ANA Discussion Forum
Treatment Options => Microsurgical Options => Topic started by: boomer on February 14, 2009, 09:06:11 pm
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Hi everybody. I’m back from Skull Base Institute where I had endoscopic AN removal plus endoscopic decompression of trigeminal nerve. So far I have no complaints. My AN at removal was 15.5 mm which is considered a small one. With this approach instead of the one of the conventual approaches the scalp incision was only 2.5 cm and the AN was also dissected off the facial nerve with no complications at all. After this was done Dr. Shahinian attention was shifted to the trigeminal nerve and noted a loop of the superior cerebella artery was compressing it. Again using micro dissection technique a piece of Teflon was placed between the artery and the nerve which was causing some of my teeth pain on the right side as well.
This surgery was on Feb 4, 2009 and was in operation for 5 hours and released from the hospital within 48 hours. That was great! I stayed in LA for 7 days just because I wanted to be sure everything was OK before flying back to Kansas. My walking wasn’t the best and I tired rather easily but nothing to complain about. The flight didn’t bother me but I did use a wheel chair in the airport just to be on the safe side.
I have been home for 3 days now and have had a few vision problems after working on the computer or reading for awhile. Things get blurry and the walls move for about a minute before focusing in.
I will be calling Monday to check this out if it continues. With this endoscopic surgery Dr. Shahinian says I will be back to normal in 3 weeks. My only really hard part is sleeping at a 45 degree angle so the brain doesn’t swell and then I would bet sever headaches. I have never ever been able to sleep in a recliner, but I’m learning. <g>
For those researching options this procedure is worth checking into. Less invasive, less hospital time and less recovery time. I would be willing to visit with anyone who might like more information.
Boomer
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Good work, Boomer! Congratulations on what sounds like an excellent outcome. This endoscopic surgery is starting to sound good, and I'm a radiation guy.
Enjoy your Lazy Boy recliner, and watch out, you may grow to like to it. ;)
Steve
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Welcome home Boomer!
It sounds like everything really went great! It sounds like endoscopic surgery may be the wave of the future for those who choose surgery over radiiosurgery. I'm truly glad to hear you sounding so well. Fatigue is to be expected with any surgery but I would guess AN/brain surgery would make it even more of a certainty. Although I did't have a lot of trouble sleeping in my bed after I got home, I found sleeping on the recliner section of the sofa much more comfortable for naps during the day. Kkeep us posted on your progress.
Best wishes,
Wendy
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Hey, Boomer ~
Congratulations on your endoscopic surgery success! I'm pleased to learn that you're recovering, nicely. Had endoscopic AN removal surgery been readily available in 2006, I would have opted for it. It seems to be the new wave in AN surgery. I hope and will pray that your recovery continues uncomplicated and you can regain normalcy, soon. :)
Jim
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Great to hear you're home and doing well. Sleep was really rough for me as well. I bought a pregnancy pillow which prevented me from turning onto the wrong side. It helped, but nothing helped more than time.
Best,
Marci
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Boomer,
Congratulations on a successful AN removal. To be out of the hospitol in onl 48 hours as well as home in less than a week must feel GREAT! Best wishes for a speedy recovery.
Jim, do you have any particular reasons why you would have opted for this new procedure over the translab approach? I assume it has to do with recovery time maybe?
Steve
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Boomer:
Thanks for the note! We were all wondering about you. Your news really gives me more confidence about my surgery at SBI on March 4. I am so happy you came out well on the other side of this. Keep in touch about the eye issues and your recovery.
Steph
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Boomer -
glad to hear things went well for you.
Best wishes for the remainder of your recovery!
Jan
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First of all, I am very happy for you! Second, just a question about SBI. It sounded very worth investigating to me and I asked in Dr. McKenna's office about the endoscopic surgery option and SBI. Unless I got the answer completely wrong, it sounded quite negative. Of course, as a surgeon he may be reluctant to sing the praises of another facility/surgeon. Any comments?
Thanks, Helga
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Hi Boomer.
Welcome home and congratulations on your succesfull surgery.
I wish you a speedy recovery. Just remember not to pace it to much.
Kenneth
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Helga:
I think it's pretty common to hear those negative things from other docs. For one thing, Shahinian doesn't use the standard protocol of a neurosurgeon and an ENT doing the surgery. The doc I consulted with at Mayo called it a "gimmick". I don't think a dime sized hole in my head, no retraction of the brain, and a 48 hour hospital stay are gimmicks. I resent the doc giving me that kind of info, when I can only attribute it to medical politics.
I think Dr. Shahinian (SBI) developed the technique and uses endoscopic for all skull base tumors. Look through their website. Look carefully at his training and experience, research.
I'm scheduled March 4.
Steph
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Wow! This is really great in comparaison with my 10 days ICU stay a 48 hours discharge sounds like Heaven. Was it a total resection?
I am so glab for you!
Dan
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Hey Boomer,
Welcome back home and it's great to hear that your surgery went well! It sounds as though your experience was exactly like that of our son's surgery. 48 hours after surgery he was released from the hospital and 48 hours after that he was completely released by Dr. Shahinian. We were back home in western Kansas on a Saturday, only 5 days after surgery!
Jared's surgery was on Dec. 29, 2008 and he was back in college for the start of the second semester on Jan. 15, 2009. Jared is now driving his car, playing intramural basketball, weight lifting/work outs, volunteer work for a hospital, attending classes, etc... Basically he is back to his normal self, sans the hearing in his right ear.
Like others, we too were told by competing surgeons that the endoscopic approach was too dangerous and should be avoided at all costs. Medical politics, indeed!!!!
Take care.
Ron & Karen
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Jim, do you have any particular reasons why you would have opted for this new procedure over the translab approach? I assume it has to do with recovery time maybe?
Steve ~
I underwent the retrosigmoid approach microsurgery and it was quite successful, but I would have preferred having no surgery at all. That wasn't possible in my case. My tumor was too big for irradiation, alone, so I underwent debulking surgery, then, radiation. As it all went well with almost no problems, I certainly can't complain. However, endoscopic surgery would have, very likely, been easier. In 2006, it was very 'new' (for ANs) and my neurosurgeon was certainly not an endoscopic surgery practitioner. As you guessed, I expect that my recovery, which was rapid, would have been even faster with endoscopic surgery. I'm pleased to see that the use of endoscopic surgery on acoustic neuromas is progressing and that AN patients are benefiting from this type of surgical procedure. Still, I don't regret going the route I took as it worked out just fine. However, I support endoscopic surgery where available and feasible for the patient. I'm waiting to see the long-term results, of course, but I trust they'll be positive.
Jim
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Hi Jim,
I had an interesting consultation with SBI today. The most interesting part of the consult was about what is resected and what is not. The doctor only takes the superior vestibular nerve and nothing else. This is assuming that only that nerve is involved. As I understand, translab surgery takes eveything in sight from the vestibular, to the cochlear, to an other nerves with the exception of the facial nerve so that motor ops in the face are preserved. In the endoscopic approach, they only take what they need to take to remove the tumor. Of course there is the obvious advantage that this procedure only leaves a dime size hole in the skull as compared to a large chunk of skull with translab. This definitely helps in the faster recovery time. However, the fact that they leave the other nerves seems to say that there "potentially" is the opportunity of these other stretched nerves to regenerate over time and restore themselves. In my case, the hearing is gone and I will be SSD. However, there is the possibility that the trigeminal nerve will restor itself and I will have restoration of feeling in my face. I know that nerves, given time, will regenerate. I was in a bad biking accident a few years back and lost nerve feeling in my left hip. It took between 2-6 months, but I eventually regained feeling in the area of my left hip. So I know that its' possible.
I think this is an important difference to note between translab and endoscopic in my opinion.
Steve
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Thanks to Boomer for starting this thread and to all others who contributed. I think if I ever need surgery in the future for an AN, I will strongly consider the endoscopic approach and SBI. My AN appears to be responding very well to CK, but who knows what will happen down the road. I also have a suspected second tumor to deal with, although that's also a candidate for CK.
From what I've read online, it seems the main objection -- whether valid or not -- to endoscopic approach is increased risk of runaway bleeding. I'd like to see data on what percentage of patients undergoing this procedure actually had this problem (i.e., resulting in complications). Then we could better tell if the objections are practical or just theoretical.
In any case, discussions on leading-edge technologies like this are one of the best aspects of this forum. Eventually, I hope, AN treatments will become so refined that none of us will have to go through the post-operative side effects so many of us have reported here.
Best,
TW
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Boomer,
Congratulations on your successful surgery. I stil have not decided what route I am taking with my 1.5cm AN, so I greatly appreciate your providing any and all followup on this option. I wish you continued good health.
Tumbleweed,
What is runaway bleeding? What are the complications? Thanks for any information.
Take care,
Darlene
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Hi, Darlene:
The folks on this forum who have had endoscopic surgery can no doubt better answer your questions, but what I've read is that there is a chance that an artery can be nicked during surgery. Since the opening to the skull is so small, the reasoning goes, it may be difficult to control the resulting hemorrhaging before the patient suffers irreversible brain damage or death.
Again, I wonder how many documented cases there have been of this type of complication during endoscopic surgery. It's such a new procedure that, the last time I looked (over a year ago), there was no hard data on this -- just rumors and innuendo.
Best,
TW
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Boomer,
I know its late coming but had to send you congrats on being a postie! :) Well done!
Phyl
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Tumbleweed,
YIKES!! That is a very scary prospect, definetly deserves further investigation. Thank you for the information now I know another aspect that needs to be looked at before making a choice. It continually amazes me how much information this forum provides.
Take care,
Darlene
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Just an FYI - but Dr. Shahinian says that he has done over 3000 endoscopic surgeries with no fatalities - a few hundred of these have been for AN.
I guess there is a risk to something going wrong in ANY surgery, though...
In any case, it seems like the risk of this is low enough, for me, to consider the playing field equal to traditional microsurgery, but again thats just me!
Also, I believe that the instruments used in endoscopic have some ability to control bleeding, but I don't know the details on that so I'd have to check into it further. Anyone know anything abut this?
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I did a little poking around on the Internet on endoscopic surgery. This link gives a nice overview of the whole subject (not its use for ANs):
http://www.webmd.com/a-to-z-guides/features/understanding-endoscopic-surgery
I agree with Laura (allegro17) that modern surgical technique uses cauterization to control bleeding as they cut, and that nicking an artery is not likely to be the main problem. But the above article has this comment, which probably explains more about the reluctance to adopt:
There is a very real risk that surgeons will feel the pressure - both from patients and from hospitals -- to use cutting-edge but unproven techniques before they are ready... Schwartz says that this is precisely what happened in the 1980s, when minimally invasive surgery was first used for operations like gallbladder removal. Patients demanded the new technique, and some surgeons started performing endoscopic surgery after taking a short crash course. "It was a disaster," Schwartz tells WebMD. "Suddenly, you had people dying and suffering horrendous complications from gallbladder removals, an operation that had almost no risk with traditional techniques. It was a terrible beginning for this technology."
Some leading medical centers are now using endoscopic surgery for neurosurgery, including hydrocephalus, so I think it will become more accepted as time goes on. When more surgeons get enough training in it, it should become more readily available for AN patients as well. Meanwhile, SBI or UPMC would seem to be the places to go.
Steve
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I had my gallbladder removed endoscopically 4 years ago. It was a breeze. Hopefully in the next decade endoscopic surgery will be the norm for AN.
Boomer, congrats and just think you are a pioneer in the brave new world of AN.
Oh by the way, my Mom was a pioneer in 1963. She was the first in our city to have open heart valve replacement surgery. Back than they did not have the meds to cool the body down, she was placed in a tub of ice before she was put out.
The amazing, wonderful world of medicine!
Anne Marie
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Some leading medical centers are now using endoscopic surgery for neurosurgery, including hydrocephalus, so I think it will become more accepted as time goes on. When more surgeons get enough training in it, it should become more readily available for AN patients as well. Meanwhile, SBI or UPMC would seem to be the places to go.
Steve
I wasn't aware that UPMC also did endoscopic surgery on ANs! It's good to know there is more than one choice of where to get this procedure done.
I've always been a bit confused as to what the difference between endoscopic and arthroscopic surgery is. Does anyone know? They sound very similar.
Thanks,
TW
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Great news!
I researched the SBI (they also show a video of the surgery on their site) and asked my neurosurgeon about endoscopic surgery. He did not have experience in endoscopic although he did have plently of experience in skull base surgeries. He was not an advocate of endoscopic surgery .... "too blind of an approach" were his words.
I wonder what the success rate is in larger tumours? Is it possible to have it after Retrosigmond for regrowth? Hmmmmmmm ... always collecting more research ...just in case.
Michelle ;D
Thanks for the post.
Steve wonder what the approach is if the tumour is stuck on the facial nerve? I would assume just as in any surgery that facial paralysis is a concern?
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Hi Jim,
I had an interesting consultation with SBI today. The most interesting part of the consult was about what is resected and what is not. The doctor only takes the superior vestibular nerve and nothing else. This is assuming that only that nerve is involved. As I understand, translab surgery takes everything in sight from the vestibular, to the cochlear, to an other nerves with the exception of the facial nerve so that motor ops in the face are preserved. In the endoscopic approach, they only take what they need to take to remove the tumor. Of course there is the obvious advantage that this procedure only leaves a dime size hole in the skull as compared to a large chunk of skull with translab. This definitely helps in the faster recovery time. However, the fact that they leave the other nerves seems to say that there "potentially" is the opportunity of these other stretched nerves to regenerate over time and restore themselves. In my case, the hearing is gone and I will be SSD. However, there is the possibility that the trigeminal nerve will restore itself and I will have restoration of feeling in my face. I know that nerves, given time, will regenerate. I was in a bad biking accident a few years back and lost nerve feeling in my left hip. It took between 2-6 months, but I eventually regained feeling in the area of my left hip. So I know that its' possible.
I think this is an important difference to note between translab and endoscopic in my opinion.
Steve ~
Sorry, I overlooked your post last week but just found it and wanted to respond.
As you know, I support endoscopic surgery. I think you raise some valid points here and I hope the assumptions you're making regarding nerve regeneration prove to be accurate in your case.
At time I was diagnosed and my 'conventional' (retrosigmoid approach) surgery scheduled, I asked my very experienced neurosurgeon (a man in his late 60's) about endoscopic surgery for acoustic neuromas. Surprisingly, he seemed to be almost totally uninformed about the procedure. He did make inquiries with other neurosurgeons in his group practice but they apparently just gave him blank stares. He said that an endoscopic procedure on an acoustic neuroma would be problematic because the surgeon wouldn't be able to see the tumor. He also mentioned, as a peripheral issue, that controlling any significant blood loss would be difficult. That was almost 3 years ago. Things have changed and endoscopic surgery for ANs is obviously becoming better known and accepted. The premise certainly seems sound and, as I've stated, were I diagnosed today, I would have to seriously consider endoscopic AN removal surgery. However, because my surgery went well and I've successfully recovered, I don't feel as if I missed something by not seeking and choosing endoscopic surgery. Still, I certainly hope your endoscopic surgery goes well and you have a swift and complete recovery. I'm sure many of us will be thinking of you on March 18th and sending up prayers on your behalf. :)
Jim
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Boomer
Congrats on the sucess of your surgery. I would love to learn more about "Endoscopic" surgery. I do not think that my Dr. is familiar with this. Could you tell me where I could find out more info?
LisaP ;D
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Hi everybody.
As you can see not to many people are aware of the of the endoscope procedure. I received a lot of my info. from checking out: http://www.skullbaseinstitute.com/
watch the video of traditional verses endoscopic and about the Acoustic Neuroma section in particular. Then I also visited with prior people who have already had this procedure done.
In visiting with Dr Shahinian on the phone one of the main questions I had was the possibility of bleeding. He did stress as he cuts he also cauterizes which makes the bleeding almost a non issue, and of which I had no problem. Mine did have to be dissected off a portion of the facial nerve I don't know how and then followed into its intracanalicular portion with no problems. I am 2 weeks post op and I think vs. the translab procedure I'm doing great. At first I did have a little double vision but it is pretty much gone then 4 days ago I started having a little dry eye problem and the right eye not closing all the way. I feel this is getting better daily. I went back to work for a few hours on Thursday & Friday last week. with no problem just the eye thing. All in all I have no regrets on the decision I made. I will definitely let you all know If I do start having any goofy problems that might be of interest to any of you considering this procedure. And, I want to thank you all for the help in my decision making.
Boomer
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Folks:
Rather than speculate, why not just go look at the research on the SBI site. The main study was of about 111 AN patients, with all different sized tumors, etc, and the outcomes of their surgery over about a year and a half. Dr. Shahinian has been doing these surgeries for more than 10 years. It's not really new. A lot of brain surgeries are done endoscopically assisted, but he does them just endocopically. Check out Dr. S's background, training and experience. He has developed some of the tools for this surgery.
AND, one of the best parts is that you can see the whole tumor (unlike retro-sig) because with the endoscope he can look around corners. It's pretty cool stuff.
Steph
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Hi everyone;
I had my surgery 16 months ago at SKULL BASE INSTITUTE with Dr. Shahinian and I feel fortunate to have done it there. I had no complications and because the procedure is less invasive, I was able to go back to work in 3 weeks. I had an MRI 8 months after and it showed that my tumor was resected completely.
Gloria
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I had no complications and because the procedure is less invasive, I was able to go back to work in 3 weeks. I had an MRI 8 months after and it showed that my tumor was resected completely.
Gloria
I'll back that up. I returned to work exactly one month after date of surgery. It could have been a week sooner, but I work in an extremely remote environment with little more than a nicely equipped first aid station, so it was better to be safe than sorry.
No complications, no regrowth, minimal scarring and no regrets.
However, insurance companies and their billing departments can kiss my rear.
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However, insurance companies and their billing departments can kiss my rear.
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Chopper, that's the first good laugh I've had in awhile! I enjoyed going back and reading your thread about endoscopic treatment. It is great to have this forum and to search on these topics. Your story is just as important now as it was back then, especially for me. I'm 52, but I'm more active and in better shape than most 35 year olds. So I'm hoping to get back to the running, biking, and off shore fishing when this is all over. I have too many years and too much fun with my three kids to look forward too. Thanks for putting your story up on the forum!
Steve
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You'll be back on track with life sooner than you know when it's done. It is seriously amazing how fast the recovery is. Even the amount of time it takes for your body to adapt and fine tune itself again is amazing.