Penn Gamma Knife Center at Pennsylvania Hospital
About the Penn Gamma Knife Center at Pennsylvania Hospital
What Types of Disorders Can the Gamma Knife Treat?
How Does the Gamma Knife Work?
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Q&A Sessions:

Acoustic Neuroma

Arteriovenous Malformation

Astrocytoma

Brain Metastasis

Gamma Knife

Hemangioblastoma

Meningioma

Pituitary Adenoma

Schwannoma

Tremor

Trigeminal Neuralgia

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About Our Team
 

Q&A Sessions: Meningioma

John Y.K. Lee, MD, Assistant Professor of Neurosurgery, is the Director of the Penn Center for Cranial Nerve Disorders and a national leader in treating cranial nerve disorders.

Rusty asks:
I had an MRI performed at Pennsylvania Hospital two months ago. There was the incidental finding of "there is a small anterior fax mass with possible calcification, 7.4mm, calcified meningioma, meningioma or ossification of the falx." My neurologist said it was nothing. What do you think?

Dr. Lee responds:
Most meningiomas of this size can be followed with serial MRI scans. I would be happy to see you in consultation to discuss this further. If you would like to schedule an appointment, please call us at 800-789-PENN. You can also request an appointment online.

Diane asks:
My husband, 45 years old, has just received the diagnosis of a meningioma located in the front right top of his skull. Not near his eye orbit. Two inches front to back; one inch deep. He is having headaches and they said there is some evidence of brain swelling around it from the pressure. He's very concerned about the recovery time with a standard craniotomy because he is self-employed. What is the difference in the Gamma Knife radiosurgery and craniotomy? Is he a candidate for it?

Dr. Lee responds:
Gamma Knife radiosurgery is a minimally invasive way to treat Meningioma without the need for conventional surgery. In order to determine his appropriateness for Gamma Knife radiosurgery, I would need to review his films to determine proximity of the tumor to the optic nerve, optic chiasm, and optic tract. I would be happy to review his films.

72opal asks:
I am a 35 year-old female and was diagnosed with a probable 8mm meningioma at the left planum sphenoidale/posterior cribriform plate a few months ago. But one day before that I was admitted in the emergency room for possible TIA. I had all stroke-like symptoms. I am still have weird symptoms slurring speech, confusion, feel of tightning/tingleness of face, more on the left. Could that be from the meningioma?

Is this something that I should be worried about and should I be considering future treatment with Gamma Knife? My doctor said 20 out of 100 people have these meningiomas and he gave me a script for Klonopin and said to have another MRI in a month. But after I went home and looked up meningioma I saw that it is usually a benign slow growing brain tumor.

Why wouldn't he have told me that? I did give him a MRI from three years ago and it didn't show the tumor at that time. I am confused on what I need to do. He also said it is strange how it is on the recent MRI but not on the one from three years ago. Should I be looking into Gamma Knife?

Dr. Lee responds:
Gamma Knife Radiosurgery is an excellent treatment for small meningiomas like yours.

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.

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.

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:

  1. Volume
  2. Location
  3. 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.

Nancy asks:
I had Gamma Knife radiosurgery on March 31, 2008 for a left frontal parasagittal meningioma that was 3.1cm x 2.9cm x 2.2cm. My problem is that I've been so fatiqued lately. Is that a side effect of the Gamma Knife?

My thyroid has been checked and it is ok. I had no symptoms prior to Gamma Knife but it had grown so thus the Gamma Knife. Also, what are the symptoms of edema and when does that typically occur after the Gamma Knife.I was initially on decadron after Gamma Knife and it knocked me for a loop!

Dr. Lee responds:
Although uncommon, I occasionally have patients with fatigue following Gamma Knife radiosurgery. It is unclear whether this is related to the treatment itself or other factors. Edema at the treatment site can occur at any time in the first year after Gamma Knife radiosurgery, but most often occurs 3-6 months later. The first symptom of edema is often headache.

Susan asks:
My son was born with a ganglin cell tumor which caused seizures. The tumor was removed when he was three and a half. He was seizure-free for 11 years. He is now having status seizures. Our surgeon is thinking of surgery. He thinks it might be the edge where the tumor was removed causing the seizures. However, if we go back in, they say it will affect his motor skills. His right hand is very weak already. Is he a candidate for Gamma Knife?

Dr. Lee responds:
Yes, he is a candidate for Gamma Knife radiosurgery. I would be happy to review your son's case and contact you with my recommendations.

Betey asks:
My husband has a one inch diameter benign tumor on the vermis of the cerebelum. He has mild symtoms. We were told there is nothing that can be done for him because of the tumor's location. Can you help?

Dr. Lee responds:
I would be happy to review his case and contact you with my recommendations.

Suresh asks:
My father is suffering from tumor. Three impressions from the MRI report as follows:

  • 3x2 cm well-defined lobulated extra axial isointense lesion at the level of foramen magnum on the left side- schwannoma / para gangiloma
  • Bilateral mastoiditis
  • Small lacunar infarcts in bilateral parietal white matter.

Is Gamma Knife treatment feasible for this size of tumors? Please help me out with your valuable feedback as we are unable to come to you. If you have any idea where this Gamma Knife treatment available in India? Eagerly waiting for the response.

Dr. Lee responds:
Yes, Gamma Knife radiosurgery is an option. I would be happy to review his case and contact you with my recommendations.

Priya asks:
I am 38 years old. I was diagonosed with a meningioma 4.4 x 3.1cm in superoinferior and transverse dimensions noted in the left anterior and medial temporal region causing mass effect on left temporal lobe and basifrontal parenchyma. It's enclosing the main artery supplying blood to the brain left supraclinoid ICA and proximal MCA and is displacing the left optic nerve and effect on the optic chiasm.

The diagnosis was done first in September 2007 and as I wanted to try alternative medicine and had no apparent symptoms due to this, so the doctors advised me to wait for six months and get another MRI done. I got one MRI in February 2008 and the size was unchanged. Then I got an MRI done in April 2008 and the size is now changed by 3mm in past two months.

Please advise if Gamma Knife or robotic drilling is possible in my case. Doctors here advise a surgery followed by Gamma Knife.

Dr. Lee responds:
I would be happy to review your case and contact you with my recommendations.

Corinne asks:
My mother (87) had Gamma Knife radiosurgery five years ago for a meningioma. As of last year, the tumor had not grown, but she is having more and more difficulty with balance, being told that the meningioma is possibly pressing on a nerve. Would additional treatment be an option? She is in good health otherwise.

Dr. Lee responds:
Gait instability in someone of her age is multifactorial. Since Gamma Knife radiosurgery has been successful in stopping tumor growth, this is unlikely to be related to the tumor.

Julie asks:
I have been diagnosed with right ventricular meningioma approximately 2.5cm. The neurosurgeon also suggests that it could be choroid plexus papilloma. If it is the latter, can I still have Gamma Knife?

Dr. Lee responds:
Yes, Gamma Knife radiosurgery is an option for both meningioma and papilloma.

NatureLover asks:
A recent MRI with contrast showed a tiny 5mm focus of enhancement near the vertex left anterior parietal lobe. The radiologist said the image could represent a very small en plaque meningioma. If this should grow eventually, would an en plaque meningioma be a good candidate for a Gamma Knife procedure? What does en plaque mean? Is it prudent to be scanned again in one year? Two years? More?

Dr. Lee responds:
I would be happy to review your case and contact you with my recommendations.

Anand asks:
I was operated on for a 3.2cm x 2.7cm x 2.1cm right CP angle clear cell meningioma (WHO Grade II) six months ago. The latest MRI shows a persistent 1.4cm x 0.25cm lesion (only two dimensions are mentioned in the report) still remaining. This was also present in the MRI taken just after the surgery.

My neurosurgeon suggested that since he had achieved a Simpson grade I resection, there was no need to undergo radition, unless the tumor increased in size. I have been advised for a MRI every six months. Should I go for Gamma Knife to treat the remaining portion of the tumor or wait to see if it increases in size?

Dr. Lee responds:
A WHO grade II meningioma is more aggressive than the more common WHO grade I meningioma. You could undergo Gamma Knife radiosurgery now or later if repeat MRI shows tumor growth. Both are reasonable options.

Teresa asks:
I have a meningioma that is throughout my skull and sinuses. I have had surgery (1994, 1997) and traditional radiation therapy (1996). I was told by the radiation oncologist that the level of radiation treatments I received meant I could never have more radiation.

Is Gamma Knife considered radiation? Even if I have maxed out on radiation, is it possible for me to receive Gamma Knife if I need more surgical intervention in the future?

Dr. Lee responds:
Gamma Knife radiosurgery is definitely a form of radiation. I would be happy to review your case and contact you with my recommendations.

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 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 on small tumors. In addition, an atypical meningioma WHO grade II has a higher likelihood to grow and recur. Hence, Gamma Knife is a good option.

To further discuss your case, please feel free to 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.

Lilly asks:
I am 80 years old and have been diagnosed having a meningioma. It is 5mm in size. Could Gamma Knife radiosurgery be used?

Dr. Lee responds:
There are always at least three options for patients with benign meningiomas: conventional craniotomy/surgical resection, Gamma Knife radiosurgery, and watchful waiting. Oftentimes, a 5 mm meningioma can be watched and observed with serial MRI scans. Gamma Knife is always an excellent neurosurgical treatment option if the tumor grows or if you develop symptoms.

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.

Karl asks:
I had a MRI four weeks ago and at the hospital they told me it is a meningioma. I then seen a neurosurgeon who advised me to either have a biopsy or wait eight months to see the growth. It is 2cm right now. It is affecting my right eye because it's near my optic nerve. Can Gamma Knife help?

Dr. Lee responds:
Gamma Knife is an effective strategy to manage meningiomas. However, you must choose an experienced Gamma Knife team. Meningiomas that intimately involve the optic nerve are not good candidates for Gamma Knife; however, an experienced group can sometimes shape the beams in such a way as to avoid complications. Each patient and situation is unique and requires delicate consideration.

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.

Michael asks:
My daughter (34 yrs) has been diagnosed with a meningioma which has completely surrounded the carotid artery, both optic nerves and the pituitary. We have been advised against endoscopic or steriotactic surgery. Is Gamma Knife a possible alternative to conventional surgery?

Dr. Lee responds:
Gamma Knife may be an option, but by your limited description and based on the age of your daughter, it does sound like conventional surgery may be the best approach. Obviously, I would require more detail than this in order to make a firm judgment.

John asks:
I have been diagnosed with a 1-1.5cm meningioma behind my left eye making a 'U' shape aropund my carotid artery. The military doctors tell me to come back and re-measure in 90 days. Is this the right approach? How sure are they now from the MRI it is a meningioma?

Dr. Lee responds:
Meningiomas can often be diagnosed based on their imaging findings alone. Hence, many doctors can be confident that the tumor is a meningioma. However, in situations where the diagnosis is in doubt, more frequent imaging may be performed to determine the growth characteristics of the tumor in question. Meningiomas grow extremely slowly. Other tumors tend to grow faster.

SyrCar asks:
Dr. Lee, my father had Gamma Knife radiosurgery in December for a brain tumor (benign meningioma). In February, he started to have blurred vision. His neurosurgeon put him on steroids. These steroids had terrible side effects (depression, anxiety, etc.) so he took him off of them. The blurred vision has worsened. He had his first MRI since his surgery. The area around the tumor is still swollen and tumor appears to be slightly bigger.

The surgeon feels that it often takes a while for the swelling to reduce. Is this common? Also, is blurred vision a common result? What are the chances for his vision to return to normal? Should we see a neuro-opthamologist? Finally, what other things can be done other than steriods to reduce swelling?

Dr. Lee responds:
It is common for benign tumors such as acoustic neuromas and sometimes meningiomas to swell temporarily after Gamma Knife radiosurgery. This has been seen in many patients and has been followed with serial MRI scans. Most of the time, the swelling improves with time.

Although Gamma Knife radiosurgery is minimally invasive, side effects are related to the surrounding brain structures such as the optic nerve. It is always important to take these things into consideration during the Gamma Knife radiosurgical planning and delivery.

Cindy asks:
I have a 2.5 frontal lobe meningioma and have been advised to have it removed surgically. Having just read about Gamma Knife surgery, I'm wondering why conventional surgery is preferable to Gamma Knife considering I wouldn't have to have a craniotomy with the GK.

Dr. Lee responds:
You are definitely correct. Gamma Knife radiosurgery has proven to provide greater than 90% tumor control for meningiomas. It avoids the risks of general anesthesia and craniotomy.

Although some tumors may be very easy to resect because they are located in an accessible location, Gamma Knife radiosurgery can also be performed on these tumors. This approach avoids any risks associated with conventional resection. I would even go so far as to suggest that there is no reason to resect the majority of meningiomas, since Gamma Knife can control these tumors.

For more information or to schedule an appointment at the Penn Gamma Knife Center, please call 1-800-789-PENN (7366) or you can also request an appointment online.

Luckycharmed asks:
I have a sphenoid wing meningioma which caused 5 mm of proptosis to my right eye. Can this type of tumor be taken care of with the Gamma Knife? If yes, will it shrink the tumor enough so my eye will go back to normal? What kind of side effects do you get from this treatment, and does it requre any bed rest after it?

Dr. Lee responds:
In general, Gamma Knife radiosurgery does not shrink tumors like meningiomas. However, we have seen in a minority of cases (approximately 25%) that there can be some reduction in size of the tumor. The decrease is small and may not be enough to completely restore the proptosis of your eye.

Side effects of Gamma Knife are specific to the location of your tumor. For example, if your tumor is very close to your optic nerve, the most important side effect relates to your vision.

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.

Laura asks:
My 70 year-old mother had a craniotomy in January 2006 to remove a golf-ball size meningioma from the area above her left temple, along the hairline. In her December 2006 MRI the tumor is growing again and is the size of a marble right now. Her doctor said she is not a candidate for Gamma Knife because she would have permanent hair loss in that spot since the tumor is right there under the surface. Is this nonsense?

Dr. Lee responds:
Hair loss can be a complication of superficially located tumors. That should not necessarily be the primary reason to perform Gamma Knife or not to perform Gamma Knife.

Paela asks:
I have a 1 inch meningioma, headaches. Will surgery be my option?

Dr. Lee responds:
Gamma Knife is an excellent option for tumors less than 15 cc in volume. Control rates are as high as 95 percent for at least 5 to 10 years.

Debbie asks:
I have a 6mm meningioma left temporal lobe orbital apex by carotid artery, I keep hearing "it's too small to be causing pain you're relating" I'd like to know your opinion and if this may be right for me.

Dr. Lee responds:
There are many patients who have meningiomas who do not have pain or headaches. Similarly, there are many patients who have meningiomas that do have headaches or pain. Hence, it is sometimes difficult to know.

Kathy asks:
My mother was diagnosed with a golf-ball size meningioma on left frontal. we were told nothing can be done and the tumor may be grown over 30 years It's hurt to see her lying on the bed and loosing muscle mass. She is 94 years old. I am just wondering if she can be a candidate for gamma-knife.

Dr. Lee responds:
Obviously, decisions in someone your mother's age would have to be made in her unique context. I would be happy to speak with her about her case.

Lori asks:
I had a meningioma removed in 2003 at the anterior aspect of the right temporal lope. An MRI on 2/5/07 showed no recurrence, however, it did show a new fusiform 8 x 5 mm meningioma at the posterior aspect of the left tentorium. At this time there is no significant mass effect. Looking at brain anatomy, this seems to be a small area. How big should it be before surgery is considered? Is Gamma Knife an option?

Dr. Lee responds:
Gamma Knife is best when the tumor is small. This allows us to deliver the high dose of radiation safely. I think you are an excellent candidate right now.

Michael asks:
I had surgery last year for a pretty big frontal atypical meningioma. Despite the surgery seemed total, one year later they found a suspicious image on the MRI.a possible anterior parasagittal meningioma (size=1,4cm) ,my surgeon tells me to wait and see for another 3 months. I’m a good candidate for Gamma Knife? I'm 30 years old

Dr. Lee responds:
Gamma Knife radiosurgery can definitely be used to treat atypical meningiomas. The management of your condition, however, is more complicated than simply a yes or a no, and I would suggest you talk to your neurosurgeon about the different options.

Linda asks:
I am a 65 year old female in otherwise excellent health. However, 7 months ago I had a focal seizure and was diagnosed with a 3.4 cm cavernous sinus meningioma behind my right eye, between the optic nerve and carotid artery. Doctors feel the tumor has been present for 10-15 yrs and is just now causing complex focal seizures. I have no other neurological symptoms. In these past 7 months, there have been 4 focal seizures of which I have absolutely no memory.

Surgically, the lesion cannot be completely removed due to its location. Gamma Knife apparently is not an option due to the tumor size. With surgical removal, any remainder or new growth would be followed-up with Gamma Knife surgery when necessary. There would be a 40% chance of no additional seizures with surgery. However, with surgery, there is the definite possiblity of complications, more and/or even worse types of (grand mal)seizures. The last MRI, MRA done 2 months ago revealed no change in the tumor or its size since origally discovered. It is also beginning to calcify. I am not at all comfortable with the thought of invasive surgery due to its possible complications. I continue to feel great each day and am able to function as I always have.

My question to you is: In your opinion, would I be better off or ok now to have no surgery, continue with the anti-seizure medications, and watch and wait for any possible tumor or neurological changes. If, at a later time, there are changes, to then make a decision regarding surgery?

Dr. Lee responds:
Your case is quite complex, and I would be happy to review your films. Your tumor can potentially be treated with Gamma Knife even despite its large size if the volume is appropriate.

If you would like to schedule an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

 


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Gamma Knife and Leksell Gamma Knife are U.S. federally registered trademarks of Elekta Instrument S.A., Geneva, Switzerland. Photo credits: Susan Pardys, Elekta, Inc.

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