ANA Discussion Forum
Treatment Options => Microsurgical Options => Topic started by: Esperanza on February 05, 2009, 10:28:21 am
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Hello,
I have had different types of surgery suggested by the specialists I have seen. One prefers translab due to "better view of the
facial nerve" - the other said he would use retrosig. based on the anatomy of my skull?
Although I would love to fly over to the US and have edoscopic surgery it is not a realistic option (unless I win the lottery!) and I hope to have plenty of time to make a decision on the route but which one? How do I decide? Maybe I should seek a third opnion?!
Any ideas/experience when different routes have been suggest would be greatfully received!
x
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X -
I had the choice of translab or retrosigmoid (or radiation) and chose retrosigmoid.
Even though they say that retrosigmoid has a larger chance of causing facial nerve damage I chose it because I was hoping to keep the hearing I had left in my AN ear (diminished, but with good word recognition).
I could have picked translab, but in my case I wanted to know that the docs had at least tried to save my level of hearing. I figured if they could, great - if they couldn't, at least we could say we tried.
If my hearing wouldn't have been as "good" as it was, I would have chosen translab.
Post op I turned out SSD with only slight facial nerve damage for a day or two post op (steroids took care of that problem) so I wasn't a textbook case - but most of us rarely are.
Good luck with your decision.
Jan
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X:
In my experience, no two Drs. will tell you the same thing. Choosing the treatment is the most difficult part of this whole AN experince. I was a candidate for everything--all the surgical approaches, radiation, and watch and wait. I had originally decided on translab because everyone told me that chances of saving my hearing were very slim. I did hear often that translab is safer for the facial nerve. However, one doc said that in his experience, facial outcome is the same with translab and retrosig. Another told me that in his experience retrosig does show high statistics for facial nerve damage, but he prefers retrosig for larger tumors. So, it could be tumor size not surgical approach that causes the facial nerve damage. But that's just was said to me.
At first I had decided on translab, then I saw one more dr, and a few days before surgery I chose retrosig.
I suggest you continue to get opinions until you have the info you need to make a decision.
Syl
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Esperanza:
The surgical approach is always a bit problematic. My surgeon chose the retrosigmoid approach because - he said - it would give him the best angle to operate on the tumor. Frankly, he didn't ask for my opinion - and I wasn't going to argue with a compassionate neurosurgeon who treated me with dignity and had three decades of surgical AN removals and many satisfied patients. In my case, it worked out well. Now, I'm rather glad I wasn't given the choice to make. As you're finding out, it can be agonizing.
My suggestion is to query each surgeon you consult on the reasons for his/her choice of surgical approaches. In effect, gently but firmly make them justify their decision. After all, you'll have to live with the consequences of that decision, whatever it may be. If a doctor is 'offended' by your question or refuses to answer forthrightly, I would not consider him (or her) as the person I want performing this kind of delicate and serious surgery. Meanwhile, your research should help you find out enough about the various surgical approaches to ask informed questions of doctors who are open about their choice of surgical procedure. It's a bit of a daunting task, but certainly worth the effort. I hope you can find a satisfactory answer, soon. :)
Jim
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Esperanza,
I totally understand your questions/concerns. I too have conflicting opinions, I had one consult in NYC and was told translab and then a phone consult with dr at House and was told Mid Fossa....I am seen another doctor on Tuesday to get his opinion. It is all very confusing, my only advice is to get as many consults as you feel comfortable with and ask lots of questions here for peoples outcomes after surgery. It can be very upsetting to hear about some peoples post op problems but there are many here who are doing very well and give me lots of hope.
Hang in there and I'll do the same, good luck with your consults and finding answers to your questions
Dawn
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I, too, was kind of at the mercy of what approach my surgeon wanted to use. At first, he told me translab and then after conferring with the doctor that would be operating on the tumor (that part of the surgery) they switched to retrosigmoid because it gave them the best view of my particular tumor (it didn't have anything to do with hearing as in other cases).
Personally, I would get another opinion. From my experience, surgeon's will generally favor the approach that they are most comfortable with. Some will give the option of approach over to the patient because they favor neither one.
If there was a higher risk of facial nerve damage with that approach, I wasn't aware of it. My main goal was to get the ENTIRE tumor removed. My surgeons could have used whatever approach was necessary to achieve that goal in my mind. Luckily, I spoke to a very good surgeon with lots of experience. Read my blog (address listed in my signature below) for more insight into my whole journey if you feel inclined.
A choice of surgeon and approach are personal ones, to me. Everyone has different goals of surgery. I just happened to have a more basic need of getting the entire thing. As Jenni said in consultation with our surgeon, she just wanted to be sure that when she was old, she would have to buy *2* rocking chairs instead of 1. The rest we'd deal with as it came.
Good luck in this part of the journey. Let us know how else we can help.
Regards,
Brian
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Thanks for your replies, I really appreciate your input - I think I will do some more researching on outcomes relating to both types of
surgery and seek a 3rd opinion (or maybe even 4th!
I'm sure the 'right' decision will make itself clear at some point!