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. |
Linda asks:
My sister is a trigeminal
neuralgia sufferer.
Can you give me a ball park cost for
the Gamma Knife procedure?
Dr. Lee responds:
Each individual case is negotiated
with each insurance provider for
reimbursement. Therefore, it
is difficult to give an exact figure. |
Janine asks:
I have just found out I have an arteriovenous
malformation (AVM) left
frontal parietal with max dimensions
approximately 3cm. The doctors also state
that it is superficial venous draniage
to SSS and no feeding aneurysm.
We have
a follow up appointment to see the
doctors. They believe that Gamma Knife
treatment could work? How effective
do you think this would be? They picked
the AVM up after doing a scan as I
had been getting bad headaches for
approximately three weeks. My husband
and I are very scared we just want
it to be fixed. Surgery is not an option.
Are there side effects to gamma knife
treatment? I am a 35 year old female.
Dr. Lee responds:
Gamma Knife radiosurgery has an 85
percent success rate for AVM. Side
effects are all related to the location
of the treated AVM and the dose used.
Based on the information provided,
Gamma Knife radiosurgery is likely
a good treatment option for you. |
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. |
Mary asks:
My sister has trigeminal
neuralgia with long episodes often
many times per day with severe pain.
She is 52 years old and has multiple
sclerosis (MS). What are the sucess
rates for these patients in general?
Dr. Lee responds:
Success rates for Gamma Knife radiosurgery
in MS-related trigeminal neuralgia
are approximately 60-70 percent of
the success in non-MS patients. |
D asks:
My mom has trigeminal
neuralgia. She
had decompression surgery in 1994, but
her pain returned three to four years
ago. She had Gamma Knife six months ago
and is still taking tegretol. She complains
of a tingling sensation in her brain/head
following the procedures, and it is still
occuring. Is this normal?
Dr. Lee responds:
With time, this should resolve. |
Bob asks:
My mother (77) suffers from essential
tremor and has undergone a deep brain
stimulator implant procedure at another
well-known hospital. Initially,
results were impressive but her condition
has deteriorated significantly and daily
tasks are difficult to complete. She
is in good health, but the tremors are
taking a toll on her quality of life.
Is a Gamma Knife procedure a possibility
after receiving a DBI?
Dr. Lee responds:
Gamma Knife radiosurgery is a possibility
but if her tremor is well-controlled,
then her deterioration may be due
to other causes that cannot be treated
with Gamma Knife radiosurgery. I
recommend seeing a neurologist. |
Christy asks:
I had Gamma Knife radiosurgery done in
April 2005 for a large arteriovenous
malformation (AVM) located deeply
on the right side of my brain. After
three years out, it is now approximately
1x1x2. What are the chances of needing
treatment again?
Dr. Lee responds:
Surgery and repeat Gamma Knife radiosurgery
are both options in this setting. |
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. |
NancyPittsburgh asks:
Does the Gamma Knife procedure do well
in prolactin
adenomas? What are the
side effects of using the Gamma Knife?
Dr. Lee responds:
Hormone-secreting tumors can be controlled
in slightly more than 50% of cases.
Side effects include panhypopituitarism and very low risk of optic nerve
injury. |
Margie asks:
My husband has trochlear nerve damage
from sinus surgery preformed in November
2005. He has tried trochlear nerve injections
and 20+ different pain medications and
none seem to help. The only thing that
has given him some relief is neurofeedback.
However,
he's tired of waiting so long for the
nerve to heal. Would the Gamma Knife
help him? Also, with such a strong
dose of radiation, is there any guarantee
that the radiation itself wouldn't
cause cancer?
Dr. Lee responds:
Gamma Knife radiosurgery can not be
used to heal nerves. |
Priya asks:
I am 38 years old. I was diagonosed with
a meningioma 4.4
x 3.1cm in superoinferior and transverse
dimensions noted in the left anterior
and medial temporal region causing mass
effect on left temporal lobe and basifrontal
parenchyma. It's enclosing the main artery
supplying blood to the brain left
supraclinoid ICA and proximal MCA and
is displacing the left optic nerve and
effect on the optic chiasm.
The diagnosis
was done first in September 2007 and
as I wanted to try alternative medicine
and had no apparent symptoms due to
this, so the doctors advised me to
wait for six months and get another
MRI done.
I got one MRI in February 2008 and
the size was unchanged. Then I
got an MRI done in April 2008 and
the size is now changed by 3mm in past
two months.
Please advise if Gamma
Knife or robotic drilling is possible
in my case. Doctors here advise a surgery
followed by Gamma Knife.
Dr. Lee responds:
I would be happy to review your 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. |
Corinne asks:
My mother (87) had Gamma Knife radiosurgery
five years ago for a meningioma.
As of last year, the tumor had not grown,
but she is having more and more difficulty
with balance, being told that the meningioma
is possibly pressing on a nerve. Would
additional treatment be an option? She
is in good health otherwise.
Dr. Lee responds:
Gait instability in someone of her
age is multifactorial. Since
Gamma Knife radiosurgery has been
successful in stopping tumor growth,
this is unlikely to be related to
the tumor. |
Julie
asks:
I have been diagnosed with right
ventricular meningioma approximately
2.5cm. The neurosurgeon also suggests
that it could be choroid plexus papilloma.
If it is the latter, can I still
have Gamma Knife?
Dr. Lee responds:
Yes, Gamma Knife radiosurgery is
an option for both meningioma and
papilloma. |
NatureLover asks:
A recent MRI with
contrast showed a tiny 5mm focus of enhancement
near the vertex left anterior parietal
lobe. The
radiologist said the image could represent
a very small en plaque meningioma.
If this should grow eventually, would
an en plaque meningioma be a good candidate
for a Gamma Knife procedure? What does
en plaque mean? Is it prudent to be scanned
again in one year? Two years? More?
Dr. Lee responds:
I would be happy to review your 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. |
Vishu asks:
My mom is having metastasis of breast
cancer to brain. She has a tumor
around size of 8cm. She is been treated
with radiotherapy and now next step
they say is chemotherapy.
Will radiosurgery
be an option for her?
Dr. Lee responds:
An 8cm tumor in the brain is very,
very large. I would recommend
conventional surgical resection. |
Anand asks:
I was operated on for a 3.2cm x 2.7cm
x 2.1cm right CP angle clear cell meningioma (WHO
Grade II) six months ago. The latest
MRI shows
a persistent 1.4cm x 0.25cm lesion (only
two dimensions are mentioned in the report)
still remaining. This was also present
in the MRI taken just after the surgery.
My
neurosurgeon suggested that since he
had achieved a Simpson grade I resection,
there was no need to undergo radition,
unless the tumor increased in size.
I have been advised for a MRI every
six months. Should I go for Gamma Knife
to treat the remaining portion of the
tumor or wait to see if it increases
in size?
Dr. Lee responds:
A WHO grade II meningioma is more aggressive
than the more common WHO grade I meningioma.
You could undergo Gamma Knife radiosurgery
now or later if repeat MRI shows tumor
growth. Both are reasonable options. |
Mark asks:
I'm contemplating having Cyberknife
surgery on an acoustic
neuroma that is less than
1cm in size. I've read so many comments
about the Gamma Knife head frame being
well tolerated yet quite painful to many
patients, too. Is Cyberknife just as
accurate as Gamma Knife? I've read conflicting
statistics.
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 acoustic neuroma.
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, Cyberknife may not be as
accurate.
To minimize discomfort during the
frame placement, we provide intravenous
sedation and analgesia as well as
local anesthetic to the pin sites. The
large majority of our patients tolerate
the frame placement very well with
little discomfort.
In conclusion, perhaps more important
than choice of instrument is the
choice of radiosurgeon and team.
You should be comfortable with their
level of experience and expertise. |
Teresa asks:
I have a meningioma that
is throughout my skull and sinuses. I
have had surgery (1994, 1997) and traditional radiation
therapy (1996). I was told by the radiation
oncologist that
the level of radiation treatments I received
meant I could never have more radiation.
Is
Gamma Knife considered radiation? Even
if I have maxed out on radiation, is
it possible for me to receive Gamma
Knife if I need more surgical intervention
in the future?
Dr. Lee responds:
Gamma Knife radiosurgery is definitely
a form of radiation. I would
be happy to review your 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. |
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. |
Laura asks:
My 17-year-old son has been diagnosed
with a hemangioblastoma in the thoracic
region of his spine. Strong family history
of VHL. We are seeking out as much information
as possible to determine our next step.
We had an MRI after a diagnosis of secondary
polycythemia. Any information you can
give would be greatly appreciated.
Dr. Lee responds:
Gamma Knife radiosurgery is the best
procedure for brain lesions. It
cannot be used in the spine. |
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. |
Margaret asks:
I now have an 8x4 cm malignant breast
tumor (third time). I had a double mastectomy with free flap reconstruction last year.
Four chemo treatments did not shrink
tumor. If it is too large for surgery,
would Gamma Knife be an option? I
currently am treated at Penn.
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 breast. |
