RECORD OF ACOUSTIC NEUROMA AND RADIOSURGERY TREATMENT USING THE GAMMA KNIFE
Neuroradiosurgery -- the Gamma Knife -- is the alternative to surgical removal of an acoustic neuroma that I chose to try. Since this procedure is fairly new and I know of no other Jerseyans who have used it, I thought that the details of my case and how I came to choose the Gamma Knife for treatment might be helpful to others faced with the same difficult decisions.
Although it is most often said that radiosurgery is a treatment option specifically for persons of advanced age or pre-existing health problems, I would like to stress at the outset that this was not the case for me. I was 62 years old and in excellent health when my tumor was discovered. For me, radiosurgery was a matter of first choice rather than a treatment of last resort.
My record begins in 1990 when I experienced a hearing loss in my right ear. This was confirmed by an audiologic evaluation (10/2/90), and a MRI brain scan (10/18/90) recommended by my physician revealed a small 1.2cm acoustic neuroma. My physician informed me (11/1/90) that surgical removal of the tumor would be necessary and should be arranged as soon as possible. He warned me that it was a very delicate operation that could result in some facial nerve loss on the right side, as well as continued hearing loss. He recommended a surgeon at the University of Cincinnati Medical Center. No mention was made of the option of non-invasive radiation therapy using the Gamma Knife. I learned of the Gamma Knife option from my sister-in-law, Ellen Barker, who is a neuroscience nursing consultant and active member of the Pennsylvania Chapter of the Acoustic Neuroma Association. Ellen was also a good friend of Dr Ladislau Steiner, Professor of Neurological Surgery and Director of the Lars Leksell Center for Radiosurgery at the University of Virginia. Ellen recommended that I should seriously consider Gamma Knife treatment of my acoustic neuroma. She would speak with Dr Steiner about my case.
At this point I informed my physician that I had learned of Gamma Knife treatment for acoustic neuromas, and intended to explore this option rather than rush into surgery. My physician had apparently heard of the Gamma Knife, but continued to urge surgical removal of the tumor as soon as possible.
My wife June and I next spent about one month reading the recent scientific literature dealing with radiation therapy for acoustic neuromas. June's PhD in physiology and familiarity with radiation technology proved to be especially valuable for this task. She is best qualified to comment on our findings, and her observations are also in this Archive..
Having reviewed the scientific literature, I telephoned Dr Steiner in Virginia (12/6/90). He talked readily and frankly about his long experience with the treatment of acoustic neuromas. He agreed that there was certainly no need for me to rush into any type of treatment since he was convinced that these tumors are typically slow-growing. I could simply wait for another MRI scan in six months to see if any growth had taken place. Surgical removal, he said, was the conventional treatment; however, for this he cautioned that it was essential to seek out the best, most experienced surgeon possible. There were in his opinion only four or five surgeons competent to perform the delicate operation. As for the Gamma Knife, Dr Steiner said that he was no longer skeptical about its use for acoustic neuromas; it could be very effective and was no longer an experimental therapy. Since 1968, 400 cases of acoustic neuroma were treated with the Gamma Knife. There were some limitations in its effectiveness, however, and surgery might still be necessary in some cases. One advantage to Gamma Knife treatment is that it does not require a long hospital stay, and is therefore less expensive (ca.$20-22,000) than surgery. One disadvantage for some people, said Dr Steiner, is psychological: that is, after the radiation treatment the tumor is still there; hopefully it has been made to stop growing and will begin to shrink, but it is still there. For some, this can be disturbing.
After talking with Dr Steiner, I decided to do nothing until after having a second MRI scan. This second scan (3/21/91) was sent to Dr Steiner for analysis. His review and comparison with the earlier scan of 10/18/90 showed no change in the size of the tumor. It still measured 1.2cm in all diameters. A decision now had to be made. Should I continue with the periodic MRIs to monitor the size of the tumor? I was having no difficulties except for the hearing loss. Conceivably, as we had by now learned, I could wait for 4-5 years or longer before taking any action. Or, should I arrange with Dr Steiner for Gamma Knife treatment, which we had learned is especially effective for small tumors such as mine? By this time, I had definitely decided on the Gamma Knife to avoid the complications of invasive surgery that I was by then reading about in the Notes of the Acoustic Neuroma Association.
Although my wife favored waiting, I decided to go ahead with the Gamma Knife. I suppose that like most people with tumors I felt the need to "do something." I called Dr Steiner and made arrangements for Gamma Knife radiosurgery. I would enter the University of Virginia Health Sciences Center in the PM of June 10, receive radiosurgery June 11, and be discharged in the AM of June 12. My brother Bob would accompany me, and Dr Steiner was kind enough to give him special permission to videotape during the radiosurgery treatment.
In my experience, the Gamma Knife treatment under Dr Steiner's direction involved a minimum of discomfort. I was somewhat apprehensive over the head frame that must be attached to the skull, but this minor operation was performed expertly and painlessly by Dr Steiner. The radiosurgery treatment itself was like having a noiseless MRI scan, although the Gamma Knife instrumentation is much more impressive. Throughout the procedure I was impressed as well by Dr Steiner's seriousness and concern for my comfort. His well-trained team of technicians also merited my admiration.
RICHARD BARKER < RBarker465 AT aol.com >
Updates by Richard Barker
6/11/91 - Treatment.
The maximum dose I received was 34Gy; the periphery was 17Gy (this is more than they are giving lately). The time of treatment was 15.44 and 15.65 minutes
12/4/9, 7/2/92, 6/10/93 - MRI scan showed no change in the size or shape
of the tumor.
Dr Steiner advised waiting for one year before checking again. I have had no serious complications since radiosurgery: no facial nerve, eye, balance or headache problems, for example. For a brief time in 1992 (Feb-April) I experienced some soft ringing in my ears at bedtime, but this did not persist. I appear to be doing very well.
4/20/94 - Hearing retested.
Loss in right ear has worsened. Left ear the same.
6/18/94 - MRI scan showed no change in tumor.
6/17/95 - MRI scan.
Dr Steiner reported: "The tumor which measured 0.32cm3 the time of the treatment now measures 0.23cm3." That is to say, there has been about a 28% reduction in the volume of the tumor.
6/15/96 - MRI scan.
Dr Steiner reported: "At the time of the treatment, this right sided vestibular schwannoma measured 0.3cm3. On the recent MRI it measures 0.2cm3, which represents a decrease in size of 33%."
9/19/96 - Hearing retested.
Right ear functionally dead. Left ear about the same.
6/19/97 - MRI scan. No change.
6/98 - No scan. Next scan 6/99©
Last Edited: Wednesday, October 30, 2002