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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.