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.
Cathy
asks:
I keep seeing that you say 90% at
10 years but what is the recurrence
rate after 10 years? Is there
a greater chance that a benign meningioma come
back after 10 years malignant? I'm
just confused because no one ever
talks about after 10 years.
Dr. Lee responds:
Gamma Knife radiosurgery has been
in use in the United States since
1987. Long term data beyond
10 years is not widely available,
however a recent study by Kondziolka
et al looks at recurrence of meningioma
after Gamma Knife radiosurgery in
patients over an 18-year period. This
study concludes the overall control
rate for patients with benign meningiomas
is 93%.
With respect to your question
about malignant transformation, the
risk of this is very low, 1:10000
perhaps 0.01 percent, after Gamma
Knife radiosurgery for benign meningioma
and some estimates place this risk
as no greater than background risk.
|
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. |
Piedropolis asks:
My brother-in-law has an agressive
melanoma metastasis
in the lung. Can the Gamma Knife help
him?
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 lung. |
Deb asks:
Exactly what types of epilepsy
would you consider for Gamma Knife.
I have right temporal lobe epilepsy.
I ask because I'm in the process for
surgery however someone mentioned this
possiblity.
Dr. Lee responds:
Epilepsy has
only rarely been treated with Gamma
Knife radiosurgery. Each case is
unique and must be carefully reviewed
in full consultation with our neurologists. It
is difficult for me to comment on
your case based on limited information.
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. |
Kat asks:
My 69 year-old mother has been
recently diagnosed with a 3.0 x 1.9
cm partially calcified extra-axial
mass extending from the inner table
of the right frontal region, consistent
with a meningioma.
She
has been forgetful and irritable lately.
Is the Gamma Knife a good option treatment
for her?
Dr. Lee responds:
Gamma Knife is often a preferred strategy
for small to medium size meningiomas.
Gamma Knife radiosurgery has proven
to provide greater than 90% tumor control
for meningiomas. I believe radiosurgery
can be an appropriate treatment option
in select patients, but each patient
and situation is unique and requires
delicate consideration.
I would
be happy to review your mother's
case and discuss neurosurgical treatment
options. 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. |
Regina asks:
Can you comment on the use
of the Gamma Knife for a lung cancer
tumor? Radiowave ablation was
used prior twice and the second time
the lung collapsed. There
is a 1.9 cm tumor now.
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 lung. |
Ganesan asks:
I had an MRI scan
and the impression says "unremarkable
MRI of the brain and internal auditory
canals. However,
incidental note made of a right frontal
convexity calcified lesion, likely
meningioma." It
also says "there is a small extra-axial
10 x 7mm lesion in the right frontal
convexity, which does demonstrate
a mild enhancement, and is otherwise
probably calcified given this appearance
on the T1 and T2-weighted images, likely
representing an incidental meningioma."
Do I need an operation
or what should be the best treatment?
Dr. Lee responds:
This extraaxial hyperdensity may
represent the early stage of a meningioma.
However, given the small size of
the lesion and the typically slow
growth rate of meningiomas, there
is generally no harm in watchful
waiting with another MRI scan in
a few months.
Should this prove
to be consistent with meningioma,
Gamma Knife radiosurgery is an excellent
treatment option. |
Peg asks:
In 1999, I had surgery for a left
cerebellopontine angle meningioma.
One year after surgery, an MRI measured
the size at 2.6 x 1.3 x 0.8 cm. I
just recently had another MRI and the
report is showing 3.4 (SI) x 2.5 (tranverse)
x 1.4 cm and is suggesting schwannoma
now.
Would Gamma Knife radiosurgery be
an option? The
doctor that did my surgery retired
and I am researching all my options
now before I decide who to consult
with. I
would like your opinion.
Dr. Lee responds:
I would be happy to see you in consultation
to discuss all of the neurosurgical
options. I perform both intracranial
microsurgery and Gamma Knife radiosurgery
for acoustic neuromas. In addition,
we offer a multidisciplinary approach
involving otolaryngology consultation
in conjunction with neurosurgical consultation
for all patients.
To make an appointment for consultation,
please call 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. |
Angie asks:
My father was diagnosed with a
grade 3 anaplastic astrocytoma. I
know what and how the Gamma Knife works
(I had it for an arteriovenous malformation). Can this be
used for my father? If so, what are
the statistics with this?
Dr. Lee responds:
Gamma Knife radiosurgery can be used
as an adjunct to conventional treatment
strategies for patients with anaplastic
astrocytomas. Each situation is different
and depending on the clinical status,
location of the tumor, and age of
the patient, different modalities
may be utilized. This decision
should be made in conjunction with
your father's neurosurgeon
and radiation oncologist.
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. |
Carter asks:
Recently I had a dental root canal
performed on an upper molar tooth/right
side. Immediately afterwards I started
to have excruciating pain on the right
side of my face, starting in the root
canal tooth and progressing upward
into the right upper sector of my brain.
The pain feels like some one has stuck
an ice pick into my brain or like a
heavy electrical charge.
Sometimes
the pain is like a roman candle firework.
The pain sparkles in my mouth area
then bursts of pain go off in the
upper right side of my brain. This
second burst of pain is the worst and
can last up to two to five minutes
at a time and then repeat itself.
I went to a dental specialist
who, over a two day period, did another
root canal and then extracted the
tooth. The pain has not gone away.
I have subsequently gone to a local
emergency room three times and last
night the ER doctor diagnosed my
problem as being "facial trigeminal
neuralgia."
I have been taking neurontin
300 mg twice daily and the ER doctor
upped the dose to 600 mg BID. The
pain medications I have been taking
have no effect on the pain regardless
of the dosages. The pain is so bad
that it causes me to cry out in agony
and to scream and to become very
despondent, including having suicidal
thoughts. The pain weirdly seems
to get worse at night around 10 pm.
I can't go on living this way and
it's interfering with my work and
my living life. Would I be a good
candidate for Gamma Knife radiosurgery?
Please advise me! Do you pre-screen
candidates by phone or in person?
Dr. Lee responds:
Typically, I see patients with trigeminal
neuralgia after they have seen a
neurologist. These patients
have either failed medical management
or they cannot tolerate the side
effects of medications. A consultation
with a neurologist who specializes
in treating trigeminal neuralgia
is beneficial because there are other
medications, such as Tegretol, which
may be useful in relieving the pain
associated with trigeminal neuralgia.
If medical management is not effective,
then neurosurgical options can be
discussed. Gamma Knife is one
of the three surgical procedures
that I perform for patients with
trigeminal neuralgia. Microvascular
decompression is the preferred strategy
for young, healthy patients who want
a non-destructive procedure. Gamma
Knife is the least invasive procedure
among the options.
I would be happy to discuss all
of the neurosurgical options with
you. Please call 800-789-PENN
to schedule an appointment. You can
also request
an appointment online. |
Barbara asks:
If a person has a pacemaker can
he still have Gamma Knife radiosurgery?
Dr. Lee responds:
I would need more information in
order to answer this question. Magnetic
resonance imaging (MRI) is the type
of study that is typically used in
planning Gamma Knife radiosurgery,
and patients with cardiac pacemakers
should not undergo MRI scans.
However,
depending on the patient's
diagnosis, there are other imaging
options for Gamma Knife radiosurgery
planning. For example, if the
Gamma Knife radiosurgery is for treatment
of a tumor, a CAT
scan can be performed
instead of an MRI as long as the
tumor is visible on CAT scan. For
trigeminal
neuralgia, a CT myelogram
can be used.
If you would like to discuss this
further, please call us at 800-789-PENN
to schedule an appointment. You can
also request
an appointment online. |
Anne asks:
Approximately how much does the
Gamma Knife procedure cost? What
is the success rate for pituitary tumors?
Dr. Lee responds:
Gamma Knife radiosurgery, when
necessary, is covered under most
insurance policies, HMO's,
Medicare, and Medicaid.
As to your second question, the
management of pituitary tumors is
complex depending on whether your
tumor is secretory or nonsecretory,
and I would be happy to discuss your
case in consultation. Please call
us at 800-789-PENN to schedule an appointment.
You can also request
an appointment online. |
Patti asks:
I have had trigeminal
neuralgia for
four years on the left side of my face
(section two, I believe it is called).
The MRI was
negative. I have been on Neurontin
3200 mg with no help, I was allergic
to Tegretol, and now I'm trying Lyrica
and Cymbalta. Baclofen was tried but
turned me into a zombie. Do you think
I would be a good candidate for Gamma
Knife? The pictures really scare
me. I am in my 60's.
Dr. Lee responds:
Gamma Knife radiosurgery is effective
for patients with trigeminal neuralgia
who are not responding to medications
or who are having significant side
effects from medications.
The procedure itself is often
associated with a certain degree
of anxiety beforehand, but fortunately
we can provide sedation during
all parts of the Gamma Knife procedure
so that patients can sleep through
it. We also provide one-to-one
nursing so that patients have a
nurse with them at all times throughout
the day.
I would be happy to discuss all
of the neurosurgical options for
trigeminal neuralgia, including
microvascular decompression, glycerol
rhizotomy, as well as radiosurgery.
Please call us at 800-789-PENN to
schedule an appointment. You can
also request
an appointment online. |
Kim asks:
If seizures are
occuring in an area of the brain where
it's too risky to undergo a brain operation
as such, would the Gamma
Knife be an alternative to correcting
complex partial seizures and/or partial
complex partial seizures? If so, what
chance might there be to become seizure-free?
Dr. Lee responds:
Gamma Knife radiosurgery can
be used to treat tumors and
thus to control the seizures that
are associated with the tumor. Seizure
disorder, in absence of a tumor,
has only rarely been treated with
Gamma Knife radiosurgery.
We would
have to consider each case carefully
in full consultation with our neurologists.
In certain instances, Gamma Knife
can be a valuable option for some
patients.
If you would like to discuss this
further, please call us at 800-789-PENN
to schedule an appointment. You can
also request
an appointment online. |
Sondra asks:
I have had Parkinson's
disease since
I was 53 years old. I am now 71 and
the drugs are not as effective. I could
not tolerate deep brain stimulation.
Can Gamma Knife radiosurgery be utilized?
Is it a non-invasive procedure?
Dr. Lee responds:
I have used Gamma Knife radiosurgery
in the past to treat patients with
Parkinson's
disease and essential
tremor. It
is less commonly used today, because
of the success of deep brain stimulation.
In select patients, however, Gamma
Knife may be the best choice.
I
would be happy to discuss this with
you. Please call us at 800-789-PENN
to schedule an appointment. 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. |
Shirl886 asks:
My 80 year-old father was diagnosed
with a golf ball size meningioma in
the right frontal lobe after having a
seizure. He was placed on steroids and
seizure medication. His health has gone
downhill since. He recently had three
seizures in one day and his medication
was upped for the seizures. He neurological
doctor says it needs to be removed as
it is just too big. The neurological
surgeon says wait and watch. What is
a good option for him? His quality of
life since August is downhill.
Dr. Lee responds:
Management of meningiomas is an
complex topic as there are many different
presentations. This is a
difficult situation, and I would be
happy to see your father in consultation
regarding this. Please call 800-789-PENN
(7366) to schedule an appointment.
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. |
Debby asks:
My 65 year-old husband has metastases to brain as a result of melanoma. In August of 2007 he received Gamma Knife radiosurgery which was pronounced successful. He has just finished a course of temodal. His latest MRI and CT scans show four new lesions to the brain, but no growth in the tumors that were shrunk by the Gamma Knife in August. Could he be a candidate for a second Gamma Knife treatment?
Dr. Lee responds:
Gamma Knife can definitely be performed in this situation; however, there have not been any clinical trials that necessarily support or refute this approach.
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. |
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. |
Carla asks:
My 68 year-old dad was diagnosed
with a glioblastoma this
year and has just finished 30 radiation
treatments along with 42 chemo pills
(temador). His MRI this
week showed the radiation didn't shrink
the tumors any nor have they grown. Would
he be a candidate for the Gamma Knife
Surgery? His current doctors have told
him it wouldn't work on him because the
cancer didn't originate in another part
of his body.
Dr. Lee responds:
Glioblastoma multiforme is a very aggressive tumor which is very diffuse and infiltrative.Gamma Knife, on the other hand, is very precise and powerful. Hence, the role of Gamma Knife in patients with glioblastoma multiforme remains to be explored. At this point, I currently reserve Gamma Knife for patients who have already had surgery and radiation and chemotherapy. |
|
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.
|