Expert: Claes-Gustaf Nordquist, M.D. - 12/8/2008

Question
QUESTION: my mom has been found with bilateral occipital ?epidermoid(they are not sure) lesion ,few months back..seems its there for a very long time...but she dont have any symptoms till today...doctors asked us to take a repeat MRI after every 6 months...we are planning to take her to america for treatment..my question is why cant we start our treatment before getting the symptoms ??And since she have two cysts, Is gamma knife surgery better than the open brain surgery???why are the doctors waiting ??And if treated properly is their any possibility for reoccurence ??waiting for your reply, please!!!!!!!!

ANSWER: I do not know if gamma knife treatment is possible in her case. That depends very much on the size of her lesions. How big are they?. The rest of your question should properly be answered by a neurosurgeon which I'm not. I'm a therapeutic radiologist.


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QUESTION: The doctor said one is in the size of a one rupee coin,and the other is a smaller one.Is there any chance of having a lesion in the brain who dont create any problem in their lifetime ???because the doctor said if that lesion dont create a problem we can leave it as it is...But is it safe to leave a lesion like that even if it dont show any symptoms?

ANSWER: Yes it is quite possible that no treatment is necessary! Her drs. who have all available information are the best to judge that. How big is a rupee coin? I have never seen one! If it is not bigger than or is smaller than an inch (2.54 cm)then GammaKnife treatment should not be a problem. Since these most probably are non malignant lesions even bigger sizes (up to close to 4 cm.) may be possible. If there are no symptoms at all it is most probably safe to leave it as it is.



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QUESTION: Sorry doctor,anyways one rupee coin is around 2.4 cms.And my question is since they asked us to go for a repaet MRI for every six months,there is a chance for the lesion to grow.Then gamma knife wont be possible right???As u said if it grows bigger than 2.5cms and later if it shows any symptom then only open surgery will be possible...Since gamma knife is a painless and non-invasive one why cant we go for that before it  grows bigger??Can i talk to the doctor regarding this?Because In my family everyone is scared about the open surgery(since there are two lesions which has to be operated one by one)Why to waste a good chance that we have now???Is open surgery not a problem in her case doctor??  This is her MRI report,"THE OCCIPITAL HORNS OF BOTH LATERAL VENTRICLES SHOWS A CYSTIC NON-ENHANCING LESION WITH DIFFUSION RESTRICTION,?EPIDERMOID.NO DILATATION OF VENTRICLES IS SEEN".

Answer
Repeated MRI scans are just a safety measure. This will not happen over night. And since these ARE benign lesions they can be treated up to close to the size of 4 cm! AND her drs. are probably correct in that treatment is not needed. So do not panic here. These are not dangerous lesions!