Tumors and Tremors: How the Gamma Knife Can Help You

Date:
10/15/2008 | 12:00 pm

South Jersey Gamma Knife You may know that the gamma knife treats both malignant and benign brain tumors. What you may not know is that the gamma knife can also successfully alleviate the symptoms from Parkinson’s disease; facial pain, such as trigeminal neuralgia; and arteriovenous malformations (abnormal collections of arteries).

Dr. H. Warren Goldman has been a major innovator in technology-driven brain surgery and utilizes the Leksell Gamma Knife® Perfexion™ at Cooper University Hospital, the only hospital in the Delaware Valley to offer patients this newest version of the Gamma Knife.

Dr. Goldman is nationally and internationally renowned for his clinical research and academic leadership in stereotactic radiosurgery and minimally invasive brain surgery. He graduated from New York Medical College, Valhalla, N.Y., and completed his residency in Neurological Surgery at The Albert Einstein College of Medicine. A frequent lecturer and author, Dr. Goldman was awarded the Medal of Honor by New York Medical Center and received the Distinguished Service Award from MCP Hahnemann University Department of Surgery. He introduced the first gamma knife in Philadelphia at two hospitals before bringing this technology to Cooper University Hospital.

This technology may help you and Dr. Goldman is the expert to ask.

Request an appointment with H. Warren Goldman, M.D., Ph.D.

H. Warren Goldman, M.D., Ph.D.: Good afternoon and thank you for joining me for this week’s Health eTalk.

Brain surgery without any incisions. The Gamma Knife Perfexion is utilized to treat patients with brain disorders such as cancers and tumors, tremors resulting from Parkinson’s disease, trigeminal neuralgia (facial pain), vascular abnormalities, functional disorders and ocular disorders. It is actually not a knife at all, but a radiosurgery medical instrument that uses 192 precisely targeted beams of gamma radiation to safely, effectively and painlessly treat the specific area with minimal effect on the surrounding healthy tissue. The gamma knife is a single session procedure, involves no incision, minimal pain, and greatly reduced risk for patients. Recovery time from gamma knife treatment is minimal; with many patients going home the same day.

I am eager to answer your questions about brain disorders, the gamma knife and your other concerns we may be able to assist you with today. So let’s get started.

How long is a typical recovery from this type of surgery? Are there cosmetic side effects?
Amber from Philadelphia

10/15/2008 12:00:37 PM

H. Warren Goldman, M.D., Ph.D.: For the majority of patients this is an outpatient procedure that takes one half a day. Although we allow patients to resume normal activities the next day, some folks report mild headache and fatigue for several days after treatment. There are no cosmetic issues related to this procedure.

I am 35 years old. My head trembles uncontrollably when I get nervous/scared about something. Even when I am calm, my son notices my head "shaking" he starts yelling at me to stop "shaking" my head. Is this serious? Should I see a doctor? I don't worry as much but my son seems to worry about it more than I do.
Sandy from Camden

10/15/2008 12:02:51 PM

H. Warren Goldman, M.D., Ph.D.: Sandy. you most likely have a form of Essential Tremor which is not dangererous but may be very annoying. Sometimes family members and friends may be more upset than the patient. I would suggest you get a referral to a neurologist for a good neurological examination and a definite diagnosis. Treatment options could be discussed at that time.

Can the Gamma Knife treat brain aneurysms?
Ron from Shrewsbury

10/15/2008 12:06:16 PM

H. Warren Goldman, M.D., Ph.D.: Brain aneurysms either rupture and present an acute life threatening requiring immediate intervention or may be found incidentally while imaging the brain for diagnostic purposes. Sealing of the aneurysm when it bleeds must be done within hours to prevent a second hemorrhage.

Gamma Knife radiosurgery seals blood vessels over many months so that it would not be an effective treatment in the acute setting. For the unruptured aneurysm which has the potential to bleed unpredictably, a more definitive treatment is called. In theory , however, studies have shown gamma knife has sealed aneurysms but this is not a good practical option because of the reasons I have given above.

Since I turned 65, I've noticed that it's harder for me to do things I was able to do just a few years ago like build model ships. My hands don't shake constantly, but they're not as steady as they used to be and I need to concantrate hard when doing detail work. I don't believe I have Parkinson’s or multiple sclerosis, that you talked about in the article, but I worry if this is something which will get worse as I get older. How bad would my shaking have to ghet before I should consider this gamma knife?
John from Hamonton

10/15/2008 12:08:51 PM

H. Warren Goldman, M.D., Ph.D.: All of us tend to lose some fine motor skill as we get older that is the result of the natural aging process. On the other hand, troublesome tremors need to be evaluated by a neurological specialist to determine the cause early enough to recommend a treatment plan that will address your problem while maintaining your normal life style. If you are having trouble doing the things you enjoy, have your family doctor refer you to a neurologist. It will be well worth the investment.

Can you gamma knife be used for melanoma of the lung?
Alice from Mount Laurel

10/15/2008 12:10:53 PM

H. Warren Goldman, M.D., Ph.D.: Hi Alice, Gamma Knife technology is exclusively for brain lesions. It is not designed for treating lung tumors. If the melanoma has spread to the brain the Gamma Knife would be an ideal treatment.

I have been told I have TGN. Can the Gamma Knife help me?
Peter from Perth Amboy

10/15/2008 12:12:26 PM

H. Warren Goldman, M.D., Ph.D.: Classical trigeminal neuralgia is a very specific facial pain syndrome that is frequently misdiagnosed. If you have the bursts of electrical pain that is worsened by touch, chewing, eating, brushing the teeth etc., and has been helped at some point by medications such as tegretol you might be an excellent candidate for Gamma Knife treatment. The exact details of your facial pain are crucial to making the correct diagnosis.

I've already had brain surgery for a benign tumor. My doctor says there's another one that's inoperable. Can you operate on this with the gamma knife?
Don from Sewall

10/15/2008 12:17:14 PM

H. Warren Goldman, M.D., Ph.D.: It depends on the size of the remaining tumor. Essentially all tumors within the brain are treatable if they meet the size criteria. Your most recent scan needs to be reviewed by a Gamma Knife specialist to make a final determination.

How do you know if the Gamma Knife treatment is successful? Could I end up having more than one Gamma Knife treatment?
Jackie from Cherry Hill

10/15/2008 12:18:59 PM

H. Warren Goldman, M.D., Ph.D.: Great question. After Gamma Knife treatment patients receive regularly scheduled MRI scans to follow the effectiveness of treatment. We should either see the tumor(lesion) shrink or stop growing. People with more aggressive tumors are scanned more frequently and all patients are followed by a member of the Gamma Knife team.

Would a person who has HHT (Osler-Weber-Rendu) benefit from the Gamma Knife if they were diagnosed with a pulmonary AVM -- In the past, my husband has had embolization at Yale (baloon insert), and then more recently has had a titanium coil inserted at point of AVM (at HUP). Would this machinary be beneficial so as not to require surgical intervention should he have another AVM that would require attention?
Janis from Laurel Springs

10/15/2008 12:23:35 PM

H. Warren Goldman, M.D., Ph.D.: Thanks for the question, Janis. OWR produces AVM's in the lung as well as brain. The Gamma Knife(GK) technology is designed exclusively to treat brain lesions and if that is your husbands problem the GK may be a good option. If he has an AVM in the lung, GK is not the right technology. You might consider the Cyberknife which provides focused beam radiation for lesion outside of the head. Cooper has a Cyberknife Center in Mount Laurel.

I remember you from MCP. Is the gamma you're using there the same as in Philadelphia?
Joan from Philadelphia

10/15/2008 12:24:25 PM

H. Warren Goldman, M.D., Ph.D.: Hi Joan, hope you are well. We now have the newest and most advanced Gamma Knife called the Perfexion. It is more precise, with shorter treatment times, more comfortable and it can also treat lesion in the upper spine. Thanks for writing in.

I have recently seen the radiosurgery commercial and I am curious. What is the difference between gamma knife and cyberKnife?
Lyn from moorestown

10/15/2008 12:25:32 PM

H. Warren Goldman, M.D., Ph.D.: Lyn, this requires a lengthy response not suitable for the e-chat format. In short, the Gamma Knife is the most accurate, single treatment technique which requires a fixed frame and its application is restricted to the brain only at this time. The CyberKnife is a linear accelerator-based instrument mounted ofn a robot that is used in multiple sessions over 3-6 days and can treat other sites such as the lung, prostate, breast etc.

H. Warren Goldman, M.D., Ph.D. : Thank you so much for your questions. I hope that the information I have provided today will help you to live a healthier life. For more information about the Gamma Knife and our services at Cooper Neurological Institute, please go to our web site at www.cooperhealth.org/cni or call 1-800-8COOPER to schedule your neurosurgical consultation.

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