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Side Effects From Surgery

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letranger:
I am scheduled to have surgery (middle fossa) to remove my acoustic neuroma in July.  I am an attorney and, although I think I have a great surgeon, I'm concerned about how the operation my affect my ability to work.  In particular, I'm very worried about cognitive difficulties that my result from the surgery and about the headaches that others who've had the operation speak about so frequently.  Does anyone have any opinions or advice?  For example, would cognitive difficulties and headaches be less likely using the translabyrinthine approach instead of the middle fossa?  How soon can I expect to be back to work at 100 percent capacity?  Thanks very much for any help you can provide. 

Mark:
Letranger,

you don't mention the size of your AN , but can I inquire as to why your not also considering radiosurgery which typically has less post treatment deficits than surgery?

Mark

letranger:
Mark,

Thanks for your response.  As to the size of my AN: from what I'm told, it's still fairly small: 0.6 x 0.9 x 0.5 cm. 

As for why I'm not considering radiosurgery: I discussed the option with my neurotologist.  He explained the procedure to me but ultimately recommended against it.  He said that I'm relatively young (late 30s) and that going the radiosurgery route would mean multiple treatments and continuous monitoring over a period of many years.  He also mentioned the possibility (admittedly remote) that radiosurgery might make the tumor malignant.  I realize that each approach has its supporters and that there is conflicting evidence.  My doctor has an excellent reputation, however, and in the end, his advice seems reasonable to me. 

macintosh:
Dear Stranger--

I would suggest that you go to the site pubmed.gov, and use <acoustic neuroma microsurgery> and <acoustic neuroma radiosurgery> as search terms. Another very useful site is www.acousticneuroma.neurosurgery.pitt.edu.

Best,

Mac

jerseygirl:
Letranger,

Middle fossa is associated with the greater risk of cognitive difficulties than translab because in MF approach the surgeon has to retract temporal lobe - it plays a role in mood, memory and language. In translab, the surgeon has to retract cerebellum which plays a far lesser role in cognitive functioning, therefore, translab is not associated with cognitive difficulties when the tumor is small and does not press on the brain yet (which is your situation).

In terms of headaches, middle fossa has an increased risk of headaches because of the muscle being cut (lateral pterygoid, as one surgeon explained to me). These headaches, if they occur, are intractable and hard to treat. Translab is not associated with these kinds of headaches because there are no major muscles to cut.

Middle fossa also has far worse facial nerve preservation rate than translab becasue they go from the top and the facial nerve is sometimes not identified. in translab, the facial nerve is identified and protected although the preservation rate decreases when the tumor size increases ( yours is small, remember).

Middle fossa has the highest rate of hearing preservation and may be that is why it is recommended for you. Translab is guaranteed deafness in the affected ear because they take the inner ear out. I do not know what is the chance of the hearing preservation with MF approach but I guess it really depends on the surgeon. Single sided deafness is not great but is not awful to live with either as many of us can attest. In addition, in the past few years, there are choices in the hearing aids for unilateral deafness - BAHA, Transear, Starkey and I also heard somebody using Siemens. Technology is forever improving, I can't wait to see what is going to be out there in 10 years. I have to add, though, that at this point, nothing is better that your own fully functioning two ears even if it is a lot of help.

The bottom line is, the choice of the approach depends on your goals and which risks you are willing to take. Some people sail through middle fossa with their hearing preserved, some people have their lives ruined by  headaches and cognitive difficulties as the result of the surgery and lost their hearing as well. There is just no way to tell upfront where you are going to be. Take care and best wishes,

                      Eve

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