Kathy asks:
I have a 54 year-old brother with Down
syndrome. He was recently diagnosed with
a sella supra sellar mass 2.3 x 2.1 x 3.3
by MRI.
The differential was pituitary macroadenoma.
He had to be sedated for his MRI because
he freaked out (screaming and crying)
as soon as he saw the MRI. Would he be
a candidate for Gamma Knife radiosurgery?
If so, does he have to be awake or can
he be sedated? I watched your video and
I don't believe he would cooperate to
have the halo put on.
Dr. Lee responds:
We provide one nurse per patient and all
of our nurses are trained to provide
specialized care for patients undergoing
Gamma Knife radiosurgery. Prior to placing
the frame, patients are given medications
through the IV to sedate them.
For example, one of my patients recently
immediately fell asleep right before the
frame placement and could not remember
the procedure at all. Most patients remember
some discomfort, but it is generally quite
tolerable.
In addition to the medication through
the IV, I use lidocaine which is injected
into the pin sites and is similar to the
novacaine used by dentists.
If you would like to discuss this further,
please call 800-789-PENN (7366) and ask
to be connected to Dr.
John Y.K. Lee's office. 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. |
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. |
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. |
Popeye asks:
I have just read about neuro-endoscopic
surgery. Would this be better than the
Gamma Knife? I always heard that the best
way to treat cancer was to remove it.
Dr. Lee responds:
Each tool has its own uses. One does
not replace another. In some cases
the endoscope is an excellent tool
for resection of a tumor, but in other
cases a microscope is better. Similarly,
Gamma Knife has its role. |
Darryl asks:
My 69 year-old father was diagnosed with
a desmoplastic neurotropic melanoma which
mainly involves the left V2 branch of
the trigeminal nerve. There is also some
probable microscopic tumor involvement
(based on the pathology report) of the
lateral maxillary sinus mucosa.
This is a very rare tumor, and my dad
does not have any evidence of a primary
skin lesion. These tumors can invade
nerves and travel long distances. Some
of the nerve was removed, but I don't
think anyone knows how much of the nerve
is truly involved. He is having a lot
of facial pain and numbness.
Do you have any idea if he would be a
candidate for Gamma Knife surgery? He is
due to start radiation therapy and possibly
adjunctive chemo., but wanted to explore
the possibility of gamma knife. Thanks
so much for any information you could provide.
Dr. Lee responds:
I would be happy to review his films. This
is a very interesting case, and Gamma
Knife is definitely useful for melanoma
that has spread to the brain, although
this is very different.
If you would like to schedule an appointment,
please call 1-800-789-PENN (7366) or request
an appointment online. |
Jackie asks:
My father was diagnosed with poorly differentiated
squamous cell lung cancer 15 years ago.
At the time he was treated with surgical
resection and subsequent chemotherapy.
He was symptom free for 15 years. About
three months ago he developed a subtle
neurologic deficit, inability to perform
fine manipulations with his right hand
if not under visual control. Recently
he had a partial seizure.
MRI revealed eight brain metastases,
two of them between 2.5 and 3 cm, the
rest smaller than 1.5 cm. He feels normal
except for the subtle neurologic deficit
and is more interested in better quality
of his remaining life than longer survival.
Could Gamma Knife be considered in his
case?
Dr. Lee responds:
The usual standard here would be to perform
whole brain radiation therapy. Given
the number of lesions, it is hard to
make an argument to support Gamma Knife
over whole brain radiation therapy. Nevertheless,
we will be participating in a trial to
compare whole brain versus Gamma Knife
as an initial strategy. |
Kareena asks:
My mother-in-law was supposed to be scheduled
for Gamma Knife surgery but her insurance
company denied the claim. She is being
treated for hemingiopericytoma, the insurance
company considers her treatment experimental.
How can I convince the insurance to get
her the coverage?
Dr. Lee responds:
Perhaps, your physician will have to
write a letter. Some of the most dramatic
responses are seen in tumors like hemangiopericytoma. |
Joe asks:
Can you tell me if the Gamma Knife could
be utilized for sacral large sacral cysts?
Dr. Lee responds:
No, Gamma Knife is a tool designed for
precision in the brain.
|
Steve asks:
I was recently diagnosed with a 1" in
diameter brain tumor and am looking at
my options. Am I a candidate for Gamma
Knife?
Dr. Lee responds:
You may be depending on the exact anatomic
configuration of your tumor. |
Stephen asks:
I am 65 years old and have just been diagnosed
with a 'conventional' epidermoid
cyst. Is this treatable with radiosurgery?
Dr. Lee responds:
Epidermoid cysts are generally not treated
with Gamma Knife. |
Cindy asks:
Why can't Gamma Knife be used for other parts
of the body below the neck? Why is gamma
ray chosen over X-rays then?
Dr. Lee responds:
Gamma rays are chosen, because of the
particular design of the Gamma Knife.
Cobalt sources work extremely well
in targeting brain tumors, and they
allow for extremely efficient dose
delivery.
Gamma Knife is the gold standard for treating
brain tumors, but it cannot treat spine,
lung, or liver tumors. |
Chance asks:
If I am claustrophobic, can I do this
test asleep?
Dr. Lee responds:
We assign one nurse per patient throughout
the entire Gamma Knife day. Hence, we
can provide intravenous conscious sedation
to help you with your claustrophobia. |
Donna asks:
Is the Gamma Knife better than regular surgery?
Dr. Lee responds:
Both radiosurgery and conventional surgery
have their respective roles. For some
tumors, Gamma Knife radiosurgery can
be equivalent and possibly superior
to conventional surgery. Side effects
from radiosurgery are usually much
less than that of conventional surgery. |
Kristen asks:
How long does the actual Gamma Knife procedure take?
Dr. Lee responds:
Generally, most patients arrive at 6am
and the earliest patients are finished
by 9:30am and the last patients are
finished by noon. There is, of course,
variability depending on the complexity
of the procedure. |
Question:
I am scheduled for Gamma Knife surgery next
week. I read that I will be able to communicate
with the surgical team. Will I also be
able to see them, say through a closed-circuit
TV? Dr. Lee responds:
The physicians are able to see you and speak
with you. The patient can speak to the
physicians but cannot see them. |
Mimi asks:
During Gamma Knife radiosurgery, how is the
frame attached to the patient's head?
Is it painful?
Dr. Lee responds:
Prior to placing the frame, patients are
given medications through the IV to sedate
them. For example, one of my patients
recently immediately fell asleep right
before the frame placement and could
not remember the procedure at all.
Most
patients remember some discomfort, but
it is generally quite tolerable. In addition
to the medication through the IV, I use
lidocaine which is injected into the
pin sites and is similar to the novacaine
used by dentists.
For more information, watch
this video to learn about how the
Gamma Knife works. |
JGator asks:
I've read that Gamma Knife surgery may cause
headaches and nausea. Is this true? What
is the recovery time? Is recovery time
related to the number of tumors treated? Dr. Lee responds:
Recovery time from the actual frame placement
is usually one day. Late side effects
from Gamma Knife usually arise approximately
two to three months from the date of
the radiosurgery. Symptoms are related
to location and total dose, but the majority
(90%) of patients experience no late
side effects at all. |
Shelley asks:
What is the difference between between Gamma
Knife radiosurgery and stereotatic radiosurgery? Dr. Lee responds:
Stereotactic radiosurgery refers to the delivery
of a high dose of radiation in a specific
three dimensional space in one session.
Gamma Knife was the first device that
was invented to perform stereotactic
radiosurgery to the brain. Since the
birth of Gamma Knife in the 1960s, many
competitors have arisen, including Cyberknife,
Novalis shaped-beam, etc. Gamma Knife
is the only system that is completely
dedicated to brain tumors and brain disorders. |
Katrina asks:
Is Gamma Knife radiation better for hemangiopericytoma
tumors than tomotherapy or other types
of radiation? What are chances of acquiring
radiation necrosis?
Dr. Lee responds:
Hemangiopericytoma can respond very well to Gamma Knife. In fact, some of the most dramatic imaging responses are seen in patients with hemangiopericytoma. |
