Q&A Sessions: Most
Recent Questions
John
Y.K. Lee, MD will be answering your questions
about Gamma Knife radiosurgery. Click here
to ask
your question.
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. |
|
Gamma Knife and Leksell Gamma
Knife are U.S. federally registered trademarks
of Elekta Instrument S.A., Geneva, Switzerland.
Photo credits: Susan Pardys, Elekta, Inc.
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