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Radiation or Surgery?

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nic101:
Hi I am a 39 yr old mother of 2 boys. I have been diagnosed with an AN that is 14 mm. I have seen a ENT surgeon who is recommending a Translabrynth Craniotomy. I went to my Neurologist appointment yesterday and he suggest that I look into Radiation Therapy. I will meet with the Radiation center within 2 weeks. This is a tough decision for me. I was so happy when I found this group and others that understand what I am going through. I would love to hear from others that have either procedure done to get some more insight. Thanks Nicole.

Ned:
My tumor was similar in size to yours. My ENT highly recommended surgery, I vascillated between surgery and radiation for weeks.  I would leave a surgeons office convinced of surgery, then meet with Radiologist and decide on radiation.  I finally decided on radiation and have never regretted. I determined that if the radiation for some reason didn't work I could always do surgery.  The surgeons would argue that operating on a tumor that had been radiated was more problematic. My biggest complaint was not being told of potential post radiation issues like tumor swelling. Now, 11 years later, tumor shrunk about 40%.

john1455:
Reading this: http://www.myacoustic.org/ helped me tremendously on choosing the right treatment for me and maybe it will help you decide as well. As I did my research and saw what side effects those who chose surgery went through, it was a no brainer for me to eliminate surgery as an option.

Dr Steven Chang at Stanford, who does both open surgery and CyberKnife, has in the past given free reviews of MRI/CT scans and offered his opinion on what he feels would be appropriate treatment. House in LA also does this but they will invariably recommend surgery because that is all they do. It would be in your best interest to seek consults from neurosurgeons who do both radiation (radiosurgery) and open surgery (microsurgery) in order to get an unbiased opinion. Doctors tend to recommend procedures they are comfortable with but that may not necessarily be what is best for the patient.

Here is another video worth watching: http://www.youtube.com/watch?v=ZbS4K9ENMAg

Good research will involve reading as many posts on this forum as possible and seeing what posters went through as well as what side effects they had. The anausa.org site gives an excellent summary of all treatment options available as well as the side effects to expect from each (use the "OVERVIEW" pull down menu). They also have a list of neurosurgeons and facilities that meet their selection criteria.

I chose radiosurgery (CyberKnife) and although it may be early yet, I feel the same as I felt pre-treatment with no fatigue issues and it has been 6 weeks since I completed CK. The first couple of days, my symptoms (tinnitus and balance) got just a tad worse but after that, I was back to my new normal. A common scare tactic by those who only do surgery is that radiation may cause future malignancy. However, the chances of that happening is extremely rare. It will be a hard decision to decide which treatment will be best for you but doing the proper research should lighten the load.

As Ned pointed out, there will be swelling of the AN after radiosurgery and that is perfectly normal. Radiation kills the tumor but tumors die slowly over time and not all at once. AN treatment, whether it be open surgery or radiation, will not likely eliminate any pre-treatment symptoms so be prepared for that.

v357139:
At that size it does make sense to explore both surgery and radiation.  You might even have the option of wait and watch, if it is not growing and not causing you any problems.  I would get opinions from very experienced doctors with great track records in surgery, and in radiation.

I offer these points, which are by no means all inclusive.
Radiation does many times have very good tumor control and avoids certain surgical risks such as CSF leaks.  It does not get rid of the tumor, but stops its growth.  After successful radiation, sometimes it shrinks over time and sometimes not.  Sometimes it swells before dying.  It takes months for the doctor to know if it worked or not.  Surgery is more final.  Weighing this may help you as you see doctors.

Again, make sure you talk to very experienced doctors, with great track records.  That will give you the best info for you to weigh.  Keep us posted.  We are here to help.

Kat From Indiana:
Hi. I  was diagnosed March 27, 2014 with 8mm x 3mm x 4mm AN. I am 55.  As I was looking at my options, I was looking closely at surgery and did not even want to consider radiation.  I saw an ENT (surgeon) 3/29.  He recommended watch & wait.  He did not want to talk about treatment options, but I did get him to tell me that his surgery of choice is Retro Sigmoid.  The ENT said to have a second MRI in 6 months.  He said not to rush into anything because no matter what, I will lose my hearing.  He said to just enjoy it while I have it.  My hearing loss in right ear is only about 15% lost, but I am useless on the phone with my right ear.  Next, I went to a neurosurgeon.  He said that radiation is the best for me.  He wanted me to see a radiologist.  This was the first time that I actually slowed down enough to give radiation a serious look.  I have an appointment with a radiologist this coming Monday.  I too have looked at the quality of life issues after surgery and it appears to me that surgery has more problematic after effects than radiation.  I won't lie, I have some real concerns for the after effects of radiation down the road and the idea of semi-annual and annual MRIs doesn't thrill me.  Even so, I think I'll take a leap of faith and try to put my trust in radiation.  Now I am trying to decide between Gamma Knife or CyberKnife. Everyone here knows how hard this decision is for you.  Sending good thoughts and prayers your way.

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