Diana asks:
My husband was diagnosed with a meningioma that
is near his brainstem. Facial numbness was
the first sign. He underwent Gamma Knife
radiosurgery in October 2007 but in February
his symptoms worsened. The tumor is shrinking
and did show some fluid on the brain but
that was taken care of with steroids.
He now has numbness of the heels, facial
numbness, headaches,
severe fatigue (so
much so he is unable to work) constantly
eats and sleeps. This has been ongoing
for about five weeks now. Are these symptoms
side effects from the Gamma Knife?
Dr. Lee responds:
It is possible that Gamma Knife can contribute
to some of this. The fatigue your
husband is experiencing may be multifactorial. |
Abby asks:
I am a 29-year-old female that was recently
sent to the emergency room due to a seizure.
After receiving a CT
scan, I was told I had a calcified
9x6 mm calcified meningioma in
the right parafalcine vertex. I am currently
on seizure medications an awaiting an MRI.
Is this something that will probably
have to be removed right away? If so,
what is the best method?
Dr. Lee responds:
I would be happy to review your
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. |
Marlene asks:
I had Gamma Knife for a left side parietal meningioma about
eight months ago. Now, after two seizures,
there is a significant amount of edema around
the tumor. Is this common?
Dr. Lee responds:
Peak swelling after Gamma Knife radiosurgery
typically occurs, if at all, around
six to eight months after the procedure.
This should resolve in the next few
months. By November 2008, one year
after your procedure, I expect this
issue to clear, as long as the plan
and dose you received were appropriate. |
Julie asks:
I recently had what I was told was a left
lunar infarction which affected my right
arm and leg. I spent two weeks in the
hospital and have made a full recovery.
However, the consultant suggested an MRI as
the cat
scan showed an abnormality in the
left lateral ventrical suggesting a meningioma.
I have now had this confirmed at a size
of 2.5. The neurosurgeon is sure that
the tumor is benign and that it caused
my symptoms and not a stroke. I am confused
as the MRI clearly showed the site of
acute stroke well away from meningioma.
I have been given options of surgery and
Gamma Knife radiosurgery. I am petrified
of both but feel non-invasive surgery would
be a good option based on what information
your site has offered. The neurosurgeon
is arranging a more detailed scan but has
explained that the tumor's position is
not in an easy place. Do you think Gamma
Knife would be a good choice?
Dr. Lee responds:
It is difficult to say decisively without
seeing your images, but, yes, it sounds
like Gamma Knife radiosurgery would be
a good option for you. 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. |
Stef asks:
My husband was diagnosed with a meningioma tumor
in the pineal region the size of a golf ball.
His option at the time was surgery. After
two surgeries, the neurosurgeon had to leave
the balance of the tumor (anywhere between
10-15 percent) as it was laying on blood
vessels. After the surgery he had a homonopesia,
he couldn't see from the right side of each
eyes. We were told he had brain damage and
his eyes should've been restored two weeks
after his second surgery. However, seven
months after surgery, his eye sight is starting
to slowly come back. He can start to see
his peripheral vision slowly.
Last week, we just went to a consultation
for the Gamma Knife treatment. His last
question to the neurosurgeons was: if
he decides to get the treatment, will
the radiation affect his vision more.
We were told from the neurosurgeons that
it may be better to wait, as it's healing.
They weren't really sure about the vision
question — whether it would get
better or worse after treatment.
My husband only has a small window of
opportunity to do this treatment as surgeries
will not be an option again for him, as
the tumour is in a spot where its hazardous.
Currently it's behind the eye cortex, which
the rays would go through to get to the
tumour. Do you concur with these neurosurgeons?
Have you experienced a case like this before?
Do you think the Gamma Knife would affect
his vision? Please advise.
Dr. Lee responds:
In comparison to another craniotomy, Gamma
Knife radiosurgery would be safer in
respect to his vision.
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. |
Catydid2 asks:
I was told that I have a 1.5cm meningioma in
the high left perital lobe posteriorly. I
have been told that it is nothing and to
come back in six months. I had a hysterectomy in
December 2006 and now take hormone replacement.
I have headaches and get slightly dizzy.
How do I tell if this is caused by the medicine
or the meningioma? Would Gamma Knife be an
option for me?
Dr. Lee responds:
Meningiomas tend to be very slow growing
and it is a very reasonable plan to
have another MRI in
six months. There is evidence showing
a correlation between hormone
replacement therapy and meningioma
growth. You may want to consider discussing
this with the practitioner managing
your HRT. Gamma Knife radiosurgery
is an option for a meningioma of this
size.
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. |
Cathy asks:
I keep seeing that you say 90 percent 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. |
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. |
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. |
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. |
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. |
Abby asks:
My 49 year-old husband went to the
emergency room with sympytoms including memory
loss, lightheadedness and confusion.
A 1cm meningioma was
found. He continues to have daily lightheaded
spells.
Is Gamma Knife a possibility for him?
Should he be seen sooner. Will these
symptoms get worse?
Dr. Lee responds:
Although Gamma Knife is a possibility
for the small meningioma, it is very
unlikely that his symptoms are referable
to this lesion. Please be sure to see
your neurologist for a complete work
up.
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. |
Louise asks:
Are brain tumors herditary?
Dr. Lee responds:
There are some forms of brain
tumors that are hereditary, but most
are not. |
Raasch asks:
On 2/15/05 an MRI scan disclose a 3 x 3 x
2.6 cm lesion "in the sella-parasellar
region, extending over the tuberculum,
along the planum. There is some lifting
of the optic chiasm. It extends into
the cavernous sinus and surrounds the
carotid artery, probably bilaterally.
There is some thickening of the bone....suggestive
of meningioma."
Subsequent annual MRIs and semi-annual
vision field tests show no change, and
totally asymptomatic. Should things rule
out continuing conservative waiting,
is Gamma Knife radiosurgery a possibility?
If so, I would like to arrange an appointment.
Thank you.
Dr. Lee responds:
This is a difficult tumor to evaluate over
the internet. Gamma Knife may be an option
depending on its proximity to vital structures.
I would be happy to see you in consultation.
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. |
Katy asks:
My 38 year-old husband has been diagnosed
with a meningioma (approximately
6 cm) which we have been told is most probably
benign. The MRI with
contrast revealed a slight swelling on the
bottom, and we were asked to return in 3
months for another. Both doctors we have
consulted agree that if the tumor is growing,
it should be removed.
It is located on the top right of his
head, and we have been told it is easily
accessible. Still, my husband has reservations
concerning traditional surgery. Would
Gamma Knife surgery be an option?
Dr. Lee responds:
Usually tumors of this size require
surgical resection. However, if the tumor
is attached to the superior sagittal sinus,
complete resection will be impossible,
and Gamma Knife will be required.
I would be happy to meet with you to discuss
these options. To schedule an appointment,
please call 800-789-PENN or you can also request
an appointment online. |
Lainey asks:
I was diagnosed with a 2cm CPA meningioma,
which has shown no significant growth in
a 6 month MRI follow up. There is mild
mass effect on the pons. I have had 2 surgical
consults, both say due to my age (45) I
should have it resected if it grows any
bigger.
Please let me know what my options would
be about Gamma Knife, as the location
of my tumor seems deep in the brain and
so I do not want a craniotomy.
Have you performed successful procedures
on my tumor location/size?
Dr. Lee responds:
I would be happy to consult with you. Fortunately,
I perform both craniotomies in
this area of the brain every week, and
I perform Gamma Knife for tumors every
week. Hence, I attempt to present an
unbiased opinion of the best treatment
option for you.
Please forward your films to my office,
and I can arrange to speak with you on
the telephone, or I can see you in the
office soon. |
pfran asks:
Family history of cancer (lung, breast,
throat). My sister has recently
been diagnosed with meningioma located
back lower portion. with min. sx
of LA pain and dizziness. mass
doubling in past two months. Would
this Gamma Knife procedure be for
her? She was told to get a second
opinion.
Dr. Lee responds:
Based on the limited information
here, I cannot be sure whether
she is a candidate. Growth rates
of meningiomas end to be slower
than what you are describing,
and hence an open biopsy or resection
may be more appropriate. I would
be happy to see her in consultation. |
Krysti asks:
I am 26, with a history of treatment
for leukemia at age 6, recently
had a resection of a meningioma.
The reports came back with a grade
11/111 atypical. I was wondering
if you would recommend radiation
as a precaution of reoccurrence.
Dr. Lee responds:
Management of atypical meningioma,
especially in the setting of
prior radiation is complicated.
I would be happy to meet with
you to discuss all available
options. |
Claudette asks:
My husband was diagnosed with a benign meningioma which
is 1.8cm on the leftside of his brain. He
has no symtoms. He has had two opinions and
each opinion was very similar except the
first dr. has said to have another MRI taken
in Sept. whereas the other dr. has said to
have a MRI two years from now. What would
you do?
Dr. Lee responds:
Most meningiomas grow very slowly, and
therefore a period of watching and
waiting is a very reasonable approach.
I generally recommend six month and
then one year MRI studies. |
George asks:
My aunt who is 51 years old has been diagnosed
last week using an MRI scan with the
following: "Extraaxial lesion within
the interhemisperic fissure in the midline,
measuring approximately 1.5cm in the
CC 1.8cm in the RL and 1.8cm in the AP
diameter. It causes mild compression
in the adjacent right and left frontal
lobes, it arises from the falx cerebri.
It contains low signal intensity foci
which probably represent calcifications
and demonstrates intense enhancement
after the administration of IV contrast.
The overall appearances suggest a meningioma.
The superior sagittal sinus lies above
the meningioma and
is not infiltrated and appears pattent
on the MR Venogram. No other intracerbral
abnormality is demonstrated.
OPINION notice is made of a small extraaxial
meningioma arising from the falx cerebri
in the midline causing only minimal mass
effects without associated white matter
edema or infiltration of the superior sagittal
sinus."
Is she a candidate for Gamma Knife Surgery?
The doctors here are recommending traditional
surgery rather than Gamma knife, adding
that the tumor cannot be removed totally
because of its position. They also recommended
a wait and see approach with another MRI
in 3 to 6 months. As she suffers from severe
headaches and numbness of the left hand
and leg would Gamma Knife not be a more
appropriate method? If treated with Gamma
Knife is there a chance that the tumor
will regrow/regress in 5 to 10 years and
if so can Gamma Knife be used again?
Dr. Lee responds:
This tumor can be treated primarily with
Gamma Knife, and thus may never require
you to undergo a craniotomy.
Tumor control rates can be as high as
95 percent at 10 years. I would be happy
to review your films, especially we have
treated patients from Europe before. |
Debe54 asks:
I have been diagnosed with right cerebellar meningioma. It is located near jugular
vein. They also said pressing against ocular bone. Is this inoperative?
Dr. Lee responds:
Most meningiomas in this location are
excellent candidates for Gamma Knife
radiosurgery. I would be happy to review
your case in consultation.
If you would like to schedule an appointment,
please call 1-800-789-PENN (7366) or request
an appointment online. |
Troubled asks:
Diagnosed with a 1. x 1.6 x 1. cm meningioma and
or thrombus, or dermoid within the posterior
aspect of the superior sagittal sinus. Is
Gamma Knife an option for me?
Dr. Lee responds:
It is difficult to determine whether
this is a tumor or not. I would be
happy to review your films in order
to determine whether Gamma Knife is
an option. |
Ruha asks:
My mother has been diagnosed with left
cerebello pontine meningiomo with
35* 33 mm size tumour last week.
In India she took this CT scan
and the doctor says this has to
be operate with in 3 weeks. I would
like to know will she be fine once
its taken out. Where is the best
place for her to get this operation
done? Please let me know how critical
is this and the best hospital to
get this surgery done.
Dr. Lee responds:
We would be happy to review your
case here for both conventional
surgical resection and Gamma
Knife radiosurgery.
If you would like to schedule an
appointment, please call 1-800-789-PENN
(7366) or request
an appointment online. |
Rebecca asks:
My CT revealed an incidental finding
of a 5mm extra axial hyperdensity
in the left frontal region, with
adjacent concavity in the inner
table of the calcarium and mild
adjacent bony remodeling. The Neurosurgeon
said that this is a calcified meningioma
and we should just wait and see.
He also stated that it is not clinically
significant and there is nothing
to worry about. I find this hard
to believe after reading that is
may be a good idea to resect or
use Gamma Knife. Does it seem to
small to warrent Gamma Knife or
resection to you?
Dr. Lee responds:
5mm extraaxial hyperdensity may
represent the early stage of
a meningioma. However, given
the small size of the tumor,
there is generally no harm in
watchful waiting with another
MRI scan in a few months. |
Stumpy asks:
Diagnosed with a 2cm meningioma in
right posterior fossa. I am considering
Gamma Knife and would like to know
an estimate of how much the procedure
costs. I have insurance but I would
be going "out of network" and wanted
a rough idea.
Oh, I am a twin ... should my
twin get MRI's as a precaution?
(We are adopted and have no other
family history -- so we are clueless
about our medical history)
Dr. Lee responds:
Gamma Knife is always covered by
insurance companies to treat tumors
of the brain. Please feel free
to call the office to discuss.
If you would like to schedule an
appointment, please call 1-800-789-PENN
(7366) or request
an appointment online. |
Lauri asks:
My mother was diagnosed six months ago with
brain stem meningioma. This week she's
getting a follow-up MRI showing growth.
She is 70 and has been ruled out for
surgery due to cardiac issues. The size
is 2.7 x 12.8 x 2.8. Is she a candidate
for Gamma Knife?
Dr. Lee responds:
Gamma Knife is definitely useful in controlling
the growth of meningiomas of
the skull base.
I would be happy to review the films and
her case.
If you would like to schedule an appointment,
please call 1-800-789-PENN (7366) or request
an appointment online. |
ME asks:
I was diagnosed with what appears to be a
meningioma of the left front temporal
region adjacent to the left temporal
lobe extending into the left frontal.
I have been told that I should monitor
this by MRI for awhile to see if it grows.
There is slight irregularity on the edges
of the tumor. Am I a candidate for Gamma
Knife treatment?
Dr. Lee responds:
You are definitely a candidate. The best
time to perform radiosurgery depends
on multiple clinical factors and I would
be happy to discuss these with you. Please
call 1-800-789-PENN (7366) or request
an appointment online. |
Ned asks:
I have a meningioma of less than 3.0cm located
the surface of right top of the brain
without any symptom. I am 69 years old.
I wonder if Gamma Knife is good for me.
Dr. Lee responds:
Gamma Knife is often a preferred strategy
for small to medium size meningiomas.
The best time to perform radiosurgery
depends on many factors. |
Millie asks:
Seven months ago I had radiosurgery for a
benign meningioma behind my left eye.
I had a MRI the other day and it did
not shrink. Do I have something to worry
about?
Dr. Lee responds:
The majority of meningiomas do not shrink
after Gamma Knife radiosurgery. The goal
is to keep them the same size and not
to grow. A small percentage, eg. 20 to
30 percent, will decrease slightly in
size. |
Lainey asks:
I have recently been diagnosed with a right
cerebellar pontine angle meningioma measuring
9mm x 17.9 mm. The radiology report also
mentions dural tails, "one extending
along the anterior aspect of the right
internal auditory canal." Am I a
candidate for Gamma Knife radiosurgery
at this point? If so, would I watch and
wait first or is it already approaching
a cut-off point? Thank you in advance.
All imformation is empowering.
Dr. Lee responds:
There is no correct answer here. Getting
an MRI
scan six months to one year from
now is a decent strategy, but so is getting
this taken care of now so that you can
rest assured. If you would like to schedule
an appointment, please call 1-800-789-PENN
(7366). You can also request
an appointment online. |
Teresa asks:
Is there a difference between a calcified
meningioma vs. a regular meningioma?
Does a calcified one still have to be
treated and can it still be treated with
Gamma Knife radiosurgery? Can a debulked
meningioma (with some still left, 6mm)
turn into a calcified one? Is that good
news or bad news or really no news at
all?
Dr. Lee responds:
The presence of calcifications implies that
the tumor has been there a long time
and is very slow growing; however, this
is simply a clinical impression and has
not necessarily been validated with prospective
or retrospective studies. I would not
necessarily jump to any conclusions based
on the presence or absence of calcifications. |
Sheryl asks:
In October 2003, my husband was diagnosed
with an "incidental finding" of
a meningioma.
At his six-month follow-up MRI the meningioma
had doubled in size and he underwent
surgery with the pathologic findings
of "Meningioma - without atypical
features.
" We asked about Gamma Knife or radiation
after the surgery and the neurosurgeon said
that he "got it all - there is nothing
to radiate.
" Unfortunately, two and one-half years
later, his recent MRI showed a regrowth at
1.5 cm. Needless to say we are quite upset.
All opinions say to have another surgery
and then radiation but I was wondering
if radiation alone at this point would
be the same as if it was performed right
after the first surgery and if it would
be as effective at curing this as having
surgery and then radiation once again. Dr. Lee responds:
Gamma Knife radiosurgery is a perfectly reasonable
option after recurrence from meningioma surgical
resection. I would be happy to review
your films and make more specific recommendations.
To schedule an appointment, please call
1-800-789-PENN (7366). You can also request
an appointment online. |
Donna asks:
What is the likelihood of a resected Grade
I meningioma within six months turning
into an atypical agressive meningioma?
And are the treatment options still the
same with Gamma Knife as with the Grade
I as long as it is still within the limits?
Dr. Lee responds:
You are describing a unique case. It is difficult
to quote risks. However, the treatment
for a grade II or grade III meningioma is
different from a typical grade I meningioma.
Gamma Knife radiosurgery remains an option,
but it must be considered in the context
of the other treatment options. Please feel free to schedule an appointment
with me by calling 1-800-789-PENN (7366).
You can also request
an appointment online.
|
Cindy asks:
I have recently been diagnosed with a 14mm
frontal lobe convex meningioma. I consulted
a neurosurgeon who stated an episode
I had of disorientation was not a symptom
of this tumor and that we should wait
for any treatment and repeat the MRI in one year. Would you normally recommend
Gamma Knife radiosurgery to a patient
who is probably asympomatic at 14mm or
employ a "watch and wait" attitude?
Dr. Lee responds:
It is always a wise strategy to wait and
to document tumor growth before proceeding
with Gamma Knife radiosurgery. In certain
cases, depending on location, we may
recommend Gamma Knife earlier. For example,
if growth of a tumor may result in increased
risks or complications, it may be better
to perform Gamma Knife at an earlier
date. Please feel free to call 1-800-789-PENN
(7366) for more information or to schedule
an appointment. You can also request
an appointment online. |
Janice asks:
My mother is 78 and had two brain surgeries
several years ago. The first was to remove
a benign brain tumor and the second,
several weeks thereafter, was because
of a serious infection caused by the
first surgery. She has since been on
tegretol to control seisures and has
had four seisures in the past three years,
two of them recently. An MRI revealed
that there are new tumors growing and
that her brain is swelling slightly.
Is she a candidate for Gamma Knife radiosurgery?
How harmful is the radiation that will
be applied? What is the likelihood that
the tumors will grow back? Are there
additional side effects?
Dr. Lee responds:
Without specifics it is difficult for me
to say anything concrete. However, if
your mother had a meningioma,
then Gamma Knife can control the growth
of the tumor 90% of the time up to 10
years. Hence, she may never require another
procedure ever again. Thus, she is most
likely a great candidate for a minimally
invasive, outpatient procedure -- Gamma
Knife. Please feel free to call 1-800-789-PENN
(7366) for more information or to schedule
an appointment. You can also request
an appointment online. |
Teresa asks:
What is the size limit of a meningioma in
the cavernous sinus for doing Gamma Knife
radiosurgery? How big is too big in the
caverous sinus? Also, have you heard
of the meningioma being too spread out
for the Gamma Knife to help?
Dr. Lee responds:
Although 3 centimeters is frequently quoted
as the size limit of Gamma Knife, there
are several factors, not just a one dimensional
size alone, that limits the applicability
of the Gamma Knife.
Total volume of the tumor is more important
than any single dimension.
In addition, the location of the tumor
is important as well as the total dose.
As always, the overall condition
of the patient and their alternatives
are another consideration. For example, it is impossible to resect
a cavernous sinus meningioma in its entirety. Hence,
the goal of any surgical procedure for
a meningioma based in the cavernous sinus
should be to debulk the tumor and then
to perform Gamma Knife radiosurgery to
the residual. This approach maximizes
the patient's best outcome. |
Teresa asks:
What would you tell a patient that has an
asymptomatic 8mm cavernous sinus meningioma (post
op surgery) that the risks are using
the Gamma Knife now vs. waiting for symptoms
or growth to occur? Would you suggest
Gamma Knife soon or wait for signs of
growth or symptoms? And what are the
risks involved?
Dr. Lee responds:
There is no hard and fast rule regarding
the timing of Gamma Knife radiosurgery
after an operation to remove a meningioma
from the cavernous sinus. I generally
wait until all symptoms from the tumor
resection have resolved, such as double
vision, facial numbness, headaches, etc.
Then, I advise the patient that they
can either watch with serial imaging
or proceed with radiosurgery.
The risks of Gamma Knife radiosurgery
for cavernous sinus meningiomas generally
involves some facial numbness or paresthesias
(tingling). These risks are mild but
definitely present. In addition, Gamma Knife radiosurgery
can provide approximately 90% tumor control
at five and ten years for these tumors. |
Liz asks:
Is there central tracking of the long term
effects of Gamma Knife? It seems most
side effects could be attributed to other
things (ie, fatigue from a long day at
work), how then is a patient to know
whether or not to contact his/her neurologist
or neurosurgeon over any changes months
after Gamma Knife? With advances in surgery
(i.e. volumetric stereotactic resection)
if the tumor isn't close ( > 5mm)
to optic nerve or hypathalamus wouldnt
resection be a cure? I was just diagnosed
with cavernous sinus meningioma or trigeminal
schwannoma (unsure of size -- 7mm x 14mm
x 9mm).
Dr. Lee responds:
A cavernous sinus meningioma or
trigeminal schwannoma in that location cannot
be cured by surgical resection. Any attempt
at complete surgical resection will most
likely cause residual neurological deficits
which would involve the movement of the eyes
(double vision), stroke (damage to the internal
carotid artery), numbness of the face. Most
advanced skull base neurosurgical centers
now recommend partial debulking of the tumor
followed by Gamma Knife radiosurgery. Depending
on the size of your lesion, you may not need
any craniotomy or debulking procedure at
all. Unfortunately, there is no center that
tracks the long-term effects of Gamma
Knife. Similarly, there is no center
that tracks the long-term effects of
surgical resection, radiation therapy,
or any common neurosurgical operation. |
Dennis asks:
My wife had a 95 percent debulking and resection
of a right cavernous sinus meningioma.
She is 54 years old. It was a grade one.
Is it likely that this five percent will
grow at a faster rate now than it was
growing prior to surgery? Will it definitely
grow or is it possible to just remain
like it is now? The neurosurgeon said
it is about as big as a piece of corn.
How often should MRI's be performed and
how much regrowth before considering
the Gamma Knife? My wife is petrified
of radiation of anykind.
Dr. Lee responds:
There is no perfect time for Gamma Knife
in this setting. The tumor will definitely
grow, but when that might be is not clear.
A good option is to watch and wait. At
the first sign of increased size, Gamma
Knife can be performed at that time.
Please feel free to contact me to discuss
options. Call 1-800-789-PENN (7366) to
schedule an appointment. You can also request
an appointment online. |
CathyD asks:
I am a 57 year-old female who had a meningioma in the region of the jugular foramen
which had invaded the temporal bone and
grown into the right ear. It was removed
on May 16, 2005. I had not been able
to hear out of the right ear for approxamitely
six months before surgery and had had
problems with ear infections for about
five years.
When I woke up from surgery, my hearing
was back and I have not had any ear problems
since then until about four months ago.
At my yearly checkup on August 25, 2006,
I learned that the tumor had grown a
substantial amount in such a short amount
of time and my is now recommending that
I have Gamma Knife radiosurgery.
What possible side affects could I have
down the road after the Gamma Knife treatment
to this area? My doctor recommended that
I have it before Thanksgiving and that
is beginning to worry me that he wanted
it done so soon. Any comments? Also, I
recovered from the surgery remarkably well
except that I woke up the next day with
this bad cough which has never gone away
and is now starting to affect my bladder
and bowels (I have already pulled ribs
and muscles in my back many times) but
nobody that I have seen has ever heard
of a cough. My doctor agrees that it was
caused from damage to the tenth cranial
nerve during surgery. Have you ever heard
of this? Dr. Lee responds:
Your tumor is complex and involves many critical
structures of the brain as evidenced
by the fact that the tumor has affected
your hearing (VIII) and your coughing
(X). Gamma Knife radiosurgery is an excellent
tool in the management of these kinds
of difficult tumors. Please call 1-800-789-PENN
(7366)and asked to be connected to John
Y.K. Lee's office. |
Junctionary asks:
My MRI report states: extra-axial lesion
flattening the right ventral lateral
aspect of the cervical medullary junction.
The lesion measures 14 x 10 mm. The findings
are suggestive of a meningioma. I'm 47
years old. What is the likelihood that
Gamma Knife radiosurgery will be an option
in my case?
Dr. Lee responds:
Gamma Knife is definitely an option. The
conventional operative approach to these
types of lesions can be highly morbid
and hence, Gamma Knife becomes an even
more attractive option. |
Chink26 asks:
I had a 95% resection for a grade 1 meningioma in the right cavernous sinus on 7/6/06.
Surgeon wants GK down the road. What
will happen if I wait awhile for this
to be done? Aren't recurrence rates slow
for a grade 1 meningioma? Aren't meningiomas
caused by radiation in the first place?
Can't it cause the meningioma to metastisize?
I'm afraid of what will happen ten or
fifteen years from now if I have Gamma
Knife radiosurgery.
Dr. Lee responds:
A cavernous sinus meningioma cannot
be cured with resection alone. Surgical resection
in this area can lead to a frozen eye, numbness
of the face, and stroke with complete weakness
on one side of the body. Hence, cavernous
sinus meningiomas often require additional
treatment, usually in the form of Gamma Knife
radiosurgery.
There is no "correct" time
to perform the Gamma Knife after resection.
I generally wait three to six months
after the first surgery. However, another
strategy is to perform serial MRI scans.
At the first sign of tumor growth, Gamma
Knife can be performed at that time.
Growth can usually be seen approximately
two years after the first surgery.
There are only a few patients with cavernous
sinus meningiomas who have been treated
fifteen years ago. The first Gamma Knife
in the country was installed in 1987. Nevertheless,
in my review of 200 patients who had Gamma
Knife radiosurgery for cavernous sinus
meningiomas, most patients tolerated the
procedure fine, and even the patients who
had Gamma Knife treatment in the early
1990s were doing well. You are correct in asking about tumor
formation after Gamma Knife radiosurgery.
Indeed, there is a small risk of late tumor
formation after Gamma Knife radiosurgery.
There are six reported cases in the literature,
of approximately 350,000 patients treated
with Gamma Knife radiosurgery in the United
States. Obviously, it is not clear whether
these are coincidence or truly radiation-induced
tumors. Nevertheless, it is a theoretical
possibility and an important consideration
in your decision-making process. |
Sam asks:
I had a suboccipital craniotomy resection
of extra-axial brain tumor at cerebellopontine
angle last November 2005. It was a cerebellopontine
meningioma; it's size was 4.5 x 3.5 x
4.3. However, I just had an MRI in July
2006 and the reports says that significant
increase in size of the residual meningioma
in the right tentorium; tumor size is
1.8 x 0.9 x 1.4.
My doctor's recommendation is to do
another operation since the tumor is
easy to remove completely and its in
a safe area of the brain and he would
not recommend a Gamma Knife procedure
since it's a high risk of reaccurrence.
However, is the Gamma Knife would be
an option to be a cure for the above
since cutting my head again is not a
joke and I would not like to go through
it again. What's your recommendation?
Dr. Lee responds:
Gamma Knife radiosurgery is definitely a
good alternative to another operation
in this location. Fortunately, the initial
surgical resection was successful in
reducing the size of the tumor, and now
it is a size that can easily be treated
with the Gamma Knife. With respect to recurrence, there is
some evidence to suggest that recurrence
rates are higher with incomplete resections
than with Gamma Knife radiosurgery. Hence,
the chances of controlling the tumor
are better with the Gamma Knife than
with conventional resection. |
Lisa asks:
I have an asymptomatic right frontal convexity
meningioma that was 1.2 x 1.4 cm in February
2006, and is now 1.3 x 1.5 x 1.5 cm.
I am otherwise in good health. My doctor
and neurosurgeon tell me that I should
not consider surgery at this time, and
that Gamma Knife is not an option that
they would consider even if it continues
to grow. I would like to avoid a craniotomy
if at all possible. What are your thoughts?
Dr. Lee responds:
Long term tumor control of meningiomas after
Gamma Knife radiosurgery is 90 percent. I
believe radiosurgery can be an appropriate
alternative to surgery in select patients.
If given a choice, most patients would choose
radiosurgery over conventional craniotomy. |
Susann asks:
I am 58 yrs. old and I have a 2 cm posterior
occipital meningioma which is associated
with a dura tail. There is thrombosis
of the superior sagittal sinus. Am I
a candidate for Gamma Knife; and if so,
what are the most common side effects
of radiosurgery in this location? How
common is common? What about the duratail(s)?
What are the chances of permanent deficits
and what could they be?
Dr. Lee responds:
Gamma Knife is an excellent procedure for
patients with meningiomas that
involve that sagittal sinus. Complications
are related to location and size of tumor
and are generally mild. Without seeing
the actual MRI films, I cannot give you
any specifics, but Gamma Knife is an
excellent option for you.
Please call 1-800-789-PENN (7366) and
ask to be connected to my office. You
can also request
an appointment online. |
Henry asks:
My niece (42) was recently diagnosed with
a 5 cm meningioma on the right temporal
lobe of her brain. She experiences headaches
and loss of sensation on her right side.
Can this be treated without invasive
or open surgery, i.e. Gamma Knife or
Fractionated Stereotactic Radiosurgery?
If not, what is the current recommended
approach to treat this particular ailment?
Dr. Lee responds:
A 5 cm meningioma is
generally considered too large for Gamma
Knife radiosurgery. The strategy for management
of this tumor should be to debulk as much
tumor as safely as possible. Then, Gamma
Knife radiosurgery can be used on the residual
tumor.
Obviously, if the surgeon feels that
the entire tumor can be resected safely
without inordinate risk, then that is
the best option. However, given the greater
safety of Gamma Knife radiosurgery compared
to conventional surgery, a tumor that
is intimately attached to critical structures
in the brain should be reserved for Gamma
Knife radiosurgery. |
Nicolas asks:
Two years and a half ago I had surgery to
remove a 5x5x3 cm post-coronar parasagital
meningioma. I then had seizures and underwent
treatment with carbamazepin. I am 43
and the seizures have stopped one year
ago. The last MRI showed a 3x5 mm recurrent
tumour and my surgeon suggested operating
again or trying the Gamma Knife. Are
the probabilities to again have post
operatory seizures the same in both cases?
Dr. Lee responds:
This is a difficult question to answer, since
nobody has good data to specifically
address this question. Most patients
who undergo Gamma Knife radiosurgery
do not develop seizures after the Gamma
Knife. |
Mae-Jo asks:
I had a massive meningioma removed a few
years back. I now have a V.P. shunt for
life. Is there a chance that another
tumor will appear? Dr. Lee responds:
Gamma Knife radiosurgery can be used as an
adjunct strategy after removal of a large
tumor. If the tumor should come back
several years later as seen on serial
MRI scans, Gamma Knife can be used to
treat the tumor. |
Erin asks:
I'm 46 and have been diagnosed with a 1.5
cm right-sided meningioma of the lesser
wing of the sphenoid, on the border of
middle and medial portion of the ridge.
This was an incidental finding and I
am completely asymptomatic. (I looked
back at an MRI from 1999 reported to
be "normal
" and it is also visible on that study,
but was about half the size it is now.) No
vessels or cranial nerves are currently involved,
and it is about 7 mm from the optic nerve
on an eye that is legally blind (uncorrectable)
anyway.
Three neurosurgeons say my case is "easy" and
I can have 100% resection with a standard
craniotomy approach. One of these strongly
favors surgery and does not care for
Gamma Knife in my case, while another
says Gamma Knife would be an equally
viable option and has regrowth rates
similar to 100% surgical resection. Now
I'm confused. I would prefer the best
long-term solution.
Dr. Lee responds:
Gamma Knife radiosurgery offers 93% control
rates at approximately 10 years for benign meningiomas based
on best available data. If you are already
blind in that eye, and if your tumor
is only 1.5 cm, Gamma Knife is a good
option.
If you would like to schedule an appointment,
call 1-800-789-PENN (7366) or you can
also request
an appointment online. |
Karen asks:
On MRI, I have been diagnosed with a 1 x
0.8 x 1.6 cm enhancing mass within the
inferomedial aspect of the left temporal
fossa adjacent to the Meckel's cave,
on the left side may represent meningioma or schwannoma. I've seen a neurosurgeon
at Penn but didn't ask these questions.
What are the risks and possible side
effects in having Gamma Knife in this
tumor location? If this is a meningioma,
even though slow growing, will it continue
to grow? What would the serial MRI time
frame be if I decide to
"watchful wait", i.e. every
six months?
The doctors are not sure that any of my
symptoms (a lingering headache different
from the migraines I get, on and off blurry
vision, retinal hemorraghes noted when
opthamologist thought I had retinal tear,
and occassional left arm weakness are directly
related to the meningioma (probably found
by coincidence) on the MRI.
Dr. Lee responds:
Small meningiomas in
the cavernous sinus region are one of the
best indications for Gamma Knife radiosurgery.
Trigeminal schwannomas can also look like
cavernous sinus meningiomas, but fortunately,
they are treated with exactly the same dose
for Gamma Knife radiosurgery. In addition,
your tumor is small and therefore amenable
to radiosurgery.
After the Gamma Knife procedure, you would
require yearly MRI scans to make sure that
the tumor does not grow. Based on my published
review of 200 patients who had this procedure
done for cavernous sinus meningiomas, we
can achieve 93% tumor control at 5-10 years
after radiosurgery. In addition, the most
common side effect of radiosurgery of tumors
in this location is numbness of the face. If you would like to schedule an appointment,
call 1-800-789-PENN (7366) or you can
also request
an appointment online. |
Donna asks:
My gadolinium-enhanced images reveal the
following: There is a mass in the area
of the cavernous sinus on the right side
that extends both into the sella and
out towards the medial temporal lobe.
This mass also extends above the internal
carotid artery on the right and totally
encases the internal carotid in the siphon.
Pituitary gland appears normal.
More likely this is a meningioma of
the cavernous sinus that has extended
both into the marrow of the sella as
well as the central cavity of the sella
turcica and outward along the margins
of the cavernous sinus. The maximum right
to left diameter is 2.4cm and the inferior
to superior dim. on the coronal images
is 2.2cm. Anterior to posterior in the
area of the orbital apex the mass measures
2.5cm.
Conclusion: Orbital mass and right cavernous
sinus mass which extends into the sella.
Likely a cavernous sinus meningoma rather
than a primary mass of the sella. Can Gamma
knife help me?
Dr. Lee responds:
Gamma Knife is very effective for patients
with cavernous sinus meningiomas. I would
want to see your films myself, however,
prior to rendering an opinion. In addition,
each patient is unique and therefore
decisions cannot be made solely on the
basis of imaging findings alone. To further discuss your situation, please
call 1-800-789-PENN (7366) and ask to
be connected to John Y.K. Lee's office.
You can also request
an appointment online. |
Mike asks:
I have been diagnosed with a 5.7 cm meningioma.
I have very little symptoms or side effects
at this time. I am a 34 year-old male.
Would the Gamma Knife radiosurgery be
an option for me or is my tumor too large?
Dr. Lee responds:
Based on your description of the meningioma
and your age, the best strategy would
be to safely remove as much of the tumor
as possible. If there is any residual
tumor, Gamma Knife can be used after
surgical resection. |
Question:
I have been told that I have a brain tumor.
It is a possibly a meningioma. By looking
at the scans can you tell what it is?
They also said it is located where extra
axial lobalated intensely enhancing mass
lesion in the mid part of the base of
the skull, just to the right of the midline
extending towards the right, caernos
sinus and stret ching in the right carotid
artey. It is approxamitely 2cm. Can it
be treated with Gamma Knife?
Dr. Lee responds:
Most, but not all, meningiomas can
be confidently diagnosed based on imaging
criteria alone. In addition, cavernous sinus
meningiomas can be successfully treated with
Gamma Knife, especially if they are small
in size, eg. < 3 cm in diameter. |
Nicos asks:
Two years and a half ago I had a classical
craniotomy for a post-coronar para-sagittal
big tumour with dimensions 5cm x 5cm
x 3cm. The biopsy showed a atypical meningioma WHO grade II. I developed post-operative
seizures fortunately controled by carbamazepin.
My last MRI screening showed a recurrent
tumor of 3mm x 5mm. I was told that Gamma
Knife is probably the best option. But
they cannot define the optimal time for
the operation neither can doctors assure
me that sezures will not reappear after
Gamma-Knife. What would you suggest?
Dr. Lee responds:
Gamma Knife radiosurgery is best performed
|
