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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.