neuroma middle fossa approach vs. translabyrinthine approach

[michellemonaghan]

Hello All!  I'm still trying to figure out what to do.  I've been told that I had an AN then was told I had a Facial Schwannoma.  I got a second opinion from the House Clinic and they said their readding was an AN.  My tumor is .08 x 1.1 x 1.8 cm, I'm 36 years old with no hearing loss at this time.  They feel that I would be best off going with the Middle Fossa Approach to try to save my hearing but I'm scared about the whole lifting the brain thing and wonder if it's worth the risk with only a 50/50 chance of saving my hearing.  What do you guys feel about Middle Fassa Approach vs. Translabyrinthine approach?

[Jim Scott]

Michelle ~

Your anxiety over choosing a surgical procedure is understandable.  Unfortunately, we're not doctors and cannot offer advice on such a serious matter as the surgical procedure you should choose.  That is best discussed with your doctor(s) who know your case and have the training and experience to offer credible advice.  Still, in the final analysis, only you can decide, which is never easy, as we know from experience. 

I did not have either of the surgical procedures you are considering.  My doctor chose to use the Retrosigmoid approach and he did have to move my cerebellum ("just a tiny bit"), as he later informed me.  I suffered no complications post-op, but that is a simply one person's experience and not offered as anything but that.  I wish we could give you absolute answers to your very pertinent question but in all honesty, we really cannot.   However, I can tell you that many of our members have undergone AN surgery using the Middle fossa or Translabyrinthine procedures and have done quite well, for what that may be worth as you contemplate your surgery decision.

Jim

[leapyrtwins]

IMO, and I'm not a doctor, mid-fossa is the way to go. 

Not everyone is a candidate for it - based on tumor size and/or location - but if it's an option docs who do mid-fossa generally recommend it.

I also personally feel why give up your hearing if you don't have to.  Hearing loss isn't a "fun" thing (for lack of a better word).  I have a BAHA which helps a lot, but it will never be like my "normal" hearing used to be.

My situation was somewhat similar to yours.  I had diminished, but decent hearing in my AN ear and opted for retrosigmoid over translab in the hopes of saving my hearing.  My tumor was wrapped around the hearing nerve, so during surgery I lost it, but I've never regretted my decision.  As I told my neurotologist and neurosurgeon, I wanted to at least say we tried.  If it wasn't meant to be, it wasn't meant to be.

Just my two cents,

Jan

[jaylogs]

Hi Michelle and welcome to our little club!!  I can feel for you, as trying to figure out different options is really stressful!  Just know that whatever decision you do make and if it feels right, then it is the RIGHT one!  I had middle fossa done by House about a year and a half ago.  My conditions were similar to yours, my AN was 8mm and I still had about 70% hearing.  So I chose middle fossa over translab (my local doctors here in Phoenix wanted to do that) because of 1. House's reputation and 2. To try to save my hearing.  I am happy to report that I did save the hearing, although it's at about 50% now.  It's hard to hear clearly out of that ear, but if I wear earphones for music, it's pretty darn passable.  I chose to get a BAHA anyways, because it was so hard to hear conversations.  So like Jan said, if it was meant to be, it was meant to be.  I know if I had totally lost my hearing and I hadn't gone with middle fossa, I might have always in the back of my mind wondered if I should have tried.  So that's my story.  Like you'll always read on here, each person is unique and will have a different outcome.  This was mine, and I hope whatever you decide, you'll be happy with yours! Good luck and let us know how it goes!
Jay

[michellemonaghan]

Thanks for all the responses.  I think that I'm just on information overload and can't make up my mind.  I know I have a very important decision to make and need to make it soon so I can get this taken care of.  I've met with a Neurosurgeon with Kaiser, an ENT specialist with OHSU, a Radio-Surgeon with Providence, gotten a second opinion from the House Clinic, and I've read just about everything out there on AN.  Now it's DECISION TIME!!!!  I should be hearing from Kaiser today to see if they approved my referral to the House Clinic.  I live in Washington State and I know they don't want to send me out of state but I would feel the most comfortable there.  I'll keep you posted on my decision........

[Mickey]

Hi Michele! With a perfectly good hearing ear being 36 years old going to one of the best AN places on earth with a small tumor, I can understand your hard decisoin. Normally anyone would want to go the path of least resistance but in your case you have everthing going for you. I would research more especially with the House Clinic to get what would perferably would be the best outcome. They should really know whats best for you under the circumstances. Best wishes, Mickey

[moe]

Hi Michelle, and welcome!
Great advice from others. Only you can make the decision. You WILL lose the hearing with TRANS LAB. What is the main consensus between all the doctors you've seen so far?

Confusing about what kind of tumor you actually have. There is a big difference between an AN and a facial schwannoma.

With translab, there is better visualization of the facial nerve (I think!), in case it is on the facial nerve.

My tumor was med-large and required translab. It was complicated but I'm doing OK!

What part of WA do you live in? I live near Tacoma/Seattle area. If you are in that vicinity, send me an Instant Message (I think that is what the logo sign reads now. Used to be "Personal message")

Anyway, we are here for you. It can get overwhelming to say the least with the barrage of stories and not all of them pleasant.

I actually didn't join the forum until AFTER my surgery..I like to welcome and support the newbies.

Keep in touch
Maureen

[Chances3]

Hi Michelle,

These decisions are very difficult to make.  I had a middle fossa done 6 months ago.  I'm 55 years old, my hearing is a lot less, but it works.  The neurosurgeon I met, told me that they never expose the brain, it stays enclosed in the dura mater.  That made me feel comfortable with my decision.  No one can make this decision for you, it has to be yours alone.  We can only give you our advice and experiences.  Here is my two cents.  Whichever procedure you decide, make sure the doctors are very experienced, and the facility is the best.  Just like shopping, meet the different doctors, find out how long they have been doing their respective procedures, and how many each year.  If possible, find other patients who have used these doctors for their experiences, and recoveries.  God Bless !!

[ibelieve2]

Michelle,

 I was diagnosed March 24, I live in IL (54) my AN is small 5mm. I have lost about 20% of my hearing. My first opinion was with Dr. Mark Wiet at Rush in Chicago he recommending Middle Fossa approach.  I am also in the process of reviewing Doctors. I have contacted Mayo- they are setting up my appointment. My second opinion is Monday with Dr. Battista in Hinsdale, IL and My 3rd opinion is with Dr. Leonitti at Loyola. 

I asked my First Opinion Doctor whom would he choose if he had the surgery and he said the University of Michigan because they were the best at perserving hearing. I am going to contact House Clinic but I am nervous about going so far away.

Denise
ibelieve2.denise@gmail.com

[nftwoed]

Hi;

  If it were my situation, I would follow HEIs advice to the letter. You're running a risk no matter what decision you make and they have seen tens of thousands of pts.
  I mean, are you really ready to live the rest of your life with one sided hearing at 36? What if something happens to the other side?
  Wow; To destroy that perfect hearing because there exist %s and what I think is hyperbole ( the mandibaling of part of the brain ) I suppose if you wish, you could go up the road to Stanford and get a radiological opinion.
  Good luck in feeling secure with your ultimate decision. That is important!

Hello All!  I'm still trying to figure out what to do.  I've been told that I had an AN then was told I had a Facial Schwannoma.  I got a second opinion from the House Clinic and they said their readding was an AN.  My tumor is .08 x 1.1 x 1.8 cm, I'm 36 years old with no hearing loss at this time.  They feel that I would be best off going with the Middle Fossa Approach to try to save my hearing but I'm scared about the whole lifting the brain thing and wonder if it's worth the risk with only a 50/50 chance of saving my hearing.  What do you guys feel about Middle Fassa Approach vs. Translabyrinthine approach?

[leapyrtwins]

I asked my First Opinion Doctor whom would he choose if he had the surgery and he said the University of Michigan because they were the best at perserving hearing.

I'm not sure how accurate this is, or if there are any studies to support this.

First opinion doc did his internship @ U of Michigan; he may have based his response on that.

Jan - playing devil's advocate once again 

[Sonja]

Michelle:

I can definitely relate to the stress involved with making such an important decision. Making decisions about where to go, what to do and what surgery to have is one of the hardest parts of having the AN. At least it was in my case. Once I made up my mind I was at ease. I was still concerned somewhat but I was ready to move forward and felt less stressed. Do all the research you need, as all the questions you can think of and try to find some stillness to allow you to make the decision. No one can really tell you which way to go. There will come a time when you know which way to go. That is normally when you feel at ease with your decision.

I would have to say HEI are one of the best if not the best in the world with regards to AN's. But you need to feel comfortable with whichever type of surgery you decide. I had translab at HEI in February 2009. HEI recommended translab, but ultimately I made the decision and felt at ease once I had. I did have about 8 consultations and not every doctor recommended translab or surgery for that matter.