Trans Lab vs. Middle Fossa approach

[Jason_B]

I have surgery at Stanford on Friday (10/05/07) and was informed today that the intent was to use the Trans Lab approach in order to prevent damage to the facial nerve. My AN is about 2.5cm, and I originally chose surgery over Stereo Rad, because I thought the intent was to try and presserve my hearing in that ear. Now I am told he will use the TL approach I must sacrifice all hearing in that ear. What should I do? Should I give radiation another look? I still have most of my hearing in that ear currently, just some fuzziness!!!!

Jason

[Larry]

Jason,

Yes, trans lab will destroy all hearing in that ear. I would get another opinion and find out why he has suggested trans lab over middle fossa or Restrisg. And for that matter, get an opinion on the radiation.

There may be a good reason for translab re the location of your AN.

Get other opinions. Don't be presured into the surgery for that date until you are well versed in the other options. If the surgeon pressures you, tell him to politely take a walk.

Laz

[4cm in Pacific Northwest]

Jason,

Go over this archive again (I posted this in YOUR post re “My surgery is scheduled at Stanford� – you 1st of two posting on that topic specific)
http://www.anarchive.org/approaches.ht

The in-between approach is Retrosigmoid (sub occipital). I really think, as I mentioned to you before in your other post- you should talk to Dr. Jackler, head of the ENT department, there at Stanford, before you undergo any surgery. Your autologous draw blood you did- DOES have a shelf life – so if you postpone surgery you should keep this in mind. Remember typically AN’s are slow growing… and are not emergency situations that make you to be hurried or rushed into a decision. Who is the neurosurgeon that is proposed to work on you?

(Feel free to respond in a private e-mail if you choose.)


The key is to be as informed as possible BEFORE you make a final decision. You should try and get the most experienced and reputable surgeons you can. Sometimes a surgeon will advocated one procedure over the other as that is what “they� are most comfortable or experienced at.(or their partnered neurosurgeon is…) However the key is to find the approach (and surgeon to match) that will fit the best need and comfort level of “the patient�.

AN’s are similar to real estate. It is not always the size that determines treatment … but “location, location, location� of the tumor.

If you read my early posts you will see that I personally deliberated between Retrosigmoid and Translab. I will not comment on whether I chose the best option until I am further into my recovery. (I am just starting into week #6 post-op) The Stanford team is confident my facial palsy and eye issues will resolve in time (and healing) … I have to just wait to find out. (IE I am waiting and will refrain from commenting if I made the best choice- for now). I can comment that Dr. Jackler is an excellent counselor in helping patients to make choices. I initially approached him for an outside opinion (not as a surgeon who would work on me) … but I was so impressed with not just in speaking with him but also his CV. (He is world renowned) I actually chose to fly out there to have him. He also came highly recommended to me by reputable Canadian neurotologists.

JASON- PLEASE SEEK MULTIPLE ‘PROFESSIONAL’ OPINIONS BEFORE YOU HAVE YOUR SURGERY. After surgery you do not want to be saying “shoulda, woulda, coulda…� .


“4�


P.S. Stanford IS a great place for treatment- it is just I am not seeing much info on Dr. Murry. The "where" is a good place as I actually do know it- fisrt hand . It is the "who" that is unknown here.

[sgerrard]

It may be that the tumor is too big for middle fossa, which I think is used mainly on tumors that are within the canal. There is some chance of hearing preservation with the retro-sigmoid approach as well, which might be worth it if you still have most of your hearing.

You can get other opinions from various sources. Dr. Steven Chang at Stanford will evaluate an MRI and audiogram, and give you a straight answer on whether radiation could help, or a retro-sig is possible. He is a neurosurgeon, and does both surgery and radiation.

There is also Dr. Jackler at Stanford, and the doctors at House Ear Clinic in Los Angeles, who will also do an evaluation if you mail them the MRI films and test results.

If possible, get some more opinions. They can't make you show up on the 5th, and don't go just because it would be convenient for them. You are entitled to multiple opinions and some time to consider them, when you are facing a major medical procedure like this.

In any event, we will be on your side through it all.

Steve

[4cm in Pacific Northwest]

Jason,

Ditto on what Steve said

"In any event, we will be on your side through it all."



4

[Obita]

Hi Jason:

Ask your Dr. why he changed his mind on the approach.  If you are not willing to sacrifice your hearing, don't.  At 2.5 cm there can't be any reason to have it out ASAP.  It is much more important for you to feel 100% sure regarding your treatment and who treats you.  A Dr. changing his mind on which approach to use is a very good reason to cancel surgery.

Take some time Jason.  You will know when you find the right Dr. and treatment.

Good luck, Kathy

[Sue]

I totally agree with everyone's advice regarding your upcoming surgery.  Do NOT do this unless you are 100% behind the surgeon's recommendations and reasons for changing their technique.  It's not like you can undo this....once it's done, it's done. 

Kindest regards,

Sue in Vancouver USA

[FlyersFan68]

As you might already know, hearing preservation isn't guaranteed with any treatment. Try to assess your own situation and factor in things such as age, health, family and long term desires. No matter what treatment you'll likely adjust fine over time.

[sahar32]

Hi,
Did u already go through the surgery? If not contact Skull Base Institute Please!! He will save your hearing!!

[Joef]

not only is saving hearing not guaranteed .. with a tumor that size its unlikely ....  and and losing your hearing in one ear its not so bad ... saving the face nerve is more important (I have some facial problems)... (now that assume the other ear works!)