ANA Discussion Forum
Treatment Options => Microsurgical Options => Topic started by: heyct on April 17, 2009, 06:06:26 pm
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I just had my consult at Stanford for both surgery & CK. I still haven't decided which route I'll go, but at least I am sure it will be there.
Dr. Jackler said that my balance will be, if it isn't already, completely gone on my AN side. I guess I'm a little confused. I must admit, I have pretty darn good balance ;). I'm not doing any leg extended yoga poses but alot of core balancing & leg work while standing on one foot. I have no vertigo or dizziness. Only a little lightheaded.
I did the basic balance test at the office & passed. I guess there is another more extensive test they can do.
He said I have probably already compensated for the loss of balance.
The nerve is probably already damaged & will eventually die off.
Let me know if I have this right:
There are 3 different nerves that go thru the IAC, facial, hearing & balance.
The balance nerve is about 2 hair widths.
Is it just too delicate to save while they are removing the tumor?
Can they ever save the balance nerve?
Thanks,
Carolyn
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Is it just too delicate to save while they are removing the tumor?
Can they ever save the balance nerve?
I think there are two reasons why they can't and don't. One is that most ANs start on the balance nerve, so it is almost always involved with the tumor. The other is that unlike hearing, where partial function is better than none, balance tends to be an all or nothing thing. If you don't get a good balance signal from the AN side, it is better to get none than to get a scrambled one. The real source of balance issues is the mismatch between the signals from the two sides.
Steve
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Great explanation, Steve.
Just an additional note - as your doctor mentioned you probably already have - the body compensates for a damaged balance nerve.
So, while most AN patients have balance issues post op, generally they go away with time as the body adjusts.
Jan
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Another thing to remember, while most call it an acoustic neuroma, another name is a vestibular schwannoma.
What is a vestibular schwannoma (acoustic neuroma)?
A vestibular schwannoma (also known as acoustic neuroma, acoustic neurinoma, or acoustic neurilemoma) is a benign, usually slow-growing tumor that develops from the balance and hearing nerves supplying the inner ear. The tumor comes from an overproduction of Schwann cells--the cells that normally wrap around nerve fibers like onion skin to help support and insulate nerves. As the vestibular schwannoma grows, it presses against the hearing and balance nerves, usually causing unilateral (one-sided) or asymmetric hearing loss, tinnitus (ringing in the ear), and dizziness/loss of balance. As the tumor grows, it can interfere with the face sensation nerve (the trigeminal nerve), causing facial numbness. Vestibular schwannomas can also press on the facial nerve (for the muscles of the face) causing facial weakness or paralysis on the side of the tumor. If the tumor becomes large, it will eventually press against nearby brain structures (such as the brainstem and the cerebellum), becoming life-threatening.
http://www.nidcd.nih.gov/health/hearing/acoustic_neuroma.asp (http://www.nidcd.nih.gov/health/hearing/acoustic_neuroma.asp)
My initial symptoms were vestibular, I just didn't realize at the time it was tumor causing them.
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Carolyn,
My body had also compensated for my balance loos prior to surgery and I had very little issues afterwards. I have some minor things to deal with but they may have been that way prior and I just may have not realized it.
I think you will find that you will have no additional problems with balance and any you do have will get taken care of with any post-op physical therapy they have you do. I went for about a month but really had no issues with any of their tests other than walking heel to toe.
Rick
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It was the same with me...my balance nerve was killed off before surgery and the ENT said that it was a good thing. My opposite has compensated. I didnt realize that as I was pretty good walking on a log. What really freaked me out is when I tried to walk heel to toe with my eyes closed. Just couldnt do it..There was a good article posted somewhere here about protecting your balance and it gave an excellent view of how the balance system wokrs. I think I have it in my favorites. I hope this works. If not someone will remember the article and can lead you to it.
http://www.hearinglosshelp.com/articles/balancesystem.htm
After surgery my balance was a little off most likely due to the weakness and the wonky head. Wonky head is hard to expliain but you will comprehend once post op. I still walk like a drunk on bad head days or when I'm tired. But the doc said to walk and walk and more walk so the brain can retrain itself.
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Is it just too delicate to save while they are removing the tumor?
Can they ever save the balance nerve?
...unlike hearing, where partial function is better than none, balance tends to be an all or nothing thing. If you don't get a good balance signal from the AN side, it is better to get none than to get a scrambled one. The real source of balance issues is the mismatch between the signals from the two sides.
Steve
Thanks for pointing that out, Steve. I think I'm getting the scrambled signal. It varies from day to day, making balance consistency a challenge for me. You should see the bruises on my legs from running into things!
Molly
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In my case the tumor was medium to large and they suggested it had probably been there for up to 10 years (a guess).
I was not aware of any balance issues pre-surgery (although in hindsight i do recall a few instances of walking my shoulder into the side of the doorframe at the kitchen at work and i guess that was odd enought for me to remember).
I passed well the basic (heel to toe) testing all the docs put me through, but did struggle when eyes were closed. I didn't think much of that though.
I did some more comprehensive balance testing at the ENT's clinic at the hospital (e.g. they put sensors on my head an i had to do a bunch of things, like watch lights, shake my head; also they rushed warm and cold water into both ears). These were meant to test for dizziness, beyond what i could comprehend on my own. I was told that there was some LACK of dizziness on my left (AN) side during the water test. I guess this indicated that there was some loss of function, and I guess the right side was picking up the slack as like i said, i didn't know i had balance issues.
After surgery, the first week (in hospital) was rough, but i barely got out of bed, except to pee and after a few days the PT suggested I get up and do a bit of walking and sitting up in chair. I ditched the walker i rented for home in a day, and managed fine using walls and hand railings and shopping cart at the g.store, but really i didn't feel so much dizzy, just out of sorts (not sure if this is the 'wonky head' to which so many refer, but for me this was temporary and really just a stage i passed through in the early weeks post surgery), which i would expect after that kind of surgery/trauma.
I really did not feel that my balance was compromised by surgery. The only thing i am aware of now is that if i am walking fast and turn my head (to look for bus coming), i misstep a bit. I would say my balance is 95% or better, it is not an issue at all.
I also asked about whether the nerve could be saved in surgery and was told no, pretty much for reasons Steve indicated. I figured their the experts.
good luck!
Trish