Two Doctor Approach

[Kate B]

Here is another question for the group.  In places that use two doctors, which one does the actual tumor removal? I wonder if it is the same at various institutions.

Let me clarify:  In the Medical Diary Show, Sherry's Story, which ran several years ago about a woman with acoustic neuromas, the House doctors were shown operating on a woman.  The narration indicated that the reason they work in teams of two is so that one doctor can do the "gross motor" (large movements) and one can do the "fine motor" (small movements). Although both could do each part of the operation, it allowed them to maintain the focus on one type of  hand movement as both require different muscle usage. 

Open/ Close: Dr. Brackmann
Tumor removal: Dr. Hitselberger (neurosurgeon)

Just curious....

[leapyrtwins]

Interesting question, Kate.

I'd have to go back and read my operative report to be 100% certain, but in my case I'm fairly sure my neurosurgeon opened up my skull, my neurotologist closed it and they both were involved in removing the AN.

AN removal is very tedious work - basically the tumor is removed layer by layer - and it's also very "close" work - done under a microscope - so it creates a big strain on the doctors' eyes.  In addition, the surgery usually takes many hours (in my case 7 1/2), so in order for both docs to be "fresh" in their work, they alternated the removal responsibility.

Sounds like Chicago Ear is a little different from House.  But, as we know, docs do things differently - even for the same type of surgery.

I always find this kind of stuff fascinating - maybe I'm just weird that way   

Jan

[BigSister]

When consulting with my doctors at University of Penna, I asked the neurosurgeon about who handles what during surgery or radiation.
His response was anything that had entered the cranial cavity was his territory and anything in the auditory canal was the ENT's territory.
Made sense to me.  Since my tumor is 2+cm there is more than enough to share when I decide on treatment!

April

[Kate B]

Interesting question, Kate.

I'd have to go back and read my operative report to be 100% certain,
Jan

It would be interesting to ask if they both removed it layer by layer as you suspect.

When consulting with my doctors at University of Penna, I asked the neurosurgeon about who handles what during surgery or radiation.
His response was anything that had entered the cranial cavity was his territory and anything in the auditory canal was the ENT's territory.
Made sense to me.
April

Thanks April.  It does make sense.  It is interesting how there are three posts and they seem to approach surgery differently. 

Kate

[kabby]

My UofPa Dr.'s told me that the ENT does the opening, removal of tumor from ear canal area, then the neurosurgeon removes the other part that is pressing into the brain, then the ENT closes.  However, I also talked to an OR nurse from Jefferson NeuroScience who said that both surgeons have an assistant/resident with them who may do the closing.

[Jim Scott]

Just an observation but at the time of my surgery this kind of minutia, although relevant and important to some, was not a primary focus for me.  However, my neurosurgeon (Dr. Goodrich) is training another neurosurgeon to take over his practice when he retires (he's about my age) and she assisted him during my surgery.  Dr. Judith Gorelick is pleasant, extremely competent (she conducts neurosurgery classes at Yale medical school) and well-trained.  I believe she did most of the skull drilling and later installed the titanium mesh.  She also helped remove the tumor, which was quite large.  My primary neurosurgeon did most of the tumor removal but it did take over 9 hours and I assume he needed a break at times.   He later told my wife that Dr. Gorelick was a 'huge' help to him during the surgery, which, from my perspective, went quite well.

I would assume that every doctor has a slightly different approach to this kind of surgery, regarding 'who does what'.  I was pleased to have two very skilled neurosurgeons performing my surgery, backed up by a 'hand picked' team.   According to Dr. Goodrich, he doesn't perform surgery at nearby Yale Medical Center because it's a teaching hospital and, in his words: "Acoustic neuroma removal surgery is no place for amateurs".  I think he meant interns and residents.  Considering the wide variety of surgical outcomes for AN removal surgery and the fact that every AN patient wants to ensure the very best 'odds' possible for a good (no complications) surgical outcome, I can endorse my neurosurgeon's operating room philosophy.  Of course interns and residents have to learn somewhere, but if we're honest, no AN patient being wheeled into an operating room for surgery really wants to be a young doctor's 'test case'.  The surgery is too delicate and the consequences of a mistake, even a small one, can be devastating for the patient.  No matter how they share the actual work of removing the tumor, I want 'pros' doing the work.  I was fortunate to have that and enjoyed a good outcome.  I wish the same for all AN surgical patients, no matter how many doctors it takes or who does what in the operating theater. 

Jim

[CHD63]

I'm with Jim that I really did not want someone who had done AN surgery before doing my AN removal.  In fact, when I had my MVD surgery in Pittsburgh 15 years ago I had to "fight" with my insurance company to have it done there.  They said one of the local neurosurgeons had done the procedure so I could not go out of network.  Finally won for approval but I did have to pay part of the difference between in and out of network costs (no small amount with brain surgery!).

With my AN surgery, Dr. Fukushima is on the visiting staff at WVU so I was able to have it done at his Duke affiliated hospital in network.  Dr. Fukushima prefers working alone for AN removal, although he does work with residents at both WVU and Duke.  As far as I know he was the only surgeon involved.  He has done hundreds of AN removals with a great success rate so I had no problem with him working alone.

Clarice

[chocolatetruffle]

hey kate
i actually had a 3rd doctor on the team (a HEI fellow) who did the "free" liposuction on my belly and think he plugged in the fat to my head. I was under the impression he was helping brackmann in opening and closing the incision area with brackmann focusing on the inner ear and Schawzt focusing on peeling the tumor off the nerves.  i was glad for the specialized team effort as this iis one heck of a long surgery to be on your feet  

[Brendalu]

Kate,
Great question.  I had an ENT who did the opening and the neurosurgeon did the removal.  I also had another person who monitored all nerve function.  The neurosurgeon also did the fat harvest and closure.
Brenda

[Kate B]

I'm with Jim that I really did not want someone who had done AN surgery before doing my AN removal. 

Clarice

Hi Clarice,
Could you clarify? 

Kate

[CHD63]

Kate ....

Sorry ..... I tend to try to make my posts brief and sometimes things get lost that way.     Also, when I proof my writing these days, I am finding too many mixed up words, left out words, etc.  For an ex-curriculum writer this is depressing for me.

15 years ago when faced with the need for MVD surgery for my trigeminal neuralgia, my insurance company told me they would only cover an in-network surgeon.  Upon checking with that person's office, the only in-network surgeon was a neurosurgeon who had done a couple of MVD procedures in the course of his practice.  Somehow I was not comfortable with a neurosurgeon experimenting inside my skull so I paid the extra (over a course of many years) to have an expert in the field do the surgery (which was very successful).

I should have said in my earlier post "I really did not want someone who had only done a couple of AN surgeries before mine doing my AN removal."  In other words, because of the relatively rare nature of ANs, I wanted someone with previous extensive experience.  As others have said, students/residents do need to learn how to do the procedure but I am not comfortable with being the one they practice on.

Clarice

[leapyrtwins]

Like chocolatetruffle, I had a third doctor also.

He was doing his residency, under Dr. Battista through Northwestern University Medical School, to become a neurotologist.  He was the one who did my fat graft.

Kate -

I believe there is a link on the Chicago Ear website to an article in a local newspaper.  It describes in detail an AN surgery performed by Drs. Wiet and Kazan.  I believe the AN they were removing at the time was 5 cm.  It's been a long time since I've read it, but I'm fairly sure it talks about the "peeling" of the tumor.

Jan

[stoneaxe]

Dr. McKenna , Neurotologist, will be doing most of the surgery on me because of the location, intracannicular. Dr. Barker, Neurosurgeon, will be there to assist and in case of problems. I'll have yet another Dr. monitoring facial nerve.

[leapyrtwins]

My facial nerve was monitored also - but I have no idea who was responsible for that task.

[stevek]

I also had a team of three, originally a team of two, but Dr. Chen had to be called in to help with the locating of the facial nerve and he spent nearly four hours doing removal around it.  Dr. Hillman did the opening and closing of the skull and the removal of the inner ear structures and my neurosurgeon, Dr Aziz, did most of the tumor removal on the brainstem.