Jan asks:
I had Gamma Knife and no longer have any
pain (seven months). I understand there
is to be numbness and tingling, but is
itching of the face a side effect and
will any of the side effects go away
or subside? Is there something I can
take or apply to my face for the itching?
Dr. Lee responds:
Itching can be a side effect of Gamma
Knife radiosurgery for trigeminal
neuralgia. It should improve. |
Rick asks:
How many Gamma Knife procedures do you perform
annually at the Center? How does that
compare to other centers in the region
and nationally?
Dr. Lee responds:
We perform the most Gamma Knife procedures
in the Delaware Valley, approximately
300 case per year. |
Joanne asks:
My mother had Gamma Knife radiosurgery exactly
two years ago. Unfortunately, her tumor
has returned in the exact same place.
Can she have the same procedure repeated?
Dr. Lee responds:
This depends on the type of tumor and
location. I would be happy to review
her films. |
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. |
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. |
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. |
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. |
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. |
ZlajaJ asks:
My mother had lung
cancer surgery and no chemo given afterwards.
This was due to excellent reports from the
oncology doctor. However, it metastisized
to two parts of her brain. The Gamma Knife
procedure was performed. However, why can't
a surgery be performed to get the lessions
out?
Dr. Lee responds:
Gamma Knife radiosurgery is often an
effective alternative to surgery for
the management of small to medium sized
brain lesions. Gamma Knife radiosurgery
eliminates the need for an invasive
procedure, such as craniotomy,
which often poses greater overall risk
to the patient. |
Robert asks:
We are US citizens based in Philippines.
My wife is 36 years old with no previous
significant history. Onset tongue "numbness " week
of May 26. Progressed to right-sided
facial "numbness" by time of birth of
child July 1. While in hospital post
c-section, internal medicine consult
found neuro exam normal except decreased
(8/10) sensation to touch on right side
of face.
MRI done
with and without contrast. Mass in cavernous
sinus on trigeminal nerve (2.1 x 1.8
x 1.5cm). Clinical opinion here of three
neurosurgeons seen say meningioma or
neuroma, with two out of three opting
for neuroma. Stereotactic radiosurgery
recommended, but at least four options
of types of stereotactic radiosurgery
discussed. Would like US-based opinion
on appropriate intervention. Specifically
why is one technique better than other
for this?
Dr. Lee responds:
The Gamma Knife is inarguably the gold
standard by which all other intracranial
radiosurgical delivery methods are judged.
Not only was it the first, it still remains
the only tool that is dedicated solely
to intracranial lesions, such as your
cavernous sinus lesion.
Since the introduction of Gamma Knife
in the 1950's, there are now many competitors
that have emerged. Some of the advantages
of the competitors include the fact that
that they can be used to treat brain tumors
as well as lung, spine, and prostate tumors.
Hence, the competitors are "all-purpose" knives.
Gamma Knife stereotactic radiosurgery
is extremely accurate, but it does require
a frame. This stereotactic frame is light
weight and is affixed to your outer skull
with four pins. The frame provides exact
MR correlation from planning to treatment
delivery in 3D. It is with the use of this
frame that Gamma Knife provides pinpoint
accuracy at less than 0.5mm. Without a
frame, other forms of radiosurgery may
not be as accurate.
In addition, I authored the largest paper
published on cavernous sinus meningioma
and Gamma Knife radiosurgery. I have attached
a copy of the paper for your convenience. |
Stan asks:
Does this leave less possibility of cancer
spreading? Also does medicare cover this?
Dr. Lee responds:
Radiosurgery typically is reimbursed
by most insurance companies, PPOs,
HMOs and Medicare when indicated. |
Dawg asks:
Is there a certain number of brain lesions
where Gamma Knife will not be used? My
father has four lesions that are all
about 4cm in size. Is this too many and
too large?
Dr. Lee responds:
Each patient's situation is unique and
there are many factors involved in
determining whether Gamma Knife radiosurgery
is a valuable treatment option. Four
lesions is generally not too many,
however, the maximum size limit is
usually 3-3.5cm.
I would be happy to review his case. Please
mail the actual films and relevant notes
to my office at:
330 South 9th Street
4th floor
Philadelphia, PA 19107
I would be happy to review the case and
contact you with my recommendations. |
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. |
