Dr. Jho vs. Dr. Shahinian

[sharonov]

In the (small) world of endoscopic surgery, these two names come up the most often when doing a google of the subject.  Dr. Jho IS board certified in neurosurgery, he takes Medicare (important for us old farts) and also claims in his website to have pioneered the use of the endoscope for brain surgery.  He's located in Pittsburgh, which is closer for everyone east of the Rockies (like me.)

Shahinian, on the other hand, is extremely expensive and not board certified in neurosurgery, which may or may not be important. 

Everyone on this board who has chosen endoscopy has gone with Shahinian and seem to be very satisfied.  Sadly, it's a very small sample of only 3-4 people.

So why did you (if you're reading this) go with Shahinian?  A slicker website?  Did he sound more knowledgeable?  Is he younger than Jho's 62?  I'm just curious.  If I choose Shahinian it's going to cost me a HUGE amount of money out of pocket.  HEI also accepts Medicare.

I did a search in the bar above and came up with many hits for Dr. Jho, but most of them were doing the same query as I.

Sharon

[leapyrtwins]

Sharon -

as you know, I didn't have my surgery with either Dr. Jho or Dr. Shahinian, but thought I'd offer my two cents worth.  You'd probably be surprised if I didn't 

From what you're saying about the two, IMO it's a no-brainer (no pun intended).

If they basically do the same thing, and have both done numerous procedures, but Jho is board certified, takes Medicare, and is closer to home - I think he should get your vote.  Nothing against Shahinian, but Jho seems like the logical choice.  And I wouldn't let Jho's age be a deciding factor.  Dr. Brackman is still doing surgeries at HEI and he's a lot older than 62.

Of course, this is just my opinion, which ultimately means nothing; just wanted to give you my perspective.

Making a treatment decision is probably one of the hardest things you'll go through in this entire process.

Jan

[sharonov]

Thanks Jan.  Your two cents are always appreciated.  Your analysis is right on, but nobody on this board has chosen Jho.  Wonder why?
Sharon

[jerseygirl]

Sharon,

Here is my opinion for whatever it is worth and food for thought for you. Dr. Jho is one of the pioneers of endoscopy in neurosurgery and he trains a lot of future doctors. These doctors, in turn, put the surgeries they have done with Dr. Jho on their resume or tell patients that they have done it themselves. The surgery takes longer and the students sometimes make mistakes which need to be covered up by the doctor. If you go, chances are Dr. Jho will not be the only one doing your surgery. He will have a young assistant in-training you might not have chosen if you knew.  I am not saying that it will not go well just that you need to think about it. Both HEI and SBI do not train students, therefore, the surgeon of your choice will be the one doing your surgery.

My second point is the type, length and amount of anesthesia that you will have during surgery which is especially a concern given that you are over 60. People of this age do not react well to anesthesia and might have cognitive effects for years. I had my first  AN surgery  about 21 years ago and I will never forget an elderly wealthy socialite that came to remove a small tumor (not an AN). I spoke to her before her surgery and she was sharp, witty and had the best attitude. This is not to mention that she was perfectly coiffed and had the biggest and most sparkling blue eyes I have ever seen. The surgery was done by a renowned neurosurgeon, lasted only 4 hours and was very "textbook" and uneventful. The patient, however, became incoherent, incontinent and disheveled and believed she was in Buckingham Palace rather than in a hospital.  Her problems were blamed on anesthesia.

My final point is that surgery is surgery and carries with it inherent risks. The surgeon might be great but if you end up on the wrong side of his illustrious statistics, it cannot be great. Nobody and nothing can guarantee you a perfect outcome. I am not sure I want to believe the assertion that Dr. Sh has NEVER lost a facial nerve but I will tell you that he has not lost MY facial nerve and all the tumor appears to be gone as evidenced by MRI. In fact, I was not given good prognosis by most doctors because of my previous surgery, some of them even refused to see me. I was a difficult case and Dr. Sh managed it.

All three institutions you are considering are absolutely fine and reputable. So, wherever you willl go should depend strictly on you and the factors you consider important. Best of luck to you!

                 Eve

[leapyrtwins]

Your analysis is right on, but nobody on this board has chosen Jho.  Wonder why?

Another great question.

My take on that is that very few on this forum have chosen endoscopic AN surgery in general.  We do have some, but compared to those who have had conventional surgery the number is relatively small.  I attribute that to the fact that endoscopic surgery, as we've mentioned before, is newer and more cutting-edge than the old "open your head" AN surgery.

Jan

[sharonov]

Wow, Eve.  You've given me a very big something to think about.  I sent my films to Dr. Jho and will talk with someone next week.  My biggest question will be, is there anyway to guarantee that only Dr. Jho will operate on me.  If there is no way that a promise like that can be made then he will definitely be out of the running as far as my choices.

Funny.  I know how old I am but never think of myself as elderly, yet it's so.  Five years ago, when this was diagnosed, I told my doctor that I seemed young to be losing my hearing.  He stopped, looked at me with a serious expression and said, "my dear, 200 years ago you would have been one of the village elders!"  I cracked up of course. (He is older than I.)

I'd better be realistic and take my age into consideration.
Sharon

[jerseygirl]

Oh, Sharon, I hope I did not insult you. I did not imply that being over 60 is a negative anything. I am not there yet but I am over 40 and every time I go to the doctor to get yearly checkups, I have to face the reality: EKG, annual mammograms (not that I follow that advice), high cholesterol and BP. In addition, my bones make sounds after I turned 35. Not fun, but real.

The woman I am talking about was over 70 but the question about anesthesia and teaching hospitals was real for me, too, even though I am younger. I figured that my brain already took a lot of beating so it did not need any more!

              Eve

[sgerrard]

Does Dr. Jho do the same kind of endoscopic surgery as Dr. Shahinian? I am under the impression that Dr. Jho uses an endocsope for visualization, but is operating with the same surgical tools used in regular microsurgery, while Dr. Shahinian uses tools that are built into the endoscope itself. Am I just making that up?

I'm not sure it has any bearing on the question of which one to pick, but I am curious about it. By the way, these days 61 is considered well short of elderly. People in their 60's often manage to get through surgery just fine.

Steve

[Patti UT]

Another name to add to the docs doing endoscope for AN's,  I found a Dr. Coimbra at the Neuro Surgery Specialists in Dallas TX doing endoscope for skull based tumor surgery.  The #'s of An's are low.
 

I would love nothing better than to find someone doing this in large numbers to feel better about chosing this type of procedure. It is new and only a few docs have done it for AN's.  But there is something to be said for "cutting edge technology"

do your research...


patti ut

[jerseygirl]

I somehow missed the posts on this thread. Here is my answer to Steve. When surgeon uses endoscope for visualization only during the surgery, it called an endoscope-assisted surgery. When the surgeon uses only an endoscope, both to visualize and to remove the tumor, it is called fully endoscopic surgery. Only two Drs in the US do fully endoscopic surgery  AND they have a lot of experience with it - Dr. Jho and Dr. Shahinian. Other doctors I have researched either don't do fully endoscopic surgery OR the don't have a lot of experience with it. Some have even claimed as experience the surgeries they did with Dr. Jho. It counts, but... .

Dr. Jho and Dr. Sh use different endoscopes of their own design and different places to access the tumor. Dr. Jho does something called retromastoid method where he makes an incision closer to the ear, relying on bony landmarks that people naturally have. In my case, these bony landmarks were destroyed in the first surgery I had 21 years ago, so Dr. Jho actually gave me a poor prognosis but still said he could try if I wanted to. Dr. Sh does retromastoid which is a little bit further away from the ear but still behind it. He does not rely on bony landmarks as Dr. Jho does. He actually inserted an endoscope through an existing metal plate in my head from the previous surgery which led to NO PAIN.

As far as the age goes, 60s is still young, no doubt about it. However, it is not twenties either. At 20 the body can take a lot more abuse and still recover. I was 25 when I had my first horrendous surgery and I don't think I could have survived it at 65. Age does make a difference, like it or not, and less anesthesia is always better. I am just being prudent.

               Eve

[Jim Scott]

Sharon ~

I don't envy you the dilemma you're facing but from my understanding of the criteria for your choices, I would have to agree with Jan's opinion and go with Dr. Jho.  He's a board-certified neurosurgeon, takes Medicare and is geographically closer.  However, we all want a good outcome to AN surgery and if you're not completely comfortable with Dr. Jho for whatever reason (age, lack of recommendations, etc) then you'll have to seriously consider SBI and Dr. Shahinian. 

As Jan pointed out, part of the problem with finding recommendations for Dr. Jho is due to the fact that endoscopic AN removal surgery is relatively new.  When I mentioned it to my neurosurgeon 3 years ago, he had never heard of it, and this was a neurosurgeon that was very keen on embracing new approaches, as he did with my AN (debulking, then FSR).  I suspect that Dr. Shahinian and SBI are a bit more aggressive in promoting their endoscopic AN surgery approach than Dr. Jho which may account for SBI having more information online.  Just a thought. 

As for age, while a very real factor in considering surgery, it is relative to the individual.  I'm no athlete but when I underwent my AN surgery and radiation, I was 63 years old.  Fortunately, I had none of the physical maladies common to those in late middle-age (arthritis, back and/or joint problems, diabetes, overweight, cardio issues, etc).  That made me a good candidate for the AN surgery and I enjoyed a rapid recovery.  However, what is true for me doesn't necessary mean it is true for anyone over 60 facing AN surgery.  Your doctor usually decides whether you're a good candidate for the surgery, from a health perspective and most won't consider it if they believe you'll have a difficult time.  Some doctors won't perform any kind of extensive surgery if the patient smokes.  I have an acquaintance who needs back surgery.  At age 65, he's a lifelong smoker.  The neurosurgeon he consulted told him that he would not perform the surgery because this mans lungs are simply incapable of sustaining him through a 6 to 8 hour operation under 'heavy' anesthesia.  That wasn't mere speculation.  My acquaintance was required to undergo a lung capacity/function test - and he failed, miserably.  Hence, no surgery.  On the other hand, I don't smoke (I quit 20 years ago).  My neurosurgeon didn't hesitate to schedule my AN surgery, based on my pre-op tests and my generally good state of health. 

The point is that it's all relative to the individual.  Although it is relevant, you can't generalize about your age and your body's ability to handle the trauma of AN removal surgery, .  My 63 years (at the time of my surgery) might be more like 53 to a doctor's observation, based on my medical history and current tests.  The same goes for any AN surgery patient.  My recovery was quite brisk (I was motivated).  Frankly, I think my neurosurgeon was a bit surprised.  He had predicted 'months' to recover and I was driving again within 2 weeks.  Granted, it took a lot longer to regain my full recovery but I managed just fine after a few weeks.  Again, that's no indicator that yours - or anyone's  - recovery will be identical.  Just an observation for you to consider, along with other comments offered here, in good faith and with the intent of helping you see all sides as you journey toward a treatment decision.   

Jim