The Miracle of Noninvasive Brain Surgery

Specialized team treats Rick Franzo’s brain tumor nonsurgically using the new Gamma Knife® Icon™

In July 2016, Rick Franzo noticed some hearing loss in his right ear, but assumed it was related to an ear cleaning his doctor had just performed. By December his balance was becoming unsteady, but he chalked it up to his earlier ear problems.

It never occurred to him that his symptoms might be connected to two previous noncancerous brain tumors called meningiomas diagnosed years earlier. One was surgically removed in 2009, and doctors were monitoring the other one discovered in 2011.

“If I hadn’t been to my ear doctor, I would have immediately thought, ‘brain tumor.’ But you get lulled into a sense of complacency,” says the 51-year-old from Cresco, Monroe County.

Tumor déjà vu

In February 2017, during Franzo’s annual brain MRI to look for any changes to the meningioma, doctors coincidentally discovered what was wrong: a new noncancerous tumor called an acoustic neuroma was growing on his eighth cranial nerve leading from his inner right ear to his brain. Pressure from the growing mass was causing his hearing loss and balance problems.

It was not good news, but Franzo vowed to face it head on like he had with his other tumors. Those experiences had actually transformed his life, leading him to write a book for brain tumor survivors and start a support group and radio show.

Franzo and his wife met with Lehigh Valley Health Network (LVHN) neurosurgeon Stefano Camici, MD, with LVPG Neurosurgery, to discuss treatment options. When Camici mentioned surgery, Franzo’s heart sank. His prior brain surgery had required removing part of his skull to cut out the tumor. The 10 1/2-hour procedure left him paralyzed from the waist down, and it took months of rehab to regain use of his legs.

But Franzo soon discovered Camici had something less intensive in mind. Because the tumor was small, he suggested treating it noninvasively using LVHN’s new Gamma Knife® Icon™ to deliver a single dose of highly targeted radiation. Best of all, Franzo could take advantage of the Icon’s comfortable frameless treatment system instead of wearing an attached headframe (which is still required for patients undergoing lengthy treatment or treatment near sensitive brain areas).

“Rick’s tumor was only a few centimeters, so he was a good candidate for this type of state-of-the-art surgery and the frameless technology,” Camici says. “Gamma Knife Icon is really the ‘gold standard’ for nonsurgical treatment of cancerous and noncancerous conditions of the brain, including acoustic neuromas, meningiomas, arteriovenous malformations (AVMs), brain metastases and trigeminal neuralgia.”

Precision teamwork

On surgery day, Franzo arrived at 7 a.m. and learned he would be the first LVHN patient to wear the frameless thermoplastic face mask. The technology uses an infrared monitoring system to shut off the Gamma Knife if a patient moves even a millimeter.

Next, Franzo’s surgical team – including Camici and radiation oncologist Robert Prosnitz, MD, with Allentown Radiation Oncology Associates at Lehigh Valley Hospital–Cedar Crest, calibrated the Gamma Knife to deliver 192 highly focused radiation beams into the tumor in a single session, without hurting surrounding healthy tissue.

Treatment lasted 20 minutes, and Franzo returned home that afternoon. “I felt nothing,” he says. “I didn’t need pain medication afterward and returned to work a few days later.”

Hope for the future

Prosnitz is hopeful that Franzo’s treatment will prevent further tumor growth and hearing loss.

“Acoustic neuromas stop growing about 95 percent of the time after Gamma Knife treatment,” he says. “Most patients also have a 50 to 60 percent chance of retaining serviceable hearing afterward.”

Since surgery, Franzo has continued working with brain tumor survivors and now enthusiastically recommends Gamma Knife. “I never imagined brain surgery could be this easy,” he says. “It gives people real hope, and it’s incredible that we have a hospital so close with this type of top technology."