About five months ago, Susan Berman was faced with a decision on how to treat her acoustic neuroma, a decision she thought she wouldn’t need to make for many years.
This kind of benign tumor usually grows slowly. But after four years of observation, Susan’s tumor had suddenly doubled in size. It was decision time. Her doctor, Stephen Cass, MD, a neurotologist at the Rocky Mountain Gamma Knife Center and a professor in the Department of Otolaryngology at the University of Colorado School of Medicine, was recommending Gamma Knife radiosurgery.
The 65-year-old Boulder woman had a lot of questions about the best way to treat the tumor, which develops on the main nerve leading from the inner ear to the brain. This nerve controls hearing and balance, so pressure from the tumor can cause hearing loss, ringing in the ear and unsteadiness. The tumor’s rapid growth threatened to further impair function for Susan and cause additional problems for her as it extended from inside the internal auditory canal toward the brainstem.
"I went with the Gamma Knife because I trusted Dr. Cass.
He knew I needed to be reassured with facts." - Susan Berman
Weighing Gamma Knife Against Surgery
Once an acoustic neuroma is causing problems or growing, there are only two options for treatment: surgery to remove the tumor or Gamma Knife radiosurgery, which is focused radiation therapy to stop the tumor from growing. Gamma Knife is often the preferred option because it provides comparable tumor control but avoids the risks and possible complications of surgery.
In some cases, a patient’s age or size of the acoustic neuroma will limit treatment to one option or the other. Generally, the best candidates for Gamma Knife are patients who have small or medium-sized tumors that are growing, and those who are older. The average age of acoustic neuroma patients Dr. Cass has treated with Gamma Knife is 55.
In Susan’s case, she says, invasive surgery with its risks of complications was not her first choice. She wanted an outpatient treatment with little down time, which Gamma Knife offered. She could go home the same day.
Before the procedure, Susan wanted to know everything she could about Gamma Knife and other focused radiation therapies. “I had a lot of questions for Dr. Cass,” she says. And she researched online.
Gamma Knife Is Non-Invasive
Gamma Knife is not really a knife, but a device that focuses beams of gamma radiation very precisely on a tumor or lesion to render it inert, with minimal effect on healthy cells. Gamma Knife therapy is a non-invasive treatment of many brain conditions, including acoustic neuromas. It can stop the growth of the tumor with little risk of permanent nerve damage and without affecting surrounding tissues.
“At one point I really put it to Dr. Cass that I was uncomfortable, fearful,” Susan says. “He stepped up to answer all my questions. He was totally available. It made a big difference for me. I went with the Gamma Knife because I trusted Dr. Cass. He knew I needed to be reassured with facts.”
She decided to move forward in May. “It was time to end this rogue tissue inside me,” she says.
On the day of her treatment she arrived at about 6:30 a.m. Nurses walked her through the procedure beforehand, detail by detail, so she knew exactly what to expect of the half-day process.
“The nursing staff was just tremendous,” Susan says. “They were right there for me. They were humorous with me. My fear and anxiety had been dealt with before I went in.”
Gamma Knife Head Frame Ensures No Movement
The head frame is the one thing most patients fear, but once they learn it’s there to ensure there is no movement — so that the radiation beams hit only the tumor — they are relieved. The Gamma Knife team attached a head frame with four pins—two on her forehead and two at the back of her head. Local anesthetic meant she felt little pain when the head frame was attached, she says, and she did not have to have her head shaved (a common myth). After getting an MRI scan, the medical team planned out the radiosurgery.
“I certainly would have preferred not to wear a headpiece and have pins in my head,” Susan says. “It looks medieval, but it also holds your head securely in place for accurate treatment, so I was fine with it.”
During the procedure, Susan lay on a bed that slides into the Gamma Knife machine, which looks very much like an MRI except that only the head goes in. Though the head is immobilized, the patient can move their shoulders, arms and legs. Many patients sleep or listen to music during treatment.
Susan, who was lightly sedated but awake during the treatment, didn’t feel the radiation or any pain from the radiation.
“Because of the shape of my tumor, it only took about a half an hour of being zapped,” Susan says. “I didn’t feel any of that.”
Go Home Same Day After Gamma Knife
After the treatment ended, and the head frame removed, Susan left the center that same afternoon. The only immediate effects she had were a short-lived mild headache and fatigue. She also had tenderness at the pin sites for a few weeks. But she was able to return to most of her normal activities right away.
“I want other patients to know what to expect,” Susan says.
She had the single Gamma Knife procedure in May. She is hopeful that the treatment was successful; it will be monitored over time to confirm that the tumor has been controlled. And, like surgery, the treatment couldn't undo the impairment from the tumor that she already had experienced.
Right now, she continues to adapt. “I’m fully functioning with a few limitations,” she says. “I ski. I hike. I backpack.”
“I experience occasional nausea or dizziness (impairments from the tumor) when I’m tired or stressed. I continue to work with the loss of hearing,” Susan says. “The body adjusts. I have a lot of sound distortion in my left ear. My ear will sometimes feel like there is water in it — not painful, but uncomfortable. My work is accepting this medical condition. I am a different person than who I was. That takes grieving, accepting and also moving on with all that I’m able to do. I have tremendous gratitude to the medical field and all who helped me with this treatment.”