Surgery with Dr. Sisti in mid January 2014

[rm516]

I am 57 years old and now decided to leave wait-n-watch status after 4 years even though I am still asymptomatic with 85-90 % hearing intact. AN size grew to 3.2 cm x 3.2 cm (large) in 2 years from 2.9 cm. x 2.9 cm x 2.8 cm.
 My radiological report says " Mild increase in size of the right CP angle vestibular schwannoma. Significant mass effect on the lateral pons, middle cerebellar peduncle and fourth ventricle with mild interval increase in ventricular size.''
Dr. Sisti is really approachable as he answered my e-mail in less than 12 hours. His “AN surgery experience” (~4000 cases) is impressive. He still does micro surgery (only on large tumors). Consulted (again) Dr. Michael Sisti  (Columbia Neurosurgeon, NYC) with my son (now first year resident physician). Dr. Sisti was surprised that my hearing is still intact. He thinks, the tumor started growing on the edge and did not involve other parts. Hearing preservation will be still attempted (< 25 % chance) , stated that tumor is very fragile and during last 15 minutes of surgery are critical, he uses a conservative approach and leaves (usually) small portions (scrap??) and if necessary he will use Gama later (<10 %).
The tumors growth and brainstem compression is of concern thus my wait-n-watch option is over.
We tentatively agreed for surgery, to be performed in middle of January 2014 after Holidays. http://www.anausa.org/smf/Smileys/classic/rolleyes.gif

[rm516]

Ok , previously I was in denial but facts remain:
1.   AN size is 3.2 cm vs 2.9 cm 2 years ago (procrastination)
2.   Hearing is still 80-85 %, perseverance being attempted..
3.   Hearing tests show some loss at higher frequency..
4.   Inside ear feels clogged and occasionally hear constant noises (tinnitus)
5.   Doctor say’s, I am at verge of starting hydrocephalus..
6.   Head / Brain gets foggy at times (stress ?)
7.   Walk is casual not perfect (so is speech and writing)
8.   Occasionally hear "Heart thumping" noises
9.   Twitching of Rt.eye (particularly in morning)
10 Micro surgery is scheduled with Dr. Michael Sisti on 14th January, 2014.
It walks or talks like AN surgery, it is AN SURGERY !

[Pamm659]

rm516, I feel riding that Denial Train is part of the process. In fact, I have been on it too but my ride will end in  Summer depending on my MRI on May. My hope is that you come out on the other side with a strong equal smile and you get home quickly. Please stop by here from time to time to give us W&W'ers some insight and guidance.
Sincerely,
Pamm

[v357139]

Ok , previously I was in denial but facts remain:
1.   AN size is 3.2 cm vs 2.9 cm 2 years ago (procrastination)
2.   Hearing is still 80-85 %, perseverance being attempted..
3.   Hearing tests show some loss at higher frequency..
4.   Inside ear feels clogged and occasionally hear constant noises (tinnitus)
5.   Doctor say’s, I am at verge of starting hydrocephalus..
6.   Head / Brain gets foggy at times (stress ?)
7.   Walk is casual not perfect (so is speech and writing)
8.   Occasionally hear "Heart thumping" noises
9.   Twitching of Rt.eye (particularly in morning)
10 Micro surgery is scheduled with Dr. Michael Sisti on 14th January, 2014.
It walks or talks like AN surgery, it is AN SURGERY !

If I had to do it again, I would have done it sooner.  Glad you are moving forward.  I also met Dr Sisti.  He is a great guy and I am sure you will do well with him.

[rm516]

How do you confirm which of the two differing opinions are correct  or is it determined (for sure) by MRI before surgery.
One Neuro surgeon (not Sisti) thought I may have meningoma and his diagnosis:
"The MRI shows a nearly 3 cm right CP angle mass, which does not
involve the internal auditory canal except some wispy contrast
enhancement. It has the appearance of a CP angle meningioma of the
posterior petrous space. Possibility remains that it is an acoustic neuroma
but there appears to be some mild hyperostosis there and the enhancement
pattern of the dura with a dural tail going into the lAC appears more
consistent with a meningioma."
My radiologist report says CP angle mass is compatible with vesibular schwannoma (as they are generally spherical and with no distinct dural tail visible)but do have significant mass effect on lateral pons.
 Dr. Sisti says, he does not have to drill into canal ? ? (Great!)
Can someone or if they knew faced the similar situation, so please comment..
Do they (surgical team) find at the time of surgery (after opening dura) to determine if it's AN or meningoma?  same technique does take care of AN or meningoma  ?.
Doctor gave me < 25 % chance to save hearing and much better chance of facial nerve preservation.
Thanks
Raj
 
PS: Sorry about rumbling and poor construction of sentences due to too much thinking into it.


 

[rupert]

From what you say, I think the general opinion of the doctors and the radiologist is that it's a AN.  Usually a tail would suggest that.  I'm no expert and not a doctor, but I think a meningioma would be growing off the brain towards the canal where AN's would be growing out from the canal. Hence a tail.  The contrast doesn't always pick up every detail.  Wispy contrast might be just that.  I wouldn't worry. They are very similar tumors and it's being removed, that's the main thing.

[Kathleen_Mc]

from what I understand same tech. for AN/ vest. schwannoma./ meningoma. Don't worry, once they get in there and see what's what they'll deal with it, and you'll be snoozing!
I am glad you are headed to surgery and can put W&W behind you and start healing!

[Derek]

Hi there rm516...

Sorry you have had to leave W&W but in your circumstances I do believe that you have made the right decision and you have the all important confidence in your surgical team. In the interim period keep yourself calm and stress free, do have a good Christmas and very best wishes for a successful outcome in the New Year.

Derek

[leapyrtwins]

I've heard only great things about Dr. Sisti. 

You're in very good hands.

Good luck w/your surgery.

Jan

[v357139]

How do you confirm which of the two differing opinions are correct  or is it determined (for sure) by MRI before surgery.
One Neuro surgeon (not Sisti) thought I may have meningoma and his diagnosis:
"The MRI shows a nearly 3 cm right CP angle mass, which does not
involve the internal auditory canal except some wispy contrast
enhancement. It has the appearance of a CP angle meningioma of the
posterior petrous space. Possibility remains that it is an acoustic neuroma
but there appears to be some mild hyperostosis there and the enhancement
pattern of the dura with a dural tail going into the lAC appears more
consistent with a meningioma."

I would ask Sisti those questions.  He has done meningiomas also.

[rm516]

<<I would ask Sisti those questions.  He has done meningiomas also.>>
[/quote]
I already did, but he says that  shape on MRI looks like AN. However, I am seeing him again on 9th January along with pre-operative tests.
Little worried..

[kcarloy]

Write down your questions to ask, then trust your surgeon and look forward to your long nap on surgery day! Soon you will focus on your recovery and your real life again!

[TexasSprinter]

Raj--best of luck with your surgery. Please keep us posted on how things go.

[v357139]

<<I would ask Sisti those questions.  He has done meningiomas also.>>

I already did, but he says that  shape on MRI looks like AN. However, I am seeing him again on 9th January along with pre-operative tests.
Little worried..
[/quote]

I would express my exact concerns to my surgeon and trust him unless it sounds really crazy.  The only other choice is getting another opinion.

[rm516]

1. Preoperative MRI could not be performed yesterday as basement (MRI room) was flooded and only emergency case's were done in another building so they asked me to have" MRI "on the day of surgery at 5:30 AM. (for diagnostics) with Neuro Resident as Doctor Sisti does not want to be surprised with any new findings at the last minute.
2.  All other tests like X-ray, blood work, EKG etc and physical went fine.
3. Dr. was very confident, gave me >95 % chance of "no facial issues", less chances for CSF leak (since no IAC tube involvement) but downgraded my chances of saving hearing to only 5 % .Oh well..
4. Explained (animated ) balance issues for couple of days due to removal of vestibular nerve but they use no retractors for brain (Tuesday's AN special -courtesy Columbia) just kidding..
5. Expected back to normal activities (bathroom etc) soon and encouraged me for walking after surgery and recommended driving in 2 weeks.(if all goes well)....
6. Either it was his confidence in surgery or his way to prepare me for this surgery (but it feels good)
7. Regarding chances of it being meningoma, he said most likely it's AN (shape) but technique is the same except in this case all has to be removed, as they regrow... Will know it after opening dura and whether my hearing can be saved by 8:45 AM.
I mentioned his publication ( Efficacy of facial nerve sparing approach in patients with vestibular schwannomas) and expected the similar results in surgery and he smiled but accepted me as his facebook friend ( Ha, Ha..)