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Tricia asks:
I understand the cut-off for Gamma Knife is 3cm. My acoustic neuroma is 2.2 x 2.9cm and located in the CP angle. There is "moderate mass effect" on the brain stem, but i don't have symptoms of compression.

I know I am a borderline case. I wonder if Gamma Knife will be effective (given the size) and safe (given the effect on the brain stem). I also have the option of treatment with a linear accelator (fractionated).

Can you please give me your thoughts on my suitability for Gamma Knife?

Dr. Lee responds:
There are other considerations, not just size of the lesion, in deciding whether or not to use Gamma Knife radiosurgery for treatment. Some of these are your age, any co-morbidities, other medical risk factors, and personal choice. Gamma Knife radiosurgery may be a reasonable option for you.

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.

Tambo asks:
I had an 8mm acoustic neuroma surgically removed in 2003 but it has now reoccurred. Is either Gamma Knife or chemotherapy an option for me or would it be better to have surgically removed a second time.

Dr. Lee responds:
Gamma Knife radiosurgery is an excellent option for acoustic neuroma recurrence after conventional surgery.

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.

Tennakoon asks:
My wife went through Gamma Knife for an acoustic neuroma two years ago and it was originaly 2.5 x 2.8 x 2.5. Then, after the Gamma Knife, it came to 2 x 2.5 x 2 and the most recent scan (MRI) shows a 2 x 2.8 x 2. What can we do about it now? It's been 2.6 years since the Gamma Knife.

Dr. Lee responds:
Acoustic neuromas follow a typical pattern after Gamma Knife radiosurgery. After Gamma Knife radiosurgery, some acoustic neuromas remain stable in size, some swell and then subside, and only 5% increase in size.

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.

Joe asks:
I have an eight year-old daughter that has an arteriovenous malformation (AVM) the size of a pea. The doctors have given me the option of brain surgury or the Gamma Knife. I would like to know the risks and side effects of the Gamma Knife compared to brain surgury.

Dr. Lee responds:
This is a difficult question to answer over the internet, because risks in neurosurgery depend heavily on the location of the lesion.

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.

Yoshida asks:
My son had a craniotomy in October 2007 to remove an arteriovenous malformation (AVM). Last Friday his doctor told us that he still has an 8mm AVM. He is suggesting embolization. Would Gamma Knife be better? The location is frontal right lobe.

Dr. Lee responds:
In this situation in an adult, Gamma Knife radiosurgery would be a definitive procedure to cure him, however the decision to use Gamma Knife radiosurgery much depends on your son's age.

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.

Mary Ellen asks:
My daughter, 25, was diagnosed with a dural AV fistula in November of 2005. She has been under the care of a local neurosurgeon who has treated her with embolization. She has had 5 procedures (embolizations) since April 2007, the last being yesterday in August 2007.

She has been told at least two more, and if desired results are not obtained she could be looking at surgery. Do you think Gamma Knife radiosurgery would be an option for her, other than open cranial surgery.

Dr. Lee responds:
Gamma Knife radiosurgery is definitely a less invasive option for dural AV fistulas. Success rates are similar to the results for arteriovenous malformations.

Megan asks:
My 29 year old husband was diagnosed with a 3x3x2 AVM in the anterior carotid artery. Apparently the location of the AVM is difficult to treat (the area includes his vision and speech abilities). My husband does not have any symptoms except that 3 months ago he had a severe headache for 3 days, which caused him to go get an MRI, followed by an MRA, followed by an angiogram.

After the angiogram, the doctor in NYC recommended a conservative approach which is to continue with MRI's every year under a Nova Study. However, we'd like to get a second opinion. Would this AVM be a candidate for the gamma knife? If no symptoms are presenting now, is it too risky to do gamme knife surgery?

Dr. Lee responds:
An arteriovenous malformation of that size is definitely a candidate for Gamma Knife radiosurgery. Some of the theoretical benefits in this situation is that Gamma Knife induces gradual closure and obliteration of the arterial feeders to the AVM and thus minimizes complications to the surrounding brain. I would be happy to review his case.

Jess22 asks:
My husband was diagnosed with a 4.5cm AVM behind the brain stem and beneath the posterior fossa it is deep seated and has a large collateral blood supply.

We have seen 4 different doctors and recieved mixed recommendations. The first doctors said that there is no treatment available and the others recommended Gamma Knife but never discussed risks associated with the procedure and likelihood of cure.

In your experience have you known Gamma Knife to be helpful with these lesions, what is the % for risks, what are the risks, and how many treatments would a lesion of this magnitude require? The AVM has never bled it only caused mass effect hydrocephalus so we are unsure of what path to chose. Thank you, also do you have any Neurosurgeons that you recommend in the Midwest?

Dr. Lee responds:
This is a very complex situation, and I would consult as many experts in the field as possible. Please feel free to contact my office, since I would be happy to review your films (either on CD or paper) and speak with you about the risks of the procedure.

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

Giles asks:
Is the Gamma Knife effective for treating tangled blood vessels? If AVM fistula isn't treated what is the survival rate?

Dr. Lee responds:
Gamma Knife is very effective for treating tangled blood vessels, eg. Arteriovenous malformations. It can obliterate them usually within two years.

Arteriovenous fistulas are different from arteriovenous malformations, but they can also be treated with Gamma Knife. The success rate is dependent on many factors.

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

Forever asks:
Can right temporal brain's AVM about 3-4 cm be treated by Gamma Knife radiosurgery?

Dr. Lee responds:
Yes, Gamma Knife is a good treatment for AVMs that are deeply located and small. Your AVM is on the borderline, but I would have to look at the films to determine its appropriateness for Gamma Knife radiosurgery.

For more information or to schedule an appointment, please call 1-800-789-PENN (7366). You can also request an appointment online.

Carol asks:
My husband was recently diagnosed with a 4-5 cm AVM in the right sylvian fissure. There is a possible venouse aneurysm on the posterior aspect of it. He is scheduled for an angiogram to help them decide if he would be able to have gamma knife vs surgery. Is it possible to use Gamma Knife if there is an aneurysm?

Dr. Lee responds:
There are at least two types of aneurysms that are associated with AVM's: feeding vessel aneurysms or intranidal aneurysms. Gamma Knife does not directly address the aneurysms, but cure of the arteriovenous malformation can cure the feeding vessel aneurysm without the need for a separate procedure for the aneurysm.

Also, a 4-5 cm AVM is not an absolute contraindication to Gamma Knife radiosurgery. Gamma Knife radiosurgery can be performed in a staged fashion (high doses separated by 3-6 months) in order to obliterate half the volume in one setting and the other half of the volume in another setting.

Tracy asks:
After having Gamma Knife radiosurgery in November for a <2 cm AVM in her occiptal lobe, she is now experiencing visual seizures, and must close her eyes and remain seated during these episodes. She is also suffering from an inablity to remember short term and transposes her numbers. Could this be due to swelling? She has been on anti-convulsants, and is also taking Zoloft for depression. I'm very concerned because this is worse than what she was experiencing prior to the Gamma Knife radiosurgery.

Dr. Lee responds:
The side effects of Gamma Knife radiosurgery are usually seen three to six months after radiosurgery. Usually, these side effects improve with time and by one year after radiosurgery can be completely resolved. Medications can be very helpful in this situation.

David asks:
My brother has a 1 cm diameter (approx) AVM located in a peduncle in the left cerebellum. He underwent a partial embolization which unfortunately led to a right side stroke from which he is recovering well. However, he needs radio surgery to completely obliterate the AVM.

What are the chances of permanent neurological deficit for Gamma Knife treatment of an AVM of this size and location? He is very concerned about any future treatment following the side-effects of the embolization procedure.

Dr. Lee responds:
The risks of Gamma Knife radiosurgery are related to several factors, including location, size, and dose. I would need to see your brother's angiogram and MRI scan in order to give you more precise numbers. By lowering the dose, I can lower the complication risk, but a lower dose would also decrease the chance for cure of the AVM. Hence, decision-making requires careful consideration of all these factors.

To further discuss your situation, please call 1-800-789-PENN (7366) and ask to be connected to John Y.K. Lee's office. You can also request an appointment online.

Warren asks:
What are the chances of having a reaction such as brain swelling from the Gamma Knife radiosurgery for an AVM?

Dr. Lee responds:
The risk of complication after Gamma Knife radiosurgery for an arteriovenous malformation is related to many factors, including dose, size, and location. All these factors need to be considered when performing the Gamma Knife procedure. Once the radiosurgical procedure is completed, there are only a few simple measures that can be done to minimize swelling. For example, steroids can be used to minimize the symptoms associated with swelling.

Dave asks:
I have been through many tests including a CT scan, MRI, MRA, MRV, and angiography. My local neurosurgeon says that I have an AVM that runs through my occipital lobe and he cannot do surgery because it's too deep.

I am 48 years old and have had a lifetime of headaches; this last one has continued since early December. Also, I have some vision irregularity and numbness in left fingers. I was told by my doctor that it is a small arterivenus malformation but looking at the pictures here on my computer it is not so big in diameter (maybe 1.5cm) but all over the place.

I see the doctor next Tuesday but when I check his web page it shows he specializes in operations and embolization. I would like to know if there is a way I can send some picturess to you to see if I should come there next.

I like what I read about you and you sound very sure of yourself, which I haven't heard from any doctors lately; just a lot of staring at the floor and passing me on.

Dr. Lee responds:
Small AVMs are best treated with Gamma Knife radiosurgery. Obliteration rates for small lesions like yours can be cured with the Gamma Knife. Side effects can be minimized with radiosurgery, as well.

Please feel free to call 1-800-789-PENN (7366) and ask to be connected to my office. I can review films without your having to travel here.

Carol asks:
My 24 year-old daughter has recently been diagnosed with an AVM in her left temporal lobe. She has been seeing doctors for the last year due to excrutiating headaches/head pain.

How successful has Gamma Knife been in treating (obliterating) the AVM and what is the likelihood that radiation of the AVM site will improve her headaches?

Dr. Lee responds:
An arteriovenous malformation in the brain is one of the best indications for Gamma Knife radiosurgery. The procedure is minimally invasive and very effective. There have been many patients who have been successfully treated with Gamma Knife, and these patients have been able to live full lives without the risks of general anesthesia and conventional surgery.

In addition, both seizures and headaches can be improved in patients who undergo Gamma Knife radiosurgery. I think it is fortunate that the Gamma Knife is available for your daughter.

If you would like more information or to schedule an appointment at the Penn Gamma Knife Center, please call 1-800-789-PENN (7366) or request an appointment online.