Penn Gamma Knife Center at Pennsylvania Hospital
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Q&A Sessions: Other Topics

John Y.K. Lee, MD will be answering your questions about Gamma Knife radiosurgery. Click here to ask your question.


Jess asks:
Which do you think is safer to remove a cerebral cavernous malformation: surgically or with the Gamma Knife?

Dr. Lee responds:
Surgical resection is the preferred management for this specific type of cavernous malformation. However, if the risks of surgery are high, Gamma Knife radiosurgery may be an alternative.

Jules64 asks:
I have been diagnosed with a prominent pituitary gland with 0.3x1.2cm delayed enchaement in the central pituitary gland with increased T1signal. It is compatible with pituitary macroademona with hemmorrhage. Also, with stable frontal white matter change. I have been being treated for 1.5 years for severe depression. After losing my sense of direction and short term memory getting worse by the moment they finally suggested the MRI, after first findings they did a second with contrast.

Am I a candidate for the Gamma Knife radiosurgery? I do not know the blood test reults yet. What I do know is that I have been treaated for colon polyps two years ago and the severe depression, loss of intrest in everything, and no sexual emotions or needs at all. I though as all that it was the depression. With these findings and treatment can I be sure that it has been the tumor the whole time? Will the Gamma Knife help me?

Dr. Lee responds:
In general, I recommend an endoscopic endonasal resection of pituitary tumors, and I reserve Gamma Knife radiosurgery for recurrences or residual pituitary tumor.

Ali asks:
I have been suffering from post-traumatic neuralgia for eight years now as a result of physical damage to my left hand side trigeminal nerve. My symptoms include pain and full spasms on my left eye lids and cheek. Will Gamma Knife offer any help at all?

Dr. Lee responds:
Gamma Knife radiosurgery is unlikely to help post-traumatic, neuropathic facial pain.

Denise asks:
Is Gamma Knife radiosurgery considered for treating liver tumors near the pancreas where standard surgery is contraindicated because of the age of the patient?

Dr. Lee responds:
Gamma Knife radiosurgery can only be used to treat lesions within the brain. It cannot be used to treat liver lesions.

Judy asks:
Could the Gamma Knife be used to treat a post-traumatic arachnoid cyst causing headaches, severe balance issues and nausea? If so, what would the sucess rates be like?

Dr. Lee responds:
No, unfortunately Gamma Knife radiosurgery cannot be used in this case.

Jo asks:
My husband had a pancoast tumor. He had Taxol, radiation, and finally surgery to remove the tumor and part of his lung. After more chemo, a year later it had spread to his adrenal gland/lymph nodes. He went on Alimta and then Tarceva with no response. Although the tumor is very slow growing they said there is nothing more to do. Is this procedure good for the adrenal gland? Is there anything we can do?

Dr. Lee responds:
Gamma Knife Radiosurgery can only be used to treat lesions in the brain. It cannot be used to treat your husband's adrenal tumor.

Anil asks:
My wife has multiple spine arteriovenous malformations from t10 t12. Please guide us for Gamma Knife. Is it successful?

Dr. Lee responds:
Gamma Knife radiosurgery can only be used to treat lesions in the brain. It cannot be used to treat spinal lesions.

Christine asks:
I have been dealing with chronic nausea and headaches for over a year. After a number of tests and procedures, the only thing doctors can come up with is that I have an overactive chemoreceptor zone. I can't live like this and I was wondering if the ctz could be removed/deactivated using the Gamma Knife. I am desperate at this point.

Dr. Lee responds:
No, Gamma Knife radiosurgery cannot be used to treat overactive chemoreceptor zones.

Laura asks:
My 17-year-old son has a hemangioblastoma on the lower thoracic region of his spine. He has VHL and was diagnosed with secondary polycythemia. Is he a candidate for Gamma Knife radiosurgery?

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 spine.

Meyers asks:
My husband has this constant ringing in his left ear. He saw a ear specialist and had a CAT scan, which the results show that there is a cyst on the left side of brain cover. Is this a common occurence in patients? Since the first scan six months ago, he has lost more hearing. Could this cyst be having an effect on his hearing?

Dr. Lee responds:
If this is an arachnoid cyst, they generally do not cause symptoms unless they expand.

Faith asks:
My sister has been diagnosed with stage four metastatic melanoma in lymph nodes in her neck, abdomen and pelvic area, but we just learned she has it in her brain also. She has two large tumors (3.5 and 2.5) and they say too many small ones to count. They are doing WBR on the small ones, but they said if the radiation doesn't shrink the small ones then they won't bother to do the Gamma Knife on the larger ones. Do you concur with this?

They said they are not even bothering with the rest of the cancer unless they get the brain tumors under control. She is 46 years old and had a mole removed 13 years ago and they say it's recurrent from that! Do you agree with the plan they are doing?

Dr. Lee responds:
The addition of Gamma Knife can definitely improve local tumor control. The overriding concern, however, is whether it will increase her survival.

Marie asks:
My grandmother has been diagnosed with a glioblastoma in what the neurosurgeon called the "the back basement of the second floor of the brain." It is in a critical area. As I did not get the information first hand, I can't get any more detailed than that. My grandmother has type II diabetes, is partially blind, and has smoked since her teens.

The neurosurgeon would like to do a biopsy, but we do not think she would be even able to handle that. Our concern now is quality of life, not quantity, but because of her recent dementia due to the tumor, we were wondering if direct radiation would alleviate it? Would she even be a candidate for the Gamma Knife?

Dr. Lee responds:
We currently use Gamma Knife radiosurgery for recurrent glioblastoma multiforme after conventional radiation treatment and chemotherapy treatment. Her dementia is unlikely to improve with Gamma Knife radiosurgery.

Toni asks:
Around October 2004, I began experiencing symptoms: left eye bulging/swelling/inflammation, with eye redness. Later diagnosed with an optic nerve tumor (glioma?). In February 2005 I underwent a craniotomy to have the tumor removed. It appears to gave returned, even bigger.

I have an appointment soon with my neurosurgeon. I have seen an occuplastics doctor who recommends removal of left eye (enucleatin?). Before I undergo such a drastic and life-altering surgery, I would like to know if you think that the Gamma Knife could possibily be another option for me?

Dr. Lee responds:
No, Gamma Knife radiosurgery would not be an option is your case.

Janet asks:
My husband has non-Hodgkin's lymphoma with a tumor on his abdomen about 5cm in diameter. Could the Gamma Knife be used to shrink this tumor?

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 abdomen.

Margie asks:
My husband has trochlear nerve damage from sinus surgery preformed in November 2005. He has tried trochlear nerve injections and 20+ different pain medications and none seem to help. The only thing that has given him some relief is neurofeedback.

However, he's tired of waiting so long for the nerve to heal. Would the Gamma Knife help him? Also, with such a strong dose of radiation, is there any guarantee that the radiation itself wouldn't cause cancer?

Dr. Lee responds:
Gamma Knife radiosurgery can not be used to heal nerves.

Margaret asks:
I now have an 8x4 cm malignant breast tumor (third time). I had a double mastectomy with free flap reconstruction last year. Four chemo treatments did not shrink tumor. If it is too large for surgery, would Gamma Knife be an option? I currently am treated at Penn.

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 breast.

Helen asks:
Can the Gamma Knife remove a slow-growing lung tumor?

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.

Paul asks:
Can the Gamma Knife be used to treat tumors in the colon.

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 colon.

Mags asks:
I was diagnosed with a cavernous angioma located on the pons. This has caused left sided nerveVI palsy, accompanied by double vision, tinnitus, and numbness on my right side. My neurologist was of no help and said there was nothing to be done. Could your procedure help me?

Dr. Lee responds:
There is some limited evidence that Gamma Knife radiosurgery can reduce the hemorrhage rate for cavernous angiomas.

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.

Daniel asks:
My father-in-law (age 69) is diagnosed with non-small cell lung cancer that has metastasized to the right frontal lobe of the brain. The brain tumor is small (only 5mm). Is he a good candidate for Gamma knife operation?

Dr. Lee responds:
Absolutely. Gamma Knife has been proven to provide survival advantage over conventional treatment.

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.

Loretta asks:
I have a 5cm tumor on my right kidney. I am scheduled for a cath proceedure using alcohol to burn the tumor (benign). Is Gamma Knife an option? I see cyberknife options all around the country but I prefer the University of Pennsylvania Health System direction.

Dr. Lee responds:
Gamma Knife is the best tool for accuracy within the brain. Cyberknife is an all-purpose tool that can treat tumors in the lung, kidney, prostate, liver, etc.

Margaret asks:
My mom, in her 70s, recently had resection of a grade four glioblastoma. The surgeon was not able to remove all of the tumor because it was too close to the corpus callosum. Would she be a candidate for Gamma Knife for the part of the tumor which could not be removed by surgery?

Dr. Lee responds:
Generally, Gamma Knife is being used as a boost option after conventional external beam radiation therapy and completion of chemotherapy. I would be happy to see her in consultation to discuss this.

To schedule an appointment, please call 800-789-PENN or you can also request an appointment online.

Linda asks:
My 12 year-old granddaughter was diagnosed with a germinoma of the brain (near the pituitary). Could she be a candidate for the Gamma Knife?

Dr. Lee responds:
I actually reviewed your daughter's case in our combined conference, and feel that the tumor is too close to the optic chiasm for conventional Gamma Knife.

Richie asks:
I had lung cancer last September and they took out my top right lobe. Then I went through chemotherapy. I was getting headaches and had a MRI and they found 6 tumors, that came from my lungs. They are all about 1 cm. What are the chances and life span with Gamma Knife.

Dr. Lee responds:
In general, patients with brain metastasis from lung cancer are treated with whole brain radiation followed by Gamma Knife. In some exceptional cases we may recommend Gamma Knife first.

JoEllen asks:
Could anxiety (GAD) be brought on after getting a right frontal craniotomy? I was fine until I had this surgery in December, now I get very frusterated, tired, dizzy, bad heartburn, and severe headaches. Could this all be from the surgery?

Dr. Lee responds:
Conventional surgery, eg craniotomy can affect brain functioning. In your case, it is also possible that steroids are causing your symptoms.

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

Joseph asks:
My neurologist checked my MRI of my head briefly and told me I had ataxia and said nothing about treatment. I am 90 years old and my thoughts are he does not desire to do anything about it. I am not feeling very active socially and I exercise daily. I feel good except I have some problem with my equilibium. I can walk without a cane but I use one. I weigh 138 to 140 lbs. and have a small frame of 5'5 1/2". I am strong and very active. I have a heart attack 16 years ago and just recently a slight stroke. I recovered in both cases. I feel doctors are hesitant to help 90 year olds.

Dr. Lee responds:
Gamma Knife cannot be used to treat ataxia unless there is a tumor or association lesion.

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

Nancee asks:
I have a choroid plexus cyst within the right temporal horn. Is this operable with the Gamma Knife? I have had Gamma Knife for trigeminal neuralgia.

Dr. Lee responds:
A choroid plexus cyst is usually an incidental finding that does not require any kind of treatment.

Question:
My 53 year-old brother was diagnosed with brain cancer in February 2006 after he presented with a debilitating headache. A left craniotomy was performed and the tumor (ID'ed as a hemangiopericytoma) was removed and chemotherapy discs were inserted in the resulting cavity. On subsequent MRI's/CT scans it was determined that another tumor was hidden behind the original tumor that removed. It is growing however I do not have the details on size and location.

My question is simple: Is he a candidate for the Gamma Knife procedure? He has refused to have another craniotomy which is what was recommended to him.

Dr. Lee responds:
Gamma Knife radiosurgery is definitely an option for him. It is difficult to determine the response rate of hemangiopericytoma to Gamma Knife, simply because there are not many patients with this particular type of tumor. Nevertheless, amma Knife radiosurgery can definitely be used to treat hemangiopericytoma.

I would be happy to see your brother. To schedule an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

Sick of Sick asks:
I have a non-enhancing multicystic lesion involving the vermis of the cerebellum 3 cm/1.3cm/1.3 cm transverse. The impression noted that the appearance is suspicious for a low-grade neoplasm. A couple of odd results on blood tests including: Tryptase 22, IGE 840 and a Beta 2 Micro of 2.06. Any thoughts?

Dr. Lee responds:
I would be happy to see you in consultation regarding these results. To schedule an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

Narayan asks:
My wife is 35 and was recently diagnosed with a colloid cyst measuring approximately 1.3 cms near the Foramen of Monro without causing any obstruction. She has a history of migraine type headaches. She went for a CT scan last month and an MRI last week. I had a CT scan done on her four years ago in India and when I showed it to the neurosurgeon here in New Jersey, he said the cyst could be seen on that film. My wife is concerned because we have a two year-old daughter. I am trying to find out if there is any surgical procedure available to have the cyst removed.

Dr. Lee responds:
Gamma Knife is not generally used to treat colloid cysts. Fortunately, most patients with colloid cysts who do not have hydrocephalus can be followed closely. Surgical resection may not be necessary. If you would like to schedule an appointment, please call 1-800-789-PENN (7366). You can also request an appointment online.

Debbie asks:
My husband had Gamma Knife about seven months ago and went for a MRI last week. What does this mean: left frontal lesion 1.3cm x 0.5cm, which demonstrates interval increase in size and ajacent edema? Does this mean it's getting worse or can this be treatment related?

Dr. Lee responds:
Without any specifics, it is difficult for me to determine. For example, it would be extremely unusual for a meningioma to grow in that short interval. A brain metastasis or glioma may demonstrate slight increase in enhancement which might even be related to prior radiation effects. Also, the radiologist who read the report may be comparing the films to older studies and may not have access to the MRI used during the Gamma Knife procedure.

Peggy asks:
My husband is 84 years old. He had a tumor from the bladder removed. The cancer is in the lining of the bladder. Can Gamma Knife radiosurgery 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. In contrast, there are all-purpose tools such as the Cyberknife that can theoretically be used to treat tumors outside of the brain.

JLGN asks:
If Gamma Knife is used on a colloid cyst that is pressing on the pituitary gland, what can I expect as a result of Gamma Knife application?

Dr. Lee responds:
Gamma Knife is generally not used to treat colloid cysts.

Lenora asks:
My 41 year-old daughter suffered a brain abscess and a stroke in December 2004. There was and still is thrombosis of the sagittal sinus vein. We were told at the time that surgery to unclot the sagittal sinus would cause her to bleed out and die, so nothing was done. She has continual head pain, 24 hours a day, in the front of her head where the thrombosis is. Morphine, dilaudid and other pain meds do nothing for the pain. Is the Gamma Knife something that might help her?

Dr. Lee responds:
Unfortunately, Gamma Knife cannot be used to treat this complex problem.

Pat asks:
My wife is nearly ten years post radical mastectomy. Recently four, perhaps five pulmonary nodules were detected on a CT scan. The brain MRI was negative and a full body PET scan showed nothing, but it was pointed out that her lesions are all less than one centimeter. Is Cyberknife ever used in such a situation, and will medicare cover a possibly benign situation?

Dr. Lee responds:
As a neurosurgeon, I am mostly familiar with tumors that spread to the brain and spine. Hence, I do not have much familiarity with Cyberknife to the lung lesions. Nevertheless, investigators at University of Pennsylvania are actively involved with these approaches.

Lynn asks:
I want to ask about the possibility to do Gamma Knife of a epidermoid cyst in the cerebellopontine angle which is more than 5 cm. Also, is shaving your hair is necessary for this procedure?

Dr. Lee responds:
Gamma Knife radiosurgery is generally not useful to treat epidermoid cysts. Conventional surgery is the best option. Please feel free to contact me at 1-800-789-PENN (7366) if you have further questions. You can also request an appointment online.

JLGN asks:
How successful is Gamma Knife to treat Rathke's cleft or pouch cysts?

Dr. Lee responds:
Gamma Knife is generally not used to treat Rathke's cleft pouches or cysts. They are generally treated with conventional surgery.

Please feel free to call 1-800-789-PENN (7366) if you would like to schedule an appointment. You can also request an appointment online.

Trouble asks:
I have a brain aneurysm about 3 to 4mm and I would like to know if you think this procedure would be appropriate?

Dr. Lee responds:
Gamma Knife is not currently used to treat brain aneurysms, only arteriovenous malformations and cavernous malformations.  However, there is active research going on in this area.

Please feel free to call 1-800-789-PENN (7366) if you would like to schedule an appointment. You can also request an appointment online.

Daniel asks:
My father just had a glioblastoma tumor removed from his brain two weeks ago. Now they are preparing him for radiation and chemotherapies. Is your Gamma Knife procedure applicable in this case.

Also, his tumor was the size of a tennis ball and was located in the R temporal aspect where his language/speech and coordination zones meet. They said that he would not have had more than a few months to live if it wasn't removed immediately. But I am wondering if he could have pursued your treatment instead of having to endure an invasive approach.

Dr. Lee responds:
At this time, Gamma Knife radiosurgery is mostly being used to treat patients with glioblastoma only upon recurrence after conventional surgery and external beam radiation therapy. Hence, it sounds like your father has undergone the best surgery and treatment that is currently available.

Karyn asks:
I have an arachnoid cyst within the posterior fossa right side adjacent to the cerebellum. It is 4.9 x 1.5 cm. I am in terrible pain. Is there any treatment besides surgery?

Dr. Lee responds:
Unfortunately, Gamma Knife is not effective in treating arachnoid cysts. Conventional craniotomy and surgery as well as shunting may be options. Please feel free to call 1-800-789-PENN (7366) to schedule an appointment. You can also request an appointment online.

Joyce asks:
If the tumor is large and/or doesn't respond, how soon can the procedure be repeated? Also, do the insurance companies usually pay for repeat treatments?

Dr. Lee responds:
The goal of Gamma Knife radiosurgery for both benign and malignant tumors is to keep them from growing. Repeat radiosurgery is usually only required in a minority of cases, and it should definitely be covered by most insurance companies, especially since the alternative often means conventional craniotomy with opening of the skull/brain.

Rymma asks:
My relative is 24. In 2001 she had surgery to remove ependymoma. It went with no complications. Though in six months after she developed seizures. They were controlled with finlepsin until recently. My relative started to feel worse about two months ago. MRI was performed and it showed the tumor growth of 1 cm. The size is 3.5 cm x 4.5 cm x 3.5 cm. She also had first episode of seizures in the past three years. Would my relative be a candidate for Gamma Knife radiosurgery? She has never had any chemo or radiation treatment before.

Dr. Lee responds:
Your relative has a tumor that can be treated with either surgery or Gamma Knife radiosurgery. However, depending on the location of the tumor, conventional surgery may be a better option. Please call 1-800-789-PENN (7366) to schedule an appointment. You can also request an appointment online.

David asks:
My daughter (26 yrs) had a neurocytoma removed in 2002 and her recent MRI now shows a recurrence measuring approx 3.5 cm within the right lateral ventricle. She has been referred to a neurosurgeon to discuss treatment. She has indicated to us that she wishes not to go through surgery again so we are trying to search out other treatment options at this time.

We read about this procedure and wonder if it would be an option to be investigated. I would like to also inform you that from the first surgery in 2002 she has titanium plates and screws where the skull was fused back together. Would the plates/screws interfere with this type of treatment? We currently have an appointment with the neurosurgeon on 9/7/06 and would very much appreciate any info you could give us.

Dr. Lee responds:
Fortunately, titanium plates and screws do not interfere with Gamma Knife radiosurgery.

Unfortunately, there are times when Gamma Knife is not necessarily the best choice and rather conventional craniotomy and resection may be the better choice. There are many features about her case that make me lean towards conventional resection such as her young age, the size of the tumor, and the type of tumor.

Nevertheless, you will have to make the decision in conjunction with your physicians. Feel free to contact me by calling 1-800-789-PENN (7366) if you would like a second opinion. You can also request an appointment online.

Lindsey asks:
My mother has a tumor that is affecting her fifth and seventh cranial nerves. It has caused facial numbness on the left side of her face. Will Gamma Knife radiosurgery be able to help her gain back any facial sensations in the affected areas?

Dr. Lee responds:
Occasionally, some patients with pain or weakness or double vision will get some pain control or improvements in muscle function after Gamma Knife. However, this is unpredictable and is only seen in a minority of patients.

Carmen asks:
What is the likelihood of having a seizure the day after surgery? Does Gamma Knife surgery create the changes of developing cancer in the future? Can you develope headaches after the surgery?

Dr. Lee responds:
There is a small risk of having a seizure after Gamma Knife radiosurgery, but I generally do not start patients on antiepileptic drugs after Gamma Knife, because the risks of the drugs are greater than the very small risk of seizure after Gamma Knife. However, if patients are already on antiepileptic drugs, I make sure that they are on therapeutic dosages.

There are approximately six reported cases in the literature of patients who have developed more malignant tumors after Gamma Knife. There have been almost 400,000 patients treated with the Gamma Knife. Hence, approximately six of 400,000 is an approximate risk rate. (This does not take into consideration length of time).

Susan asks:
What is the difference between a lesion on the brain and a brain tumor?

Response:
A lesion in the brain is a generic term that includes brain tumors, vascular malformations, arteriovenous malformations, cavernous malformations, or even functional lesions as is seen with the treatment of movement disorders.

Huy asks:
Can the Gamma Knife be used to treat stomach cancer that has already spread to other parts of the body?

Dr. Lee responds:
Gamma Knife radiosurgery is used to treat tumors that are located in the brain. Rarely, colon cancer can spread to the brain, and even more rarely certain other gastrointestinal cancers such as gastric cancer might spread to the brain. In that case, Gamma Knife radiosurgery can be used to treat that.

Joyce asks:
Thank you for responding to my original question about my husband's skull base tumor (....my husband, age 51, was diagnosed with a 3.5 x 1.9 x 1.4 cm right skull base tumor at the level of the jugular fossa and hypoglossal canal, that grows down through the jugular foramen...) and your thought that it might be a glomus jugulare tumor.

My apologies, but I neglected to inform you that he had a cerebral angiogram which indicated tumor is not a glomus jugulare. We were told maybe schwanoma, maybe paranglioma, but no confirmation of type of tumor. Therefore, would gamma knife still be best option? Also, is the size noted above considered "large?" Thank you again. This is a wonderful option on your web site!

Dr. Lee responds:
I generally use different doses for different tumors. Hence, I would prefer some kind of tissue diagnosis, perhaps through a biopsy. With respect to size, I would consider this a "medium"-sized tumor, but without having looked at the film, I cannot be sure.

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

Joyce asks:
My husband, age 51, was diagnosed with a 3.5 x 1.9 x 1.4 cm right skull base tumor at the level of the jugular fossa and hypoglossal canal, that grows down through the jugular foramen (MRI report). He has paralysis of right vocal cords (and is very hoarse), paralysis of right tongue muscle, and right neck/shoulder muscle atrophy. The type of skull base tumor has not been identified, but neurosurgeon and ENT doctors believe it is almost definitely benign.

He is scheduled for Gamma Knife treatment. However, one of the neurosurgeons we consulted prefers surgery (to remove tumor and then biopsy it). Our understanding is that since the nerve damage will not be reversed with neurosurgery, the less risky approach (with same results) is Gamma Knife. Your opinion, please? Also, do you agree that this sized tumor is treatable with Gamma Knife? What are the risks of nearby areas being effected by the radation?

Dr. Lee responds:
It sounds like you have a glomus jugulare tumor. This is a very difficult tumor to cure with surgery or with Gamma Knife radiosurgery. Nevertheless, Gamma Knife is the less-invasive option that seems to offer some ability to control tumor growth.

With respect to size, it is sometimes easier to treat larger tumors in this area, because the tumor is not located directly in the brain. Hence, radiation fall-off in this location does not cause the same side effects as elsewhere in the brain. In conclusion, I think the size of this tumor could be appropriate for radiosurgery.

911oper asks:
Has Gamma Knife radiosurgery been done to relieve occipital neuralgia?

Dr. Lee responds:
Gamma Knife radiosurgery has not been used to treat occipital neuralgia, although it has been used on occasion to treat patients with sphenopalatine neuralgia and glossopharyngeal neuralgia. These other neuralgias are much less common than trigeminal neuralgia.

Bunk asks:
Fifteen months ago I had a seizure in a neurosurgeons office (I thought a fainting spell). I have these seizures once every four or five years. The doctor, after receiving reports from a MRI and brain scan, said that I have an arachnoid cyst. Because it is so close to the brain he refused to operate or provide any follow-up treatment. He did give me a perscription for Phenytoin SOD 100mg pills to be taken three time a day for the rest of my life.

Although I feel fine (I will be 69 in March), the doctor painted a not-so-rosy picture of perfect health. I read a lot on the cause and treatment of these cysts. I would like to know if their is anything new about operations on them (Gamma Knife, etc), new treatments using ovarian drugs, or any combination of drugs to shrink the cysts.

Although I think the doctor is extremly qualified (he is attached to a hospial that is considered medium in size), would it be best to concentrate my search in the best known metroploitan hospitals who engage in experimenting with this type of cysts?

Dr. Lee responds:
Unfortunately, Gamma Knife radiosurgery has not been used to treat arachnoid cysts. Fortunately, arachnoid cysts are usually considered benign lesions that do not generally require any kind of surgical intervention.

Anthony asks:
My 80 year-old father had an MRI on 12/4/2006 – it revealed a possible glioblastoma multiforme, 7cm in diameter. He does not want surgery. Is Gamma Knife a good alternative treatment?

Dr. Lee responds:
I generally treat patients with glioblastoma multiforme (GBM) with the Gamma Knife only if there is a small, nodular recurrence after craniotomy and external beam radiation therapy. I would be happy to review his case.

To schedule an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

Vlad asks:
I have seizure focus near the front of the motor strip three millimeters away. I'm having Gamma Knife done. Seizures always start in right leg. Will this affect my motor skills more (no drugs work)? Also, I have oligodendroglioma for the sixth year with no change.

Dr. Lee responds:
Gamma Knife radiosurgery can be used to treat tumors and thus to control the seizures that are associated with the tumor. If you would like to schedule an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

Barb asks:
My Dad is 85 years old and had no major health problems until the doctors said he had a cerebellum stroke. Three months have passed and now they say it's a tumor and not a stroke. It has grown three times larger and into the brainstem. Can your radiosurgery help him and will his age prevent him from having this done?

Dr. Lee responds:
Radiosurgery is most commonly used to treat tumors. However, it is important to know what kind of tumor it is. In addition, his age is not a contraindication to radiosurgery. It is important to keep everything in the context of his overall disease process.

For more information or to schedule an appointment, please call 1-800-789-PENN (7366). You can also request an appointment online.

BigBill asks:
I have increasingly lost some weight throughout my battle with cancer and have heard about herbal and nutritional supplements. Are they ok to take if I am having Gamma Knife radiosurgery? Which should I avoid and which can I take? Does one treatment of the Gamma Knife usually take care of a small tumor or is it usually to hit one tumor more then once? Basically, I have four tumors and I am unsure how four treatments will work.

Dr. Lee responds:
Gamma Knife radiosurgery is not affected by herbal or nutritional supplements to the best of our knowledge. Hence, please feel free to take any and all supplements.

During one radiosurgery session, I can target up to five tumors in one setting. You will not need to come back many different times. We can usually treat all tumors in the same framing session.

Denise asks:
Can the Gamma Knife be used to treat migraines?

Dr. Lee responds:
No, the Gamma Knife cannot be used to treat migraines.

Kathy asks:
My daughter who is 21 has had severe hand tremors for about three years. She is under the care of a neurologist who has stated that it is due to the Lymes disease that she had at the age of five. She is on medication but her tremors have become increasingly worse. She is a culinary student and now it is affecting her work. Her tremors are said to be intention tremors. Would she be a candidate for this new procedure?

Dr. Lee responds:
Gamma Knife radiosurgery is generally reserved for patients with multiple medical problems that prevent them from undergoing other surgical procedures. The first line surgical option is deep brain stimulation, which is a procedure that I also perform. Explore our health encyclopedia to learn more about hand tremors.

Please feel free to call 1-800-789-PENN (7366) and ask to be connected to my office for a consultation. You can also request an appointment online.

Francis asks:
Has Gamma Knife surgery been used for CLT thalamotomy in the case of chronic thalamic pain?

Dr. Lee responds:
The use of Gamma Knife radiosurgery to treat central pain as in the creation of a thalamic lesion for pain is an extremely rare and unusual procedure.

Jen asks:
I am a 30 year-old female with a cavernous hemangioma in my medula. I have been experiencing symptoms for some time now, but was just recently diagnosed due to a recent bleed. My current doctor is just observing the hemangioma for the time being, however, I am still experiencing downbeat nystagmus, which is effecting my daily life, because I have diffucultly seeing well and can not drive. Is the Gamma Knife an option in my case?

Dr. Lee responds:
Gamma Knife is an option, although the evidence for its efficacy is limited to just a few case series. The goal of the procedure is to decrease symptom events such as seizures and hemorrhages.

Please call 1-800-789-PENN (7366) and ask to be connected to my office for a consultation. You can also request an appointment online.

Mark asks:
My wife's cerebellum has a fluid-filled cyst and another one on the meninges linings. Is Gamma Knife something to consider as an option for treatment as she has had two surgeries for the cerebellum cyst and intervention again is not being reccomended. The third surgery resulted in a shunt to drain the hydrocephalus. The symptoms are returning almost as if she is dealing with the initial problem again.

Dr. Lee responds:
Gamma Knife radiosurgery is not generally used to control these kind of cysts, unless there is an associated tumor.

Richard asks:
Have you ever heard of Gamma Knife being used for occipital neuralgia?

Dr. Lee responds:
I have never performed Gamma Knife radiosurgery for occipital neuralgia, but there are many unique new procedures for occipital neuralgia, including peripheral nerve stimulation.

I would be happy to discuss these options with you. Please call 1-800-789-PENN (7366) and asked to be connected to my office. You can also request an appointment online.

Arnold asks:
My wife has a tumor between the two main blood vessels behind her left ear called a paraganglioma. Could we treat this with a Gamma Knife?

Dr. Lee responds:
A paraganglioma can be treated with the Gamma Knife depending on its exact location. We have treated several patients with these tumors, oftentimes in conjunction with our otorhinolaryngologists.

I would be happy to discuss these options with you. Please call 1-800-789-PENN (7366) and asked to be connected to my office. You can also request an appointment online.

Irene asks:
I have been diagnosed with trigeminal neuralgia by one neurologist and neuropathy by another. One suggests Gamma Knife and the other says I will not be helped by that procedure and should have a spinal tap to ascertain if my problem is bacterial or fungal in nature. I have the symptoms of shocks combined with aching and burning. Could you tell me what my next step should be?

Dr. Lee responds:
It is always safe to obtain tests before proceeding to an invasive procedure. Gamma Knife radiosurgery can always be performed at a later date.

Jess asks:
Hi, I'm 16 and have a craniopharyngioma and I'm just wondering if I could use Gamma Knife instead of getting surgery?

Dr. Lee responds:
The first line of treatment for a craniopharyngioma is surgical resection. If the tumor comes back after surgery, Gamma Knife can be used as an alternative.

Kathi asks:
Can Gamma Knife be used to correct a shunt installation for normal pressure hydrocephalus?

Dr. Lee responds:
No, Gamma Knife cannot be used to correct a shunt installation for normal pressure hydrocephalus.

Kathy asks:
My husband suffers from chronic pain that sits slightly to the left of and under his sternum. He has been a patient at the Penn Pain Clinic for 10 years with modest results. We understand that this procedure might hold out hope as other centers around the country describe chronic pain as one of the conditions for which this surgery is applicable. Please advise as soon as possible. We are at our wits' ends for something that will give him more than functionality (which is increasingly more difficult) but also quality of life.

Dr. Lee responds:
Gamma Knife radiosurgery is not typically used to treat chronic pain of this nature. Nevertheless, there may be neuromodulatory strategies such as the placement of spinal cord stimulators which may help to manage his pain.

Ruthie asks:
Is there a size limit for benign tumor removal with Gamma Knife radiosurgery?

Dr. Lee responds:
Size limitations depend on location. For example, larger tumors in silent locations can be treated, even if they are slightly larger than the usual limitation of 3 to 4 centimeters in diameter. Smaller tumors that are in critical locations right next to the optic nerve, for example, cannot be treated safely at any size. Hence, neurosurgery and Gamma Knife radiosurgery are dependent on location.

Sandy asks:
A friend of mine has a 1.6cm tumor in his temporal lobe. He has NF-1 and may be susceptible to future brain tumors. Would the Gamma Knife be appropriate for his case?

Dr. Lee responds:
Gamma Knife is a very good treatment strategy for small tumors. However, without further details it is difficult to say.

Craig asks:
Can you use Gamma Knife radiosurgery to treat lymphoma?

Dr. Lee responds:
Lymphoma is generally not treated with the Gamma Knife, except in extreme situations such as recurrence after conventional chemotherapy.

Rich asks:
I have a friend who has been diagnosed with an aneurysm. Can Gamma Knife radiosurgery be used to treat this?

Dr. Lee responds:
Unfortunately, Gamma Knife cannot be used to treat cerebral aneurysms.

Larry asks:
Is this used to treat epilepsy?

Dr. Lee responds:
Epilepsy has only rarely been treated with Gamma Knife radiosurgery. We would have to consider each case carefully in full consultation with our neurologists. In certain instances, Gamma Knife can be a valuable option for some patients.

Toni asks:
My husband has recurrent submandibular salivary gland cancer (undifferentiated cells) that is close to the internal carotid. He has had surgery and radiation which finished in January 2005.

Would he be a candidate for Gamma Knife surgery? The doctors are planning on giving him additional radiation after doing a PET scan and CT angiogram to check the carotids.

Dr. Lee responds:
Gamma Knife radiosurgery is primarily designed for tumors within the brain. Occasionally salivary gland tumors will find their ways into the brain. I have seen this in patients with adenoid cystic carcinoma. However, if the tumor is primarily located in the neck and mouth region, Gamma Knife radiosurgery is not as suitable a treatment.

Ralph asks:
Will the Gamma Knife shrink a brain tumor the size of a base ball?

Dr. Lee responds:
Gamma Knife radiosurgery achieves its advantages over conventional delivery of radiation by virtue of its power and precision. By directing 201 beams directly at a small focus within the brain, Gamma Knife can deliver minimal radiation to surrounding brain parenchyma and maximal radiation to the center of the target.

Unfortunately, many of these advantages are lost when tumors are extremely large. The general size cut-off for Gamma Knife radiosurgery is 3.5 to 4 centimeters. Each person and situation are unique, however, and warrant individual attention.

Dennis asks:
I had the Gamma Knife procedure. I must be one of very few that did have a side effect from the procedure. I had the surgery 2/02 and was fine until about 5/02. Then I developed numbness on the entire right side of face. I understand now that when I had the procedure, it either burned or killed the nerves to my cornea. Is there anything else be done? The pain in the eye is severe.

Dr. Lee responds:
It sounds like you were treated for a very complicated tumor, such as a cavernous sinus meningioma which often wraps itself around the trigeminal nerve. Damage to the nerve can cause the unfortunate condition called " anesthesia dolorosa" which is the paradoxical state of being both numb and yet having severe pain. The management of anesthesia dolorosa is very difficult, and I would be sure to see a pain management expert. There are both medical options and occasionally surgical options.

Fortunately, there have been advances in the field of Gamma Knife radiosurgery that seek to avoid this particular complication. The most important is the appropriate selection of doses. With more and more experience with Gamma Knife, most neurosurgeons have discovered that appropriate doses can minimize this particular complication.

Jim asks:
Can or will the Gamma Knife be used as a tool for mental health research or, after significant research/testing, as a surgical device to cure or lessen the symptoms of major mental illnesses?

Dr. Lee responds:
I appreciate your inquiry into the field of psychiatric neurosurgery. Ablative procedures such as cingulotomy or capsulotomy for psychiatric diseases have a sordid history here in the United States. Nevertheless, there are some centers which are making great advances in the treatment of these patients using the Gamma Knife.

I am experienced in this treatment, but I would only embark upon this type of practice with the participation of experienced and careful physicians and patients.

Carol asks:
Would Gamma Knife be able to be used for an ependymoma recurrence in the fourth ventricle/brainstem?

Dr. Lee responds:
Each patient's situation is unique and requires careful analysis. However, it is definitely possible to treat a recurrent or residual ependymoma of the fourth ventricle with the Gamma Knife. In addition, there are obviously special concerns if the patient is a child or has already received radiation treatment. We would have to carefully discuss all these issues.

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

Denny asks:
My 21 year old daughter had a large oligodendroglioma tumor removed from her left frontal lobe in 2005. In January 2007, a follow-up MRI revealed a 1.7x2.1cm recurrence at the rear of the tumor cavity, about 1mm in front of the pre-motor cortex. Would this regrowth best be treated with the Gamma Knife, or would another surgical resection be indicated?

Dr. Lee responds:
Gamma Knife can be used to treat patients with oligodendrogliomas. The results after Gamma Knife, however, are not as well characterized as other tumor types, primarily because oligodendrogliomas are not that common. Nevertheless, Gamma Knife radiosurgery can be performed safely on many tumors and does seem to inhibit the growth of many of them.

Janet asks:
My brother, 53, was just diagnosed with a primary brain tumor in the front/left side of his brain. It's inoperable because of its location. He is scheduled for a biopsy soon. Should he go through with biopsy before we seek Gamma Knife treatment or see your physicans first? We're so desperate - this has all come on so quickly. Symtoms just appeared during the week of 12/20 -- difficulty typing, slurring of speech, balance. He's on steroids now to reduce swelling around tumor. Please direct if we're interested in the Gamma Knife.

Dr. Lee responds:
Biopsy is always useful because of the importance of knowing the correct diagnosis. I would be happy to review his case. If you would like to schedule an appointment, please call 1-800-789-PENN (7366). You can also request an appointment online.

Lisa asks:
My son has large bi-lateral arachnoid cysts in the middle cranial fossa. Both Johns Hopkins and CHKD have recommeded fenestration with craniotomy to treat. The cyst is displacing the optic nerve and he has developmental delays (speech etc). Is Gamma Knife and optiona surgey for treating arachnoid cysts?

Dr. Lee responds:
Gamma Knife is not used to treat arachnoid cysts; however, I would be happy to see you in consultation to discuss surgical options.

Robin asks:
Hello, my daughter was diagnosed with a chiari 1 malformation last year. At the same time was also diagnosed with Epilepsy/seizures (which I still question if they really are seizures). Anyway, we don't know if the chiari has changed in size as she hasn't had her 1 year MRI yet. I saw that the Gamma Knife can be used for epilepsy. Can it be used for chiari malformations?

Dr. Lee responds:
Gamma Knife is not used to treat Chiari I malformation.

Gloria asks:
Do you recomend Gamma Knife surgery for astrocitoma pilocitico phase 1 with 1c.m. of diameter ubucated in the fourth craneal space at the left hemisphere on a five years old boy

Dr. Lee responds:
This tumor can be completely cured with surgical resection when performed by a well-trained pediatric neurosurgeon. Hence, I would not necessarily perform Gamma Knife in this situation. There are other situations where similar tumors may be perfectly amenable to Gamma Knife radiosurgery.

RicktheB asks:
My wife has a tumor which may involve either the carotid artery or the vagus nerve. We are having a biopsy done to determine more detail. Meanwhile I am exploring options as we have been told by her specialist that if surgery was indicated on the vagus nerve there could be severe post-op. disabilities. GKS was not mentioned as an option. Should we explore this route?

Dr. Lee responds:
Gamma Knife can be used to treat glomus jugulare or vagale tumors. Control rates are very good with minimal side effects.

Lynette asks:
If you're not put to sleep why do you need to be sedated?

Dr. Lee responds:
We give intravenous sedation for the placement of the frame, and for those patients who are claustrophobic and require sedation for the MRI scan. Patients do not actually feel or hear anything during the actual radiation delivery, and we encourage patients to bring their own music.

Allen asks:
My daughter has a uterine fibroid cyst that is putting pressure on the sacral plexus and causing many problems with urethral pain... She is looking at options other than blocking hormones and open surgery. Is the Gamma Knife used for removal of fibroid uterine cysts?

Dr. Lee responds:
Gamma Knife is a tool that is specifically designed to treat intracranial tumors and disorders. It cannot be used to treat uterine tumors or cysts.

KRC asks:
If someone who was a heroine addict and then became incarcerated for 2 years - what are their chances of a full recovery and what kind of treatment should they be on?

Dr. Lee responds:
There are a three excellent medication options available to individuals in this predicament. Each is associated with an excellent prognosis provided the patient follows the treatment plan. These include methadone maintenance, buprenorphine treatment, and naltrexone. The first two options are “agonist treatment” in which the patient takes an opiate medication that replaces heroin at the receptor site. Naltrexone is an opiate blocker that prevents heroin from reaching the opiate receptor.

Michael asks:
My wife was diagnosed with 2 Venous Angiomas, for years now she has been seen by countless doctors with no prevail, her syptoms have come and gone with Seizures, TIA's, numbness in her extremities, blurred vision, headaches with pressure in her head, and probably some others I cant think of, my wife and myself were recently looking at the option of going through a Gamma Knife surgery. Would it benifit more going through this option, and would these syptoms go away?

Dr. Lee responds:
Venous angiomas are generally considered developmental anomalies and are not considered pathologic problems. Hence, they are unlikely to hemorrhage or to cause symptoms. I generally do not perform Gamma Knife radiosurgery for these types of lesions unless they are associated with another type of vascular malformation that does tend to hemorrhage such as an arteriovenous malformation or cavernous malformation.

Jojo asks:
I have a 3mm pituitary tumor on the right side. Even though I have not tried the meds to shrink it, would I be considered for the Gamma Knife? I do have a lot of strange symptoms.

Dr. Lee responds:
The management of pituitary tumors is complex, and I would be happy to discuss your case in consultation.

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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