Ehsan asks:
My son, who is 6 years old, has been suffering from a brain tumor craniophramgioma. We have operated from agha khan hospital karachi, after the surgery tumor size was 2.5 x 2.5 x 2.5 cm. The radiotherapist told us to come back after three months - if the tumor will grow, then we will start radiothrapy. After 3 months tumor size is 5 x 5 x 4 cm. Now, they are saying to operate again. That is a very difficult decision for me. Is this treatable from gamma knife.
Dr. Lee responds:
This size is too large for Gamma Knife Radiosurgery treatment to this kind of tumor. |
Kay asks:
I was diagnosed with an acoustic neuroma that measures 2.6cm transversex3.0cm craniocaudalx2.7cm AP. Surgery was recommended by one surgeon but I was wondering, what is the difference between the gamma knife and Proton therapy? Would I be a candidate for both and if so, when does Penn plan to open its Proton Therapy facility.
Dr. Lee responds:
Yes. You could be a candidate for all three. I would be happy to discuss all three options 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. |
mt asks:
I had transphenoidal surgery to remove a pituitary adenoma a year ago with a pathology report of immunoreactivity for synaptophysin and ACTH. MY follow up MRI's in March showed that there is residual of the tumor, July and October MRI's show it measures slightly larger. I am diabetic and my sugar has been high since my surgery. I have been trying different meds and insulin and am concerned if the gamma knife will effect my sugar negatively. I had elevated blood levels in June of ACTH and Cortisol which indicated possible Cushing's Disease. I have since had two 24 hour urine test for cortisol and creatine levels which came out negative. So if it is not Cushings they want to do gamma knife. Is this my best option?
Dr. Lee responds:
Gamma Knife Radiosurgery can be an effective way to control pituitary adenomas. |
Jo asks:
I had gamma knife procedure done in April of 2007 for atypical trigeminal -- the pain and electric shocks are back. Is there a follow procedure or what can I do next?
Dr. Lee responds:
Repeat Gamma Knife Radiosurgery or other surgical procedure such as Microvascular Decompression (MVD) or peripheral nerve stimulation may be an option. I would be happy to discuss options 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. |
Rick asks:
Would you please list any references you know of for long term safety of gamma knife (5-25 years) for benign tumors e.g AN, meningioma. e.g rates of secondary malignancy, cognitive decline, etc. Thanks !!
Dr. Lee responds:
Long term data from any neurosurgical procedure including conventional resection is not readily available because of the lack of uniform follow-up. Other countries with centralized health care systems may be able to provide more useful long term data. |
Vit asks:
My mom is having a Meningoima of about 4mm. Should she proceed to Gamma Knife as recommended by the doctor or should she wait for further MRI after a few months to see whether there's any growth or changes before any treatment?
Dr. Lee responds:
I would recommend serial MRI scans to track growth pattern. |
Kathy asks:
I read that the Gamma Knife can be used to help people with Epilepsy. What would this entail and what could the expected outcome be?
Dr. Lee responds:
Gamma Knife Radiosurgery is primarily used for patients with lesions such as tumors or vascular malformations in the brain that cause epilepsy. |
Helen asks:
I had the Gamma Knife Surgery almost 2 years ago,but the pain is coming back. Can I have it done again ?
Dr. Lee responds:
Yes, repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia can be successful. |
Heidi asks:
I have an acoustic neuroma and symptoms indicated it is putting pressure on my brain stem and causing breathing and tightness in my chest now. If the gamma knife is not advisable for the size, how many craniotomies have you done? We think that it must be taken care of soon. I am 37 with 5 young children. THANKS.
Dr. Lee responds:
Our center treats many patients with Acoustic Neuroma. I perform both surgery and radiosurgery and would be happy to see you in the office to discuss the relative merits of each 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. |
Candycane asks:
I have a paraganglioma. Is gamma knife an option?
Dr. Lee responds:
Yes, Gamma Knife Radiosurgery can be used to treat paragangiomas. If you have any additional questions or would like to schedule an appointment at 800-789-PENN. You can also request an appointment online. |
Sara asks:
My mother was diagnosed with an AVM when she was 25 (she is now 50). Originally she was told that her AVM was unable to be operated on based on its location and size. Over the years, she has seen neurologist after neurologist and nobody seems to be able to manage her pain, migraines and psychological side effects. I know your specialty is in the Gamma Knife radiosurgery - but do you do have consultations on AVM's and potential treatments? If not, please refer me to someone at HUP who could. Thanks!
Dr. Lee responds:
I would be happy to see your mother in consultation regarding her AVM and potential treatment options. 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. |
Mark asks:
I had Gamma Knife in Dec. '04 for AVM in the left occipital lobe. In May of '05, I had a Grand-Mal Seizure. With this, I dislocated my shoulder, tore my rotator cuff and broke the upper bone in my arm. I spent a week in the hospital to fix my arm/shoulder. Since this time, I have had a seizure every May for the past 3 years. I am now on and upto 600mg of Lamictal and 500mg of Dilantin a day. I have only had one issue since this last increase. Where now? We were not told about the possilbe seizures after the Gamma Knife procedure and did not get put on medicine till the first seizure. I am running out of time and energy. I am lost.
Dr. Lee responds:
Seizures are a side effect of any procedure in the brain, including Gamma Knife Radiosurgery. In addition, Arteriovenous Malformations in your brain make you more susceptible to seizures. |
Darshit asks:
I have been diagnosed with Solid Hemangioblastoma in subcortical left cerebellar hemisphere. The size of lesion measures 13x12x10 mm. Please inform is it curable? What are the risk factors? Thanks in advance.
Dr. Lee responds:
Gamma Knife Radiosurgery can be used to treat hemangioblastomas of this size successfully. |
Chris asks:
My son is 4 1/2 years old and was diagnosed with a cerebellar Pilocytic Astrocytoma in August 2008. It was the size of a golf ball, and surgically resected on 8/6/08. This was also complicated by a syringomyelia, which thankfully is now resolved with the tumor removal. His MRI in September showed residual bits of tumor around the brainstem. He already has right sided facial paralysis from his first surgery, so I would like to avoid a repeat resection if possible. Can the gamma knife procedure be performed on children.... and....which procedure is better for residual tumor, gamma knife, or proton beam radiation? Thank you!
Dr. Lee responds:
Gamma Knife Radiosurgery can be done in this situation and it has been safely performed by Dr. Lunsford at University of Pittsburgh Medical Center. Proton Beam Therapy may be another option. |
SO asks:
My wife had a embolization for AVM the last three months (July 12, 2008. Did the follow up Angiogram on Oct. 31, 2008.) The result is 90% success. But the doctor advised that she needed to do the 10% for Gamma Knife. It is necessary to do? Also what are the side effects for this treatment?
Dr. Lee responds:
Embolization alone is usually not a permanent cure for AVM. Surgery or Gamma Knife Radiosurgery can provide cure. |
Carol asks:
I have had Trigeminal Neuralgia for 4 years and pain pills do not work any longer. I was told that I have to have a procedure done. It is my 3rd nerve in my face that causes me constant pain. I don't know what procedure to have - gamma knife or microvascular decompression. Which one would be safer and have the least amount of side effects? I'm so confused.
Dr. Lee responds:
Microvascular Decompression provides the longest lasting relief of trigeminal neuralgia symptoms but is more invasive than Gamma Knife Radiosurgery. I would be happy to see you to discuss these options, since I perform a high volume of both procedures and can discuss the relative merits of each. 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. |
Debbie asks:
I have a 21 year old son who has been diagnosed with astrocytoma glioma Grade II. As I understand it, surgery is not an option due to the extent of the tumor. A physician at NIH is recommending treatment with Temodar. Another physician at Johns Hopkins is recommending radiation or "wait and see". They have been monitoring this for about a year with very little, if any, growth. He appears normal in every way except for 20-30 second episodes of inability to speak with accompanying "tingling" sensations. Is he a candidate for the gamma knife procedure. Thank you.
Dr. Lee responds:
Gamma Knife Radiosurgery is occasionally performed for grade II astrocytomas, but most patients usually undergo a fractionated treatment such as what is being offered at JHU. |
Noor asks:
My mom is 52 years old and was diagnosed with glioblastoma (grade 4 in the front part of her brain). She's gone through surgery, but of course they didn't remove all the tumor. She went through radiotherapy and is going through chemo. Can gamma knife be an option to make her quality of life and longer?
Dr. Lee responds:
Gamma Knife Radiosurgery can be used for gliomas, as it is another method to deliver high doses of radiation. However, glioblastoma is often refractory to conventional treatments. |
Pat asks:
My husband is 72 years old with a history
of COPD and
has has a triple bypass in
2003. He has been diagnosed with a golf
ball to lemon size meningioma in
the right frontal area after a seizure.
Because of his medical history and age
I would prefer a noninvasive treatment
if possible.
Do you think he could be
a candidate for Gamma Knife radiosurgery?
Please, I need a quick response if
you could review his films. The neursurgeon
in the local hospital where he is has
suggested surgical removal, but I told
him I would like a second opinion.
Dr. Lee responds:
It is difficult from the description
to determine if your husband would
be a candidate for Gamma Knife radiosurgery.
I would be happy to review your husband's
MRI images
if you could send them to my office
on CD along with a copy of the radiologist's
report.
Please send the information to:
Department of Neurosurgery
Attn: Dr. John Lee
330 South 9th Street
4th floor
Philadelphia, PA 19107
|
Joyce asks:
Can a tumor that is 4cm large be treated
successfully with this method?
Dr. Lee responds:
Gamma Knife radiosurgery side effects
are determined by:
- Volume
- Location
- Individual Sensitivity
A single
linear dimension of 3cm can represent
a small volume if it is 3cm x 1cm
x 1cm. I would be happy to review
the films. Please send MRI films
on cd and radiology reports to my
attention:
Department of Neurosurgery
Attn: Dr. John Lee
330 South 9th Street
4th floor
Philadelphia, PA 19107
|
Evie asks:
What are the side effects of Gamma Knife surgery please?
Dr. Lee responds:
Side effects of Gamma Knife are specific
to your diagnosis and the location
of treatment and dose used. Most
patients who undergo Gamma Knife radiosurgery,
however, have minimal side effects.
They may have a little headache after
the procedure, but they can go home
on the same day and return to full
activities by the next day. I
would be happy to discuss this in more
detail, if you could provide more specifics. |
Lynn asks:
How much does it cost for the Gamma Knife treatment for brain
cancer?
Dr. Lee responds:
Gamma Knife radiosurgery is covered by
most insurance providers as well as
Medicaid and Medicare. The cost without
insurance varies depending on the complexity
of the treatment plan. |
Daniel asks:
What are the advantages and disadvantages of the GammaKnife as compared to the
Cyberknife?
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 acoustic neuroma.
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, Cyberknife may not be as accurate.
To minimize discomfort during the frame placement, we provide intravenous sedation and analgesia as well as local anesthetic to the pin sites. The large majority of our patients tolerate the frame placement very well with little discomfort. In conclusion, perhaps more important than choice of instrument is the choice of radiosurgeon and team. You should be comfortable with their level of experience and expertise. |
Go asks:
In March, my mother was diagnosed with adenocarcinoma lung
cancer, with one brain metastasis.
She had a successful brain surgery to resect this tumor and has been on Tarceva
for the past five months. She just had a scan with no trace of tumors in
her brain, and the lung tumor is now inactive.
Now a radiation oncologist wants
her to undergo whole brain radiation
as well as lung radiation. I am not
sure that her quality of life will
be extremely compromised after whole
brain radiation. Is this a clear benefit
to her? Should we consider not having
whole brain radiation? What would your
opinion be in her situation?
She did
see Tracey
Evans back in March — Dr.
Evans recommended you for the neurosurgery.
My mom lives in Dallas and we decided
to have the surgery done near her.
She has been under the care of a lung
oncologist since
then. But we would be willing to have
her radiation done here with you if
you felt that it would be better.
Dr. Lee responds:
The role of WBXRT in the management of
brain metastasis used to be quite straightforward.
Everybody would get their entire brain
radiated. Today with the widespread
availability of good MRI scans
and stereotactic radiosurgery, the
role of WBXRT has changed.
I would be
happy to see you and your mother in
consultation to discuss treatment options
further. 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. |
Homi asks:
My mother has ovarian cancer that spreads
to her brain while on Toxel; there are many small pockets in brain. Doctors are
suggesting full head radiation. Should she use Gamma Knife? Does it work with
Gamma Knife? Since she has still cancer in stomach, I worry if they take her
off Toxel and work on head, the cancer would spread to other organs which are
still clean. What is the solution here?
Dr. Lee responds:
In general, Gamma Knife radiosurgery
is used for patients with less than
five brain
metastases. |
Wanda asks:
What is the success rate for the Gamma Knife surgery as it relates to trigeminal
neuralgia? Will I still have to take medication once the surgery is done?
Currently, I am taking 1600 mg of Neurontin twice a day and 200 mg of Lamictal.
This
has stopped working for me the pain in
my face has increased. It seems
to have affected my nasal cavity.
Also, every since I started taking
the Lamictal, I have aged. At the
age of 50, I look as though I am
60 years old. That should not be.
Last year, everyone thought I was
at least 38.
Dr. Lee responds:
80-90 percent of patients treated with
Gamma Knife radiosurgery for trigeminal
neuralgia have good pain relief such
that they would repeat the procedure
again. The durability of benefit is
variable. |
Clarissa asks:
Just diagnosed with meningioma via CT
Scan. Now have to decide on treatment and would obviously prefer Gamma Knife
non invasive. However, I also have a pacemaker and MRI cannot
be used. Can Gamma Knife procedures be done with CT as well or is MRI essential?
Dr. Lee responds:
Yes. |
Kirk asks:
Dr Lee, I have glossopharyngeal neuralgia and trigeminal
neuralgia. I have had failed MVD. Is there any work being done using Gamma Knife for glossopharyngeal neuralgia?
Dr. Lee responds:
There is one case report of this having
been performed at Wake Forest. See
Stieber VW et al. 2005. |
JR asks:
A 65 year-old relative has been diagnosed with a 1 cm mass in the vermis. There
is no hydrocephalus. He has no support
system near him, and he is refusing open surgery at this time. Is the gamma
knife appropriate?
Dr. Lee responds:
Gamma Knife radiosurgery can be done
without pathologic confirmation only
if the MRI findings
are pathognomonic (a pathognomonic
sign is a particular sign whose presence
means, beyond any doubt, that a particular
disease is present). In your relative's
case, the MRI findings may be more
difficult to interpret. |
Martha asks:
I have been diagnosed with an auditory neuroma size .5 Very small. I do have
a small amount of hearing loss in the ear that has the tumor. I have been
told to wait and see how fast it grows by a top surgeon in New York City.
Do
you think it would be useful for me
to have a consultation? I would like
very much to preserve my hearing and
have been told there is a good chance
I will lose it in my right ear. I welcome
your opinion and would be happy to
set up a consultation if you think
it would be useful.
Dr. Lee responds:
Absolutely. Small to medium sized acoustic
neuromas are best treated with either
observation or Gamma Knife Radiosurgery.
See Pollock et al, 2006, "Patient
outcomes after vestibular schwannoma
management: a prospective comparison
of microsurgical resection and stereotactic
radiosurgery" which provides the
best prospective study and evidence to
support this strategy. |
Barbara asks:
I had a Gamma Knife procedure for an acoustic
neuroma about six months ago. If my follow-up MRI shows
no change or slight enlargement-is this common? I heard the tumor can swell before
it shrinks. How long can it take to see results?
Dr. Lee responds:
Yes, it is common at the six month MRI
to see swelling. At the 12 month MRI,
you should see a decrease in the size
of the tumor or stability. |
Kim asks:
I had a stage II oligodendroglioma fully
resected about eight years ago. It came back as a stage II again and small
(the tip of your finger). This tumor was also removed. They want me to do radiation.
Is Gamma Knife used in situations where the tumor was fully resected?
Dr. Lee responds:
Conventional radiation with IMRT is a more common treatment strategy for your tumor. |
CarolJane asks:
I am a fifteen year breast cancer survivor,
dealing with metastasis to the bones
since late 2001. Along with that, we've been monitoring two meningiomas.
One in the left temple area is stable. The other, may need some attention. It's
in the right frontal lobe, and has grown slightly, about two mm. in each direction,
in the past six months. It's about the size of a grape. The radiology report
states that it could be an atypical, aggressive meningioma, a metastasis, or
a "collision tumor" - combination of the two.
I'm scheduled for another
consult with a neurosurgeon. I'm assuming
he'll send me to a radiation oncologist.
Would you advise a second opinion
outside of our locality? Also, my
local hospital has a Gamma Knife department.
Any idea of how they compare to Penn?
Dr. Lee responds:
Absolutely, I would recommend a second
opinion. I would be happy to review
your films and/or see you for consultation.
If you would like, please send your
MRI images on cd along with reports
to me:
Department of Neurosurgery
Attn: Dr. John Lee
330 South 9th Street
4th floor
Philadelphia, PA 19107
|
Patrick asks:
My wife was just diagnosed with frontal meningioma (3cm+)
golf ball size. Is Gamma Knife possible with this size of meningioma.
Our neuro advised us that because of its size gamma is unlikely.
Dr. Lee responds:
Gamma Knife radiosurgery side effects
are determined by:
- Volume
- Location
- Individual sensitivity
A single
linear dimension of 3cm can represent
a small volume if it is 3cm x 1cm
x 1cm. I would be happy to review
your wife's films. Please send MRI films on cd and radiology reports
to me:
Department of Neurosurgery
Attn: Dr. John Lee
330 South 9th Street
4th floor
Philadelphia, PA 19107
|
Joe asks:
I was diagnosed with trigeminal
neuralgia more
than two years ago, and suffer unbelievable
headaches every
day and am interested in the Gamma Knife
procedure. Mine is on the right side
and accompany cheek and eye spasms and
sensitivity to sound and light.
But due to a back injury years ago I
am on disability.
Since I do get medicare
as well as medical assistance from
the state of PA (Medicaid) I was wondering
if either of those two insurance options
would help to pay for the procedure.
Ultimately,
I would like to get back to working
but I currently cannot due to the headaches
and high doses of meds. to keep them
at bay. Currently I take prescription
pain medications including oxycodone
and would like to get away from them.
If the insurance I have does not pay
for it, approximately how much does
the procedure cost if I had to pay
for it myself?
Dr. Lee responds:
Gamma Knife radiosurgery is covered
by both Medicare and Medicaid. I
would be happy to see you for consultation
regarding your trigeminal neuralgia.
To schedule an appointment, please
call us at 800-789-PENN. You can
also request
an appointment online. |
Dan asks:
My mother is 78 years old and was just
diagnosed yesterday with meningiomas.
She is going to get another MRI of her
spine to see if there are meningiomas
there, too. Is she a proper candidate
for Gamma Knife radiosurgery? I am very
concerned about having my mother cut
open with brain
surgery due to her age
and if there is a nonsurgical alternative
for her, I would like to explore it.
Dr. Lee responds:
Absolutely, your mother would be
an excellent candidate for Gamma
Knife radiosurgery. It is less
invasive than traditional cranial
surgery, and is therefore often a
better alternative for elderly patients. |
