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Linda asks:
I had Gamma Knife radiosurgery about a year ago (for a right acoustic neuroma) and have been experiencing a constant ring in my ear, somtimes worse than usual. Is this from the tumor or Gamma Knife radiosurgery? And will it subside?

Dr. Lee responds:
The tinnitus, or ringing, that you are experiencing could be from the tumor or secondary to the Gamma Knife treatment. This is a difficult question for which there is not an easy answer. However, tinnitus tends to subside over time in the majority of patients with acoustic neuroma who have undergone Gamma Knife radiosurgery treatment.

If you would like to discuss this further, please call 800-789-PENN (7366) and ask to be connected to Dr. John Y.K. Lee's office. You can also request an appointment online.

Ray asks:
Can you please describe the conditions under which the Gamma Knife or microsurgery procedures would be a superior over endoscopic surgery for acoustic neuroma?

Dr. Lee responds:
Gamma Knife has an excellent safety record for patients with small to medium sized acoustic neuromas. The risks of Gamma Knife are far less than that of conventional surgical resection, and I would be happy to discuss them with you.

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.

F. Scott asks:
I have a recurrence of an acoustic neuroma which now measures some 33mm x 24mm approx. Would I be considered for Gamma Knife surgery? What constitutes a small, medium and large acoustic neuroma?

Dr. Lee responds:
Based on your description of your acoustic neuroma recurrence, you would be considered for Gamma Knife radiosurgery.

Typically, the maximum dimension of a lesion in any one direction is stated as 3.0 to 3.5 cm for Gamma Knife radiosurgery, however, there are other important factors that must be considered when making the decision to treat using Gamma Knife radiosurgery including the volume of the tumor, the patient's age and medical condition, and prior intervention.

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.

Sumedha asks:
My husband, 50 years old, was diagnosed with right acoustic schwannoma. The lesion measures 34mm (anteroposteriorly), 30mm (side to side), 30mm (superoinferiorly). Can he be a candidate for Gamma Knife?

Dr. Lee responds:
Small to medium-size acoustics are generally best treated with Gamma Knife radiosurgery. Larger tumors may require microsurgical resection first, followed by Gamma Knife for any residual tumor.

I would be happy to review the images and then speak with your husband about eligibility for Gamma Knife radiosurgery.

Please feel free to contact me with any questions about your care by calling 1-800-789-PENN (7366) or request an appointment online.

Edmund asks:
I have been just diagnosed with an acoustic neuroma measuring 1.3 x 0.6 cm. I am interested in Gamma Knife radiotherapy in place of conventional neurosurgery. Can I send you a CR-ROM of the MRI to look at and comment on?

Dr. Lee responds:
Gamma Knife Radiosurgery has revolutionized the management of patients with acoustic neuromas. The number of craniotomies and surgical resections has decreased over the last few years, and the number of Gamma Knife radiosurgical procedures for acoustic neuromas has increased. It is a safe and minimally invasive option for you.

If you would like to discuss this further, please call 1-800-789-PENN (7366) and ask to be connected to Dr. John Y.K. Lee's office. You can also request an appointment online.

Marianne asks:
My 25 year-old son has just been diagnosed with a 1-2cm trigeminal schwanoma situated within the front and back compartment of the brain. We are currently at the monitoring stage to check its growth rate with a view to Gamma Knife or a double crainiotomy.

His symptoms have been stabbing facial pain and numbness and vision problems in his left eye. Would you be so kind as to tell me what experience you have with these? They are quite rare in the UK and even more rare in one so young.

Dr. Lee responds:
Although trigeminal schwannomas are not as common as vestibular schwannomas (a.k.a. acoustic neuroma), trigeminal schwannomas can behave similarly. Gamma Knife radiosurgery is very effective at controlling the growth of schwannomas of the brain.

In addition, Gamma Knife has been shown to help patients with pain in the face associated with tumors. For example, there are patients with meningiomas of petrous apex or tentorial margin which cause facial pain. Gamma Knife can treat the tumor and help with the pain.

I would be happy to review the films and discuss eligibility over the telephone. Please call 800-789-PENN (7366) and ask to be connected to my office.

Chris asks:
I was wondering if I had been diagnosed with a acoustic neuroma causing ringing in the ears. And if I have the acoustic neuroma removed with Gamma Knife radiosurgery, would the tinnitus be reduced? Are there any long-term side effects from getting an acoustic neuroma removed from the inner ear nerve, (loss of hearing and or louder ringing)? Did you have any positive outcomes with patients on this subject alone?

Dr. Lee responds:
Tinnitus effects are difficult to quantify. However, in a prospective cohort study conducted at the Mayo Clinic, Pollock et al. demonstrated improved quality of life in patients who underwent Gamma Knife as compared to surgery for similar size tumors. Hence, Gamma Knife is currently an excellent option for patients with small to medium size acoustic neuromas.

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.

BarbDom asks:
My wife Barb had Gamma Knife surgery 29 months ago for an acoustic neuroma on the left side. The tumor seemed to shrink for a while but now is definitely re-growing at the same rate as before the treatment. The size is now 22 mm TRANSV INC IAC and 17 mm mean intracranial diameter.

Is my wife eligible for a second Gamma Knife treatment? What may happen if she has another Gamma Knife treatment and it doesn't work again? What are the pros and cons of this and of an eventual resection?

Dr. Lee responds:
I would be happy to see you in consultation in the office regarding this. Please call 800-789-PENN (7366) to schedule an appointment. You can also request an appointment online.

Scott asks:
My wife has an acoustic neuroma tumor, about 2.4 cm. We have seen four specialists, two ear/nose/throat doctors, two neurosurgens... all with different opinions. It is cystic (2 small cysts inside of turmor). One doctor sugested Gamma Knife is not as effeictive on cyctic tumor therefore surgery is the right course of action. We traveled to another hospital and they recommended radiation and it would be no problem on either cystic or non-cystic tumors.

Are there any stats on Gamma Knife reaction on cystic turmor vs tumors? What are the low dose radiation effects on the rest of the body after Gamma Knife? My wife was set to have the Gamma Knife but the doctor put doubt about Gamma Knife response to cystic tumors.

Dr. Lee responds:
I have not heard of cysts decreasing the response to Gamma Knife.  In general, small to medium size acoustic neuromas of this size are definitely amenable to Gamma Knife.

If you have any additional questions or would like to schedule an appointment with me, please call us at 800-789-PENN. You can also request an appointment online.

Daniel asks:
One of my close relatives, a 23 year-old female, has been diagnosed with acoustic neuroma. Her MRI scan revealed a large (42 x 31 x 29 mm) mass legion that is fairly well circumscribed right CP angle extra axial. Is it adjoining the right petrous bone and can be seen compressing/distorting adjacent cerebellar hemisphere, right cerebellar peduncles, and right side of the brainstem.

The fourth ventricle and distal cerebral aqueduct appear compressed along their right antero lateral aspects. This mass could not be identified as separate from cisternal segment of right th/8th nerve complex. No definite extension was seen into the right internal auditory canal on non-contrast scan.

The neurosurgeon has advised surgery, explaining the possibility of imminent seventh nerve damage (facial nerve)! She currently does not show any neurological complaints like headache, nausea, imbalance, etc. Hearing loss is persistent for at least the past four to five years. No hydrocephalous condition has been observed.

Is this suitable for Gamma Knife radiosurgery? We are obviously concerned with the traditional surgery due to facial nerve damage possibliity. We are from India.

Dr. Lee responds:
Aggressive surgical debulking with minimal risk to the facial nerve followed by Gamma Knife radiosurgery is one of the better options in this situation. I perform this type of approach with the goal of maximizing normal neurologic function and maximizing tumor control. I would be happy to discuss your situation with you.

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.

Diane asks:
I have been diagnosed with a 2 cm acoustic neuroma. I have been seeing a prominent doctor in the area regarding this. I mentioned the Gamma Knife procedure to him and he was strictly opposed to it. He said if I had Gamma Knife and needed surgery after, he would not do it. I don't understand. I read all your questions and answers and it appears like I am a good candidate for Gamma Knife. What's your opinion?

Dr. Lee responds:
You are an excellent candidate for Gamma Knife, and I would be happy to see you in consultation. We have performed many procedures for patients with exactly the same size tumor with great success.

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.

Cheryl asks:
I was very recently diagnosed with acoustic neuroma. If I have the Gamma Knife procedure performed, will the ringing stop in my ears? Will I lose my hearing altogether? What is the effective rate of Gamma Knife on this particular situation?

Dr. Lee responds:
Depending on the size of the tumor, Gamma Knife has definitely shown to result in improved hearing rates, facial nerve preservation rates, and quality of life as compared to conventional surgical resection.

If you would like to schedule an appointment, please call us at
800-789-PENN or you can also request an appointment online.

Chuck asks:
I recently had acoustic neuroma surgery but they were only able to remove half of it because I started hemoraging. Is it possible to have the Gamma Knife surgery now. The tumor is now 1.5 cm?

Dr. Lee responds:
Absolutely. Gamma Knife radiosurgery is very commonly used in this situation. Indeed, Gamma Knife has changed the management strategy of acoustic neuromas, because sometimes complete resection is too risky to the facial nerve and hearing nerve, and thus it is sometimes better to debulk the tumor and then to Gamma Knife the rest.

If you would like to schedule an appointment, please call 800-789-PENN or you can also request an appointment online.

Flora asks:
My mother recently underwent surgery for a 2.5 cystic acoustic neuroma. Sadly, the tumour was so involved in the facial nerve, the surgeon decided not to remove any of the tumour, thinking that it could instead be treated with Gamma Knife.

She has a few small cysts in the tumour, plus 2 large cysts attached to it(which the surgeon drained). The surgeon believed there are really good possibilities with Gamma Knife despite the cysts. Do you agree?

Dr. Lee responds:
Absolutely. In fact, this staged approach has become a valuable approach for many patients. It maximizes clinical outcome by avoiding hearing and facial nerve injury, and controls tumor growth.

Mrs. Riley asks:
I am 31 years old with near normal hearing in my ears. I have minimal balance issues. I have a 1.8 cm left acoustic neuroma. Should I receive gamma knife treatment? Am I too young to watch and wait?

Dr. Lee responds:
For small to medium size acoustic neuromas, Gamma Knife offers many advantages over conventional surgery.

Rosie asks:
I was recently diagnosed with a 9mm x 8mm x 10mm acoustic neuroma. I am a healthy 49 year-old. I'm very confused on which route of treatment to take. I thought about the surgery but the risks scare me, yet what are the risks of Gamma Knife down the road? Please help me try to make a decision!

Dr. Lee responds:
Gamma Knife has an excellent safety record for patients with small to medium sized acoustic neuromas. Your tumor definitely fits in the small category. The risks of Gamma Knife are far less than that of conventional surgical resection, and I would be happy to discuss them with you.

If you would like to schedule an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

Peggy asks:
I am claustrophic and looking at how the Gamma Knife is done. I don't know that I could handle it, do they give sedatives? I have an acoustic neuroma - medium size pressing on brain stem.

Dr. Lee responds:
We provide one nurse per patient and all our nurses are trained to provide intravenous sedation so that you will not feel anxious or much pain.

Jo asks:
I recently had Gamma Knife and found the fitting of the halo very painful (acoustic neuroma). Is this typical because the skull itself cannot be numbed?

Dr. Lee responds:
We generally provide both intravenous medications and local infiltration at the pin sites to minimize the pain associated with halo placement. Most patients tolerate the procedure very well.

Shoma asks:
My husband has been diagnosed with acoustic neuroma. The MRI scan detects "the presence of a large cavitary mass in the cerebellopontine angle cistern that measures 3.2 x 3.0 cm. There is no extension in the left internal auditory canal. The above abnormality probably represents an acoustic schwannoma...". He has severe headaches and dizziness/nausea. Will Gamma Knife treatment be effective in his case and would it cure this problem?

Dr. Lee responds:
If you mail the films to my office, I would be happy to review them and then speak with you about your case.

If you would like to schedule an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

Maggie asks:
I'm considering options for treatment of my acoustic neuroma (approx 11mm x 12mm) and the Gamma Knife is very appealing. I weigh about 244 lbs and am about 5'5" tall. Am I too big for treatment with the Gamma Knife?

Dr. Lee responds:
You are not too big for Gamma Knife. I would be happy to see you and to discuss your options.

If you would like to schedule an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

Shyam asks:
I underwent stereotactic radiosurgery a couple of years back for reoccoured acoustic neuroma . On the Neurosurgeon's advice, I had my MRI done one year after the SRS. Last year the follow-up MRI revealed no change in the size of the tumour. I am due for an MRI again early next year. I would like to know what would be the options before me if the tumor does not shrink or becomes larger?

Dr. Lee responds:
Less than 10 percent of patients demonstrate increase in size of the tumor after Gamma Knife radiosurgery. However, conventional resection would be the primary option, depending on your situation. I would want to review your case more thoroughly, prior to making any specific recommendations, however.

To schedule an appointment, please call 1-800-789-PENN (7366). You can also request an appointment online.

Engee asks:
My sister had undergone Gamma Knife radiosurgery when her acoustic neuroma (facial nerve neuroma) measued 29 x 24 x 27 mm. Now after six months, an MRI scan shows 31 x 21 x 27 mm. She still experiences headaches and other symptoms she had before the operation. Please advise what should be done.

Dr. Lee responds:
Fortunately, we now have a lot of experience with Gamma Knife for acoustic neuromas, and we know that there can be some temporary swelling of the tumor after Gamma Knife. This is usually seen in the first few months. Usually, the MRI scan also demonstrates central necrosis, eg. a black center on the MRI scan. With future scans, most of these tumors will shrink over time.

Cliff asks:
Could a treated neuroma turn malignant as a result of treatment? What is the time span? Is there pertinent factor related to cranial surgery versus Gamma Knife treatment? I have a decision to make about which procedure to choose.

Dr. Lee responds:
There is a very rare risk of malignancy formation in the same area as Gamma Knife treatment which is usually seen 10 to 20 years after Gamma Knife. There have been six reported cases in the literature out of almost 400,000 patients who have undergone Gamma Knife radiosurgery.

It is difficult to truly quantify this risk, but most patients are willing to accept it. The alternative usually involves the 1/1000 risk of death or 1/100 risk of hearing loss or facial paralysis associated with the conventional craniotomy and resection of an acoustic neuroma.

Ann asks:
I was diagnosed with a 1.2cm acoustic neuroma 2.5 years ago and am currently investigating my treatment options. Could you tell me why I should choose Gamma Knife over Cyberknife?

Dr. Lee responds:
There are many reasons why Gamma Knife is superior to other technologies. For example, Gamma Knife has the longest proven track record for treating acoustic neuromas. It is the gold standard by which all other competitors are measured. The Gamma Knife is designed only to treat brain lesions and therefore the users of Gamma Knife are focused on brain lesions. Nothing is more accurate than the Gamma Knife. All other competitors always compare themselves to Gamma Knife.

Larry asks:
I am 61 years old, very physically fit and fairly healthy. I have just been diagnosed with an acoustic neuroma vistibular 5cm. After hearing from my doctor about conventional surgery, the recuperation time and the after-effects of surgery I feel that Gamma Knife would be a god-sent alternative. However, since my tumor is large I would like to know if I'm a candidate for this procedure. My tumor is on the right side. I have hearing loss, some balance problems and numbness of the lips and tongue.

Dr. Lee responds:
Five centimeters is large for Gamma Knife radiosurgery, primarily because the advantages of stereotactic dosing are lost with such large volumes. Hence, the best course of action is surgical debulking with radiosurgery for the residual. The plan should be to debulk the tumor and to maximize neural preservation even if this means that there is some tumor left behind. You can always Gamma Knife residual tumor, but you cannot reanimate a paralyzed face.

Charlie asks:
One doctor says wait and see; the next doctor says treat it now. One doctor says Gamma Knife; the next doctor says Cyber. Now what? I'm 61, very healthy with and acoustic neuroma 2.2 cm. I have 10% hearing loss on the left side and left cerebellar pontine angle that causes impression on brainstem.

Dr. Lee responds:
Unlike the situation twenty years ago, today there are many options for the treatment of patients with acoustic neuroma. There is no single best solution for any patient, since each option has advantages and disadvantages. For example, Gamma Knife radiosurgery is extremely accurate, but it requires a frame. Without a frame, Cyberknife may not be as accurate. Surgery removes the tumor, but there are risks of death and stroke. In addition, watchful waiting with serial MRI scans is always an option.

Please feel free to call 1-800-789-PENN (7366) and ask to be connected to Dr. John Y.K. Lee's office at Pennsylvania Hospital.

Charlie asks:
After an exam that took place at my local Veterans Hospital and a subsequent MRI and neurosurgeon exam, I have been diagnosed to have an acoustic neuroma measuring approxamitely 2.1 to 2.4 cm.

I am a healthy, active 60 year-old currently living in Southern Florida during the winter, and return to Southern New Jersey in the spring each year. After searching the Web and speaking with a number of folks, your name and “The Penn Gamma Knife Center” were highly recommended as to where “I need to go”.

Most of my support base (family and friends) reside in the Philadelphia area, therefore I’d like the opportunity to meet with you to explore my options for radiosurgery.

I can arrange my schedule to visit with you at your earliest convenience. I am a Vietnam Vet and currently utilizing my veterans medical benefits for services. Dr Lee, I hope that I have the opportunity to visit with you in the very near future. Please advise as to how I should proceed with appointments.

Dr. Lee responds:
Gamma Knife Radiosurgery has revolutionized the management of patients with acoustic neuromas. The number of craniotomies and surgical resections has decreased over the last few years, and the number of Gamma Knife radiosurgical procedures for acoustic neuromas has increased. It is a safe and minimally invasive option for you.

To schedule an appointment at the Penn Gamma Knife Center, please call 1-800-789-PENN (7366) or you can also request an appointment online.

Stuart asks:
I have a re-occurence of an acoustic neuroma . It was surgically removed in 1989. Hearing was lost on the effected side. No facial nerve loss was apparent. A 1995 MRI was clear; in a 2000 MRI a very small tumor was missed. The 2006 MRI shows a tumor measuring transverse 14 x AP 8mm with volume of 387 cubic millimeters.

I'm considering Gamma Knife or Cyberknife treatment. Can you comment on the two treatments and do you recommend one over the other. Do you do both treatments?

Dr. Lee responds:
The Gamma Knife is 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. There are now many competitors that have emerged over the decades since the introduction of Gamma Knife in the 1950s. 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. In contrast, the Gamma Knife is used ONLY for intracranial lesions, such as your acoustic neuroma.

Perhaps more important than choice of instrument, however, is the choice of radiosurgeon and team. You should be comfortable with their level of experience and expertise.

Another benefit of your situation today is that you have multiple options. In 1989, the year you had surgery, Gamma Knife radiosurgery had only just been installed at the University of Pittsburgh and University of Virginia, and Cyberknife had not yet been invented. Hence, patients like yourself did not have many options. Today, however, you have the good fortune to be able to choose to either wait and see, to repeat surgery, or to choose radiosurgery either with the Gamma Knife or other competitors.

Please feel free to contact me with any questions about your care by calling 1-800-789-PENN (7366) or request an appointment online.

Heather asks:
My mother-in-law was just diagnosed with acoustic neuroma, the tumor is benign and of medium size. The doctors are reluctant to perform surgery because she has factor V blood disease which requires her to be on blood thinners for the rest of her life. Would she be a candidate for Gamma Knife? And how effective is this procedure?

Dr. Lee responds:
Your mother-in-law who has a hematologic problem is a perfect candidate for Gamma Knife radiosurgery of the acoustic neuroma. Facial nerve and hearing preservation rates can be quite high in addition to tumor control. Please feel free to contact me regarding her care by calling 1-800-789-PENN (7366) or request an appointment online.

LR asks:
I have been diagnosed with a right acoustic neuroma measuring 11mm by 9mm. I experience some lose of balance when moving suddenly and if some one whispers to me, I do not know what they are saying to me. My neurologist asked me to see a neurosurgeon, which I did, and he suggested seeing you. I am 54 years of age. It was suggested Gamma Knife surgery. I have a family history of father falling alot and ringing in his ears, and grandfather with the same symptoms. My grandmother had bell palsy and fell alot. Is this a hereditary gene or is just so happens we all have the same symptoms. I am a little scared and don't want to fall and break bones since I have osteopenia at this point in time. Will the ringing in the ears stop and loss of balance.

Dr. Lee responds:
Although hearing loss is a prominent symptom of acoustic neuromas, many patients find tinnitus (ringing in the ear) and vertigo (spinning sensation) to be more bothersome. Fortunately, we have some data on hearing preservation. Unfortunately, we do not have good data on the effect of Gamma Knife radiosurgery on tinnitus and vertigo. This is something that I have been working with the otorhinolaryngologists to collect.

Sandy asks:
I was diagnosed in 2000 with an acoustic neuroma. My annual MRI's haven't shown growth until this Feb. It measured 2.2 x 1.6 cm on axial images (it was 1.9 x 1.6 cm on 2/14/06) & 1.9 x 1.4 cm in maximum dimension on coronal image (it was 1.9 x 1.3 cm on 2/14/06).

I was wondering if I'm a candidate for the Gamma Knife or radiostatic surgery? Am I yet at serious risk for intercranial pressure?

Dr. Lee responds:
If your acoustic neuroma is growing and is still < 3.5 cm in maximum dimension, you are definitely a candidate for Gamma Knife radiosurgery. I would be happy to see you in consultation to discuss the procedure and the risks.