Original E-mail Exchange

From: "Nancy Allen"

To:   "Paul C. Francel, M.D., Ph.D. "

Subject:    Inoperable brain tumor query

Date:        Fri., May 14, 1999

Dr. Francel,
I hope you will remember me from Billy McGowen's recent surgery for epilepsy.  We visited some that day (April 21). I am her best friend and  I am happy to report she has not had a seizure since the surgery and is doing extremely well.

I would like to ask your thoughts on a difficult problem I am facing with my husband and I am asking you because I trust your judgment.  My husband, a 61 year-old healthy person otherwise was diagnosed in Jan. 1992 with a benign chondromyxoma in the right middle cranial fossa that appears to extend from the right cavernous sinus. It is now 3 X 3.5 cm.* according to last MRI.   It was partially removed by another neurosurgeon in Jan. 1992 called at that time a right medial sphenoid wing intracavernous tumor.  Now it has gradually returned to this size.  My husband Arnold is beginning to have some symptoms including occasional severe headaches and, of course, there is the very serious concern that it will eventually become fatal.
*That measurement was an error, it was actually 5 cm. when Dr. Francel measured it.

Here are my two questions:
1.    I know this tumor is extremely rare.  Have you ever heard of
anyone using radiation to this type of tumor causing some improvement
(either arrested growth or some shrinkage?)
2.    Do you feel this tumor is too large to be treated with the gamma
knife?  My research shows it is either slightly too large or at the
outer limited.

Arnold's former neurosurgeon said nothing could be gained with surgery at this point. He considered it inoperable in his judgement.

Arnold and I talked on May 12 with a respected radiologist at an Oklahoma City Hospital  about the possible use of the Peacock radiation system (linear accelerator).  He didn't know if it could help but was going to check it out.  He stated to me that the tumor was inoperable.  I am wondering about the gamma knife or any other ideas you might have to save my husband.

Thanks for your time,
Nancy Allen, LPN, MS

From: "Paul C. Francel"

To:   "Nancy Allen "

Subject:    RE: Inoperable brain tumor query

Date:        Sat, 15 May 1999 23:14:29 -0500

I think I can answer your question well on this. I am not responding in an arrogant fashion, but I direct the university skull base team as the neurosurgeon, and have had extensive training and my own experience with removal of cavernous sinus tumors, having been trained by Dr Vinco Dolenc, father of cavernous sinus tumor surgery (he lives in Yugoslavia*) but I trained with him extensively in my previous training. However, you may not even need open surgery because gamma knife is very effective for treatment of cavernous sinus tumors.  This is because the dosage of radiation used is below the tolerance of the cranial nerves and the carotid artery there, and therefore can be treated noninvasively there.
*now called Slovenia

I recommend that you come and see me with the films so that we can discuss the options.  It is hard for me to talk to you further about which treatment would be best without seeing him and his films. Don't worry about the size quote:  the 3 cm. size limit described for gamma knife only applies when the lesion is in the brain, not when the tumor is skull based.   We can go over it further in the office to see what would be the best plan of attack.  Call me as soon as possible for an appointment.

Hope that helps.