cannot use a radiation on the same
area more that once. Is that true and
if so what are my options, if any?
Also, if I have to have the tumor surgically
removed is it likely that I will have
permanent damage to my facial nerve,
and if so to what extent? What can
I realistically expect?
Dr. Lee responds:
Conventional radiation therapy over
a period of several weeks may be an
option. |
Rusty asks:
I had an MRI performed
at Pennsylvania Hospital two
months ago. There was the incidental
finding of "there
is a small anterior fax mass with possible
calcification, 7.4mm, calcified meningioma,
meningioma or ossification of the falx."
My neurologist said it was nothing. What
do you think?
Dr. Lee responds:
Most meningiomas of
this size can be followed with serial
MRI scans. I would be happy to see
you in consultation to discuss this
further. If you would like to schedule
an appointment, please call us at
800-789-PENN. You can also request
an appointment online. |
Sherri asks:
I have a friend who had the Gamma Knife
radiosurgery done eight years ago for
an arteriovenous
malformation (AVM) located at the
low temporal occipital junction on the
right, and had two seizures,
one following the other about a week
ago. She was under some stress at the
time. Could that have caused the seizures?
Dr. Lee responds:
It is possible that stress could
have contributed to her seizure;
however she should be sure to get
a new MRI scan and follow-up with
her physician. |
Clara asks:
My mom has a right acoustic
neuroma within
the internal auditory meatus, which is
about 5.5mm in width, 5mm in the antero-posterior
diameter and 5mm in the supero-inferior
diameter. She now resides in Hong Kong
(HK). The doctor in HK recommends my
mom to have Gamma Knife radiosurgery.
May I ask how much it costs for a Gamma
Knife Surgery at your facility, without
any insurance? We will pay the medical
expenses out of our pocket.
Dr. Lee responds:
All requests for treatment for international
patients need to be submitted to
Philadelphia International Medicine.
This organization assists international
patients in finding and coordinating
care in the Philadelphia region,
including the Penn Gamma Knife Center.
You can contact them via their
web site: http://www.philadelphiamedicine.com.
They will be able to provide information
regarding cost and assist in scheduling
a consultation for you mother, if
you so choose. Thank you for
your interest in our center. |
Tara asks:
I've been treated for migraines for
over 10 years. This past month I had
a headache that
lasted over three days. I went to the
emergency room and had a CT
scan (the
fourth in 10 years). This time they diagnosed
me with trigeminal
neuralgia. I'm having
a hard time finding any doctors to see
me because I do not have insurance. Would
I benefit from Gamma Knife and is there
any assistance in paying for it?
Dr. Lee responds:
Gamma Knife radiosurgery is a good
treatment option for patients with
typical trigeminal neuralgia. Unfortunately,
there is no assistance available
to help with the cost. |
Jules64 asks:
I have been diagnosed with a prominent
pituitary gland with 0.3x1.2cm delayed
enchaement in the central pituitary gland
with increased T1signal. It is compatible
with pituitary macroademona with hemmorrhage.
Also, with stable frontal white matter
change. I have been being treated for
1.5 years for severe depression.
After losing my sense of direction and
short term memory getting worse by the
moment they finally suggested the MRI,
after first findings they did a second
with contrast.
Am I a candidate for the
Gamma Knife radiosurgery? I do not
know the blood test reults yet. What
I do know is that I have been treaated
for colon polyps two years ago and
the severe depression, loss of intrest
in everything, and no sexual emotions
or needs at all. I though as all that
it was the depression. With these
findings and treatment can I be sure
that it has been the tumor the whole
time? Will the Gamma Knife help me?
Dr. Lee responds:
In general, I recommend an endoscopic
endonasal resection of pituitary
tumors, and I reserve Gamma Knife
radiosurgery for recurrences or residual
pituitary tumor. |
Pam asks:
I'm scheduled for Gamma Knife radiosurgery.
My pain lasts about 2-5 seconds (seems
like eternity), but I can feel a bit
of a burn afterwards. Does this mean
I may have atypical trigeminal
neuralgia
and that the Gamma Surgery may not help?
Does this mean I should not do the surgery?
Dr. Lee responds:
This sounds more like typical trigeminal
neuralgia. Gamma Knife radiosurgery
is a good treatment option for patients
with typical trigeminal neuralgia. |
Jan asks:
I had Gamma Knife, and no longer have
any pain (seven months). I understand
there is to be numbness and tingling,
but is itching of the face a side
effect and will any of the side effects
go away or subside? Is there something
I can take or apply to my face for
the itching?
Dr. Lee responds:
Itching can be a side effect of Gamma
Knife radiosurgery for trigeminal
neuralgia. It should improve. |
Ali asks:
I have been suffering from post-traumatic
neuralgia for eight years now as
a result of physical damage to my
left hand side trigeminal nerve.
My symptoms include pain and full
spasms on my left eye lids and cheek.
Will Gamma Knife offer any help at
all?
Dr. Lee responds:
Gamma Knife radiosurgery is unlikely
to help post-traumatic, neuropathic
facial pain. |
Denise asks:
Is Gamma Knife radiosurgery considered
for treating liver tumors near the pancreas
where standard surgery is contraindicated
because of the age of the patient?
Dr. Lee responds:
Gamma Knife Radiosurgery can only
be used to treat lesions within the
brain. It cannot be used to
treat liver lesions. |
Judy asks:
Could the Gamma Knife be used to treat
a post-traumatic arachnoid cyst causing
headaches, severe balance issues and
nausea? If so, what would the sucess
rates be like?
Dr. Lee responds:
No, unfortunately, Gamma Knife Radiosurgery
cannot be used in this case. |
Rick asks:
How many Gamma Knife procedures do you
perform annually at the Center? How does
that compare to other centers in the
region and nationally?
Dr. Lee responds:
We perform the most Gamma Knife procedures
in the Delaware Valley, approximately
300 case per year. |
Lee asks:
I was diagnosed with possible hemangioma or schwannoma after
progressive hearing loss and pulsatile
tinnitus in
right ear but it has taken four doctors
to classify the enhancement as such.
Would Gamma Knife be considered
in this scenerio? If so, can it preserve
hearing and/or deal with the pulsatile
tinnitus?
Dr. Lee responds:
Gamma Knife Radiosurgery can be used
to treat benign brain tumors including
schwannomas. I would be happy
to review your films. Please
send them on CD to:
Department of Neurosurgery
Attn: Dr. John Lee
330 South 9th Street
4th floor
Philadelphia, PA 19107
|
Jo asks:
My husband had a pancoast tumor.
He had Taxol, radiation, and finally
surgery to remove the tumor and part
of his lung. After more chemo,
a year later it had spread to his adrenal
gland/lymph nodes. He went on Alimta
and then Tarceva with no response. Although
the tumor is very slow growing they said
there is nothing more to do. Is this
procedure good for the adrenal gland?
Is there anything we can do?
Dr. Lee responds:
Gamma Knife Radiosurgery can only
be used to treat lesions in the brain.
It cannot be used to treat your husband's
adrenal tumor. |
Anil asks:
My wife has multiple spine arteriovenous
malformations (AVM) from
t10 t12. Please guide us for Gamma Knife.
Is it successful?
Dr. Lee responds:
Gamma Knife Radiosurgery can only
be used to treat lesions in the brain. It
cannot be used to treat spinal lesions. |
Diane asks:
My husband, 45 years old, has just received
the diagnosis of a meningioma located
in the front right top of his skull.
Not near his eye orbit. Two inches
front to back; one inch deep. He
is having headaches and
they said there is some evidence of brain
swelling around it from the pressure.
He's very concerned about the recovery
time with a standard craniotomy because
he is self-employed. What is the
difference in the Gamma Knife radiosurgery
and craniotomy? Is he a candidate
for it?
Dr. Lee responds:
Gamma Knife radiosurgery is a minimally
invasive way to treat Meningioma
without the need for conventional
surgery. In order to determine
his appropriateness for Gamma Knife
radiosurgery, I would need to review
his films to determine proximity
of the tumor to the optic nerve,
optic chiasm, and optic tract. I
would be happy to review his films
if you could send them to me on CD.
Please send them on to:
Department of Neurosurgery
Attn: Dr. John Lee
330 South 9th Street
4th floor
Philadelphia, PA 19107 |
Joanne asks:
My mother had Gamma Knife radiosurgery
exactly two years ago. Unfortunately,
her tumor has returned in the exact
same place. Can she have the same procedure
repeated?
Dr. Lee responds:
This depends on the type of tumor
and location. I would be happy
to review her films. |
Brenda asks:
I have a left 6cm temperal/parietal
arteriovenous
malformation (AVM). I have had
two embolizations done but there is still
10 percent that could not be treated
because it is too deep and the vessel
is huge. I also had several 9mm intranidal
aneurysms.
I have severe headaches everyday.
I have to go for speech therapy because
I can't remember my words. My eyes
get blurred daily and my right side
stays numb. Would I be a candidate
for the Gamma Knife radiosurgery?
If I just leave the rest of the AVM alone
without any more treatment am I at more
risk for a rupture?
Dr. Lee responds:
Gamma Knife Radiosurgery may be a
treatment option. I would be
happy to review your films. Please
send them on CD to:
Department of Neurosurgery
Attn: Dr. John Lee
330 South 9th Street
4th floor
Philadelphia, PA 19107 |
Nicki asks:
My 56 year-old sister was diagnosed in
six months ago with metastatic melanoma — five
tumors in
her brain. The largest was surgically
removed and biopsied; the remaining tumors
(and three new ones) were removed with
the Gamma Knife. After three months,
a new MRI shows
two new tumors and a reappearance at
the site of one original. She is set
to begin whole brain radiation this week.
Can the Gamma Knife be used again to
take out the existing tumors?
Dr. Lee responds:
Gamma Knife Radiosurgery can be used
to treat the two new metastatic melanoma
lesions. In fact, Gamma Knife
radiosurgery may be more successful
at controlling individual melanoma
metastasis as compared to whole brain
radiation therapy. |
72opal asks:
I am a 35 year-old female and was diagnosed
with a probable 8mm meningioma at
the left planum sphenoidale/posterior
cribriform plate a few months ago. But
one day before that I was admitted in
the emergency room for possible TIA. I
had all stroke-like symptoms. I am
still have weird symptoms slurring
speech, confusion, feel of tightning/tingleness
of face, more on the left. Could that
be from the meningioma?
Is this something that I should be
worried about and should
I be considering future treatment with
Gamma Knife? My doctor said 20 out
of 100 people have these meningiomas
and he gave me a script for Klonopin
and said to have another MRI in
a month. But after I went home and
looked up meningioma I saw that it
is usually a benign slow growing brain
tumor.
Why wouldn't he have told me
that? I did give him a MRI from
three years ago and it didn't show
the tumor at that time. I am confused
on what I need to do. He also said
it is strange how it is on the recent
MRI but not on the one from three years
ago. Should I be looking into Gamma
Knife?
Dr. Lee responds:
Gamma Knife Radiosurgery is an excellent
treatment for small meningiomas like
yours. |
Brenda asks:
I have a left 6cm temperal/parietal
arteriovenous
malformation (AVM). I had two embolizations
done but there is still 10 percent that
could not be treated because it is too
deep and the vessel is huge. I also had
several 9mm intranidal aneurysms.
I have severe headaches everyday.
I have to go for speech therapy because
I can't remember my words. My eyes
get blurred daily and my right side
stays numb. Would I be a candidate
for the Gamma Knife? If I just leave
the rest of the AVM alone without
any more treatment, am I at more
risk for a rupture?
Dr. Lee responds:
Gamma Knife Radiosurgery may be a
treatment option. I would be
happy to review your films. Please
send them on CD to:
Department of Neurosurgery
Attn: Dr. John Lee
330 South 9th Street
4th floor
Philadelphia, PA 19107
|
Nicki asks:
My 56 year-old sister was diagnosed in
five months ago with metastatic melanoma:
five tumors in her brain. The largest
was surgically removed and biopsied;
the remaining tumors (and three new ones)
were removed with the Gamma Knife. After
three months, a new MRI shows two new
tumors and a reappearance at the site
of one original. She is set to begin
whole brain radiation this week. Can
the Gamma Knife be used again to take
out the existing tumors?
Dr. Lee responds:
Gamma Knife Radiosurgery can be used
to treat the two new metastatic melanoma
lesions. In fact, Gamma Knife
Radiosurgery may be more successful
at controlling individual melanoma
metastasis as compared to whole brain
radiation therapy.
If you have any additional questions
or would like to schedule an appointment,
please call us at 800-789-PENN. You
can also request
an appointment online. |
Ellen asks:
I have been suffering from trigeminal
neuralgia for two years. Right now
I am in a fully active state. No
food, little or no fluids for two
days. My neurologist is out of town and
I am on max doses of meds. I would
like to have an evaluation from Dr.
Lee. How long is the waiting time for
an appointment?
Dr. Lee responds:
I would be happy to see you for a
consultation as soon as possible,
even this week. If you would
like to schedule an appointment,
please call us at 800-789-PENN. You
can also request
an appointment online.
I
let my scheduling coordinator know
to expect your call. Thank
you for your interest in the Penn
Gamma Knife Center. |
Nancy asks:
I had Gamma Knife radiosurgery on March 31, 2008 for a left frontal parasagittal meningioma that
was 3.1cm x 2.9cm x 2.2cm. My problem
is that I've been so fatiqued lately.
Is that a side effect of the Gamma
Knife?
My thyroid has been checked and it
is ok. I had no symptoms prior to Gamma
Knife but it had grown so thus the
Gamma Knife. Also, what are the symptoms
of edema and when does that typically
occur after the Gamma Knife.I was initially
on decadron after Gamma Knife and it
knocked me for a loop!
Dr. Lee responds:
Although uncommon, I occasionally
have patients with fatigue following
Gamma Knife radiosurgery. It is unclear
whether this is related to the treatment
itself or other factors. Edema at
the treatment site can occur at any
time in the first year after Gamma
Knife radiosurgery, but most often
occurs 3-6 months later. The first
symptom of edema is often headache. |
Christine asks:
I have been dealing with chronic nausea and headaches for over a year. After a number of tests and procedures, the only thing doctors can come up with is that I have an overactive chemoreceptor zone. I can't live like this and I was wondering if the ctz could be removed/deactivated using the Gamma Knife. I am desperate at this point.
Dr. Lee responds:
No, Gamma Knife radiosurgery cannot be used to treat overactive chemoreceptor zones. |
ZlajaJ asks:
My mother had lung cancer surgery and no chemo given afterwards. This was due to excellent reports from the oncology doctor. However, it metastisized to two parts of her brain. The Gamma Knife procedure was performed. However, why can't a surgery be performed to get the lessions out?
Dr. Lee responds:
Gamma Knife radiosurgery is often an
effective alternative to surgery
for the management of small to medium
sized brain lesions. Gamma Knife
radiosurgery eliminates the need
for an invasive procedure, such as craniotomy,
which often poses greater overall
risk to the patient. |
Robert asks:
We are US citizens based in Philippines. My wife is 36 years old with no previous significant history. Onset tongue "numbness " week of May 26. Progressed to right-sided facial "numbness" by time of birth of child July 1. While in hospital post c-section, internal medicine consult found neuro exam normal except decreased (8/10) sensation to touch on right side of face.
MRI done with and without contrast. Mass in cavernous sinus on trigeminal nerve (2.1 x 1.8 x 1.5cm). Clinical opinion here of three neurosurgeons seen say meningioma or neuroma, with two out of three opting for neuroma. Stereotactic radiosurgery recommended, but at least four options of types of stereotactic radiosurgery discussed. Would like US-based opinion on appropriate intervention. Specifically why is one technique better than other for this?
Dr. Lee responds:
The Gamma Knife is inarguably the gold standard by which all other intracranial radiosurgical delivery methods are judged. Not only was it the first, it still remains the only tool that is dedicated solely to intracranial lesions, such as your cavernous sinus lesion.
Since the introduction of Gamma Knife in the 1950's, there are now many competitors that have emerged. Some of the advantages of the competitors include the fact that that they can be used to treat brain tumors as well as lung, spine, and prostate tumors. Hence, the competitors are "all-purpose" knives.
Gamma Knife stereotactic radiosurgery is extremely accurate, but it does require a frame. This stereotactic frame is light weight and is affixed to your outer skull with four pins. The frame provides exact MR correlation from planning to treatment delivery in 3D. It is with the use of this frame that Gamma Knife provides pinpoint accuracy at less than 0.5mm. Without a frame, other forms of radiosurgery may not be as accurate.
In addition, I authored the largest paper published on cavernous sinus meningioma and Gamma Knife radiosurgery. I have attached a copy of the paper for your convenience. |
Laura asks:
My 17-year-old son has a hemangioblastoma
on the lower thoracic region of his spine.
He has VHL and was diagnosed with secondary
polycythemia. Is he a candidate for Gamma
Knife radiosurgery?
Dr. Lee responds:
Gamma Knife is designed to be used
only in the brain, and hence it is
the most powerful and precise tool
for brain tumors. It cannot be used
to treat tumors in the spine. |
Meyers asks:
My husband has this constant ringing
in his left ear. He saw a ear specialist
and had a CAT
scan, which the results
show that there is a cyst on
the left side of brain cover. Is this
a common occurence in patients? Since
the first scan six months ago, he
has lost more hearing. Could this cyst
be having an effect on his hearing?
Dr. Lee responds:
If this is an arachnoid cyst, they
generally do not cause symptoms unless
they expand. |
Stan asks:
Does this leave less possibility of cancer
spreading? Also does medicare
cover this?
Dr. Lee responds:
Radiosurgery typically is reimbursed
by most insurance companies, PPOs,
HMOs and Medicare when indicated. |
Susan asks:
My son was born with a ganglin cell tumor which
caused seizures. The tumor was removed
when he was three and a half. He was
seizure-free for 11 years. He is now
having status seizures.
Our surgeon is thinking of surgery. He
thinks it might be the edge where the
tumor was removed causing the seizures.
However, if we go back in, they say it
will affect his motor skills. His right
hand is very weak already. Is he a candidate
for Gamma Knife?
Dr. Lee responds:
Yes, he is a candidate for Gamma
Knife radiosurgery. I
would be happy to review your son's
case. Please mail the actual films
and relevant notes to my office at:
330 South 9th Street
4th floor
Philadelphia, PA 19107
I would be happy to review the case
and contact you with my recommendations. |
Dawg asks:
Is there a certain number of brain lesions
where Gamma Knife will not be used? My
father has four lesions that are all
about 4cm in size. Is this too many
and too large?
Dr. Lee responds:
Each patient's situation is
unique and there are many factors
involved in determining whether Gamma
Knife radiosurgery is a valuable
treatment option. Four lesions
is generally not too many, however,
the maximum size limit is usually
3-3.5cm.
I would be happy to
review his case. Please mail the
actual films and relevant notes to
my office at:
330 South 9th Street
4th floor
Philadelphia, PA 19107
I would be happy to review the case
and contact you with my recommendations. |
Faith
asks:
My sister has been diagnosed with
stage four metastatic melanoma in
lymph nodes in her neck, abdomen
and pelvic area, but we just learned
she has it in her brain also. She
has two large tumors (3.5 and 2.5)
and they say too many small ones
to count. They are doing WBR on the
small ones, but they said if the
radiation doesn't shrink the small
ones then they won't bother to do
the Gamma Knife on the larger ones.
Do you concur with this?
They said
they are not even bothering with
the rest of the cancer unless they
get the brain tumors under control.
She is 46 years old and had a mole
removed 13 years ago and they say it's
recurrent from that! Do you agree
with the plan they are doing?
Dr. Lee responds:
The addition of Gamma Knife can definitely
improve local tumor control. The
overriding concern, however, is whether
it will increase her survival. |
Marie asks:
My grandmother has been diagnosed with
a glioblastoma in
what the neurosurgeon called the "the
back basement of the second floor of
the brain." It is in
a critical area. As I did not get the
information first hand, I can't get
any more detailed than that. My grandmother
has type
II diabetes, is partially blind,
and has smoked since her teens.
The neurosurgeon
would like to do a biopsy,
but we do not think she would be even
able to handle that. Our concern now
is quality of life, not quantity, but
because of her recent dementia due
to the tumor, we were wondering if
direct radiation would alleviate it?
Would she even be a candidate for the
Gamma Knife?
Dr. Lee responds:
We currently use Gamma Knife radiosurgery
for recurrent glioblastoma multiforme
after conventional radiation treatment
and chemotherapy treatment.
Her dementia is unlikely to improve
with Gamma Knife radiosurgery. |
Betey asks:
My husband has a one inch diameter
benign tumor on the vermis of the
cerebelum. He has mild symtoms. We
were told there is nothing that can
be done for him because of the tumor's
location. Can you help?
Dr. Lee responds:
I would be happy to review his case.
Please mail the actual films and
relevant notes to my office at:
330 South 9th Street
4th floor
Philadelphia, PA 19107
I would be happy to review the case
and contact you with my recommendations. |
Suresh asks:
My father is suffering from tumor.
Three impressions from the MRI report
as follows:
3x2
cm well-defined lobulated extra
axial isointense lesion at the level
of foramen magnum on the left side-
schwannoma / para gangiloma.
Bilateral
mastoiditis
Small lacunar infarcts
in bilateral parietal white matter.
Is Gamma Knife treatment feasible
for this size of tumors? Please help
me out with your valuable feedback
as we are unable to come to you. If
you have any idea where this Gamma
Knife treatment available in India?
Eagerly waiting for the response.
Dr. Lee responds:
Yes, Gamma Knife radiosurgery is an
option. I would be happy to review
his case. Please mail the actual films
and relevant notes to my office at:
330 South 9th Street
4th floor
Philadelphia, PA 19107
I would be happy to review the case
and contact you with my recommendations. |
