ANA Discussion Forum

Useful Information => Physicians => Topic started by: neuroma_racer on January 20, 2010, 02:18:25 am

Title: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: neuroma_racer on January 20, 2010, 02:18:25 am
well,
that's the question (see "subject")

trying to gauge how confident i am in given responses.

typically i would expect the more one does (either # cases/year) or(total # cases/career) would generally favor better outcomes.
anticipating experience=improved skill
(barring of course, that one is accruing lots of bad outcomes, along with the volume)

a friend, with whom i visited about HIS AN experience, related the following:
"Jesse, I [he] spoke to Dr. ___, near the coast, and he (otologist) said that he [otologist] does like 20/year, but out at house, they do like 200/year"
said friend went to HEI, and had a wonderful outcome.

admittedly, that conversation between that otologist, and my friend occurred four to five years ago.
also, that number of "200" must represent HEI as a total, not any one physician, (otherwise one guy is doing a new AN . . . 4 days a week).

I met with an otologist the other day, whose numbers were much lower than either of those numbers.
not sure how confident i should or shouldn't be, based on that.

thoughts?
jesse
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: leapyrtwins on January 20, 2010, 06:50:00 am
Jesse -

the ANA recommends seeking treatment with a medical professional who has lots of "experience" in treating ANs.  They actually have a number of cases per year you should look for, but I don't recall what that number is.  I'm sure if you contacted the ANA they would tell you.

To this day I have no idea how many ANs my neurotologist has removed surgically - or how many he's zapped with GK - but my outcome was excellent.  At the time of my surgery, almost 3 years ago, he had been removing ANs for 18 years.  He also teaches at a well-known medical school and he came highly recommended by my ENT - a doc I've known for over 30 years.  I was comfortable with him and confident of his skills and never asked for a number.

It stands to reason that the docs @ HEI would have a huge number of cases each year, since patients flock there from all over the country - and even outside the country.  Others docs, including mine I'd imagine, don't have the opportunity to do as many surgeries since ANs are relatively rare.

That said, while others will disagree with me, IMO you should go with a doctor whose number of surgical procedures you are comfortable with. 

Jan
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: lori67 on January 20, 2010, 07:49:49 am
Jesse,

I think the "magic number" I remember reading somewhere was something like 50 a year.  Sounds reasonable to me.

I honestly don't remember the number my surgeon had done.  He was only 38 years old when he did my surgery so I'm sure he didn't have numbers like they report at certain coastal facilities, but his credentials were impressive, he was up to date on the latest techniques and was as qualified as anyone else to do the surgery in my opinion.  Quantity does not necessarily mean quality.  By the way, the only negative I've had to deal with is some facial paralysis, but since I had facial nerve issues going into the surgery, I wasn't surprised by this outcome.  I certainly don't fault the doctor for that - sometimes these things just happen, even to the best and most experienced doctors out there.

I think the key is to find a doctor YOU are comfortable with - the numbers are a good guideline but should not be the only factor in making your choice.

Lori
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: Cheryl R on January 20, 2010, 08:30:44 am
Part of ones outcome depends on tumor location and what it has already done to the nerves.      Size matters too but if one has nerve damage already then  even a very experienced surgeon can't make it better.        Time to heal in lots of cases but some don't.             Even House has pts with problems.   
     Univ of Iowa does 60 a year and I have heard more than Mayo but not sure if that is right.   
                                                                Cheryl R
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: Brendalu on January 20, 2010, 11:17:25 am
I wish I had know about this forum long before I had my surgery!  I know I am repeating myself.  For my ENT, he does about six a year.  My neurosurgeon had only done a few.  The neurosurgeon had done a lot of other tumor removals, so I felt confident with them both.  I didn't know at the time that anyone did as many as have been posted!!  I am permanently disabled, but not all of it is due to the AN, I also have MS and have had two strokes
I really think the reason I had very little nerve damage is because I was hooked up to a computer and LeRoy was monitoring the entire surgery.  Thank you, LeRoy!

Brenda
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: Nickittynic on January 20, 2010, 11:19:55 am
I think my surgeon quoted "over 400" total.
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: Debbi on January 20, 2010, 11:58:50 am
I definitely subscribe to the "more is better" philosophy here.  One surgeon I met with said he did 15 to 20 a year - I crossed him off my list and went with the surgeon who does 1-2 a week.  That said, you really have to feel comfortable with your surgical team, no matter what criteria you use.

Debbi
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: Jim Scott on January 20, 2010, 04:46:22 pm
Jesse ~

This is a very relevant question and certainly one that should be at or near the top of the list when you have a consultation with a doctor you're considering to operate on your AN. 

The first neurosurgeon I consulted hesitantly admitted, after much prodding, that "he thought" he had performed "about 60".   I thanked him for his time and headed for the door.  Fortunately, my wife's doctor, a neurosurgeon that had recently performed extensive surgeries on her spine (but didn't perform AN resections) recommended a doctor in his practice.  This neurosurgeon, Dr. Issac Goodrich, had been performing AN removal surgery (along with spinal and other neurosurgery) for close to 30 years.   He was an instructor at nearby Yale Medical School and was a graduate of the same institution.  When I asked him how many AN surgeries he had performed, he laughed and said "thousands".  The nurses at the hospital where I had my MRI praised this surgeon and said that I was lucky to secure his services.  My surgery went as good as it could possibly go, with practically no complications and a rapid recovery.  He teamed with a brilliant young radiation oncologist (Dr. Johnathan Haas) to 'map' my FSR treatments, using a 'fresh' (post-op) CT and MRI scan.  The FSR went smoothly and the result was a much smaller AN showing necrosis and signs of shrinkage within 2 years.  My symptoms disappeared following the surgery and my balance has improved, although I'm still SSD, which was expected, even though I underwent Retrosigmoid Approach surgery.   

My take-away from my AN experience is to seek and engage a doctor with as much AN removal experience as possible.  I was fully prepared to travel across the country (I live in Connecticut) to HEI, if necessary.  Fortunately, I didn't have to.  As we often mention on these forums, there are excellent surgeons with AN removal experience all over the country.  One just has to be proactive in searching for one in your area.  With your medical background, I would assume that might be a bit easier for you than others.  In any case, I wish you complete success in your quest.

Jim
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: DHJ on January 20, 2010, 06:02:17 pm
Hi Jesse    Find a surgeon with lots of AN experience. My Doc.performs  1 or 2 AN surgeries per week and quotes a very high success rate. He also comes highly recommended by patients. I am comfortable with his advice but I am still researching radiation. Keep searching for a surgeon with lots of AN experience.  Good Luck Dave
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: Lilan on January 20, 2010, 07:11:00 pm
Teasing ahead, with love:

Now Jim, you always sound so humble when talk about the very fine surgeon in your own backyard -- I always pictured some little country doctor like on "Murder, She Wrote" ---- who just happened to do a great job for you ---

He was an instructor at nearby Yale Medical School and was a graduate of the same institution.


Now this is some backyard!  :D :D :D






Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: rupert on January 20, 2010, 08:10:13 pm

    I think that experience is a major consideration for AN treatment.  I don't necessarily feel that the Doc who has done more than another is going to have better results.    There are a lot of factors as to how many a particular Doc does.   I think years of experience along with numbers would be a combination to look at.  Just remember that the object is to remove the tumor as best one can.  experience counts!    Also remember that this type of treatment is usually done by a team of doctors.  Usually at least two.  Maybe one has 30 years of experience and the other only a couple.  You need to look at  how long your team has worked together  and get a feel for their comfort level working side by side .     Bryan
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: leapyrtwins on January 20, 2010, 09:16:35 pm
Also remember that this type of treatment is usually done by a team of doctors.  Usually at least two.  Maybe one has 30 years of experience and the other only a couple.  You need to look at  how long your team has worked together  and get a feel for their comfort level working side by side .

This is an excellent point by Bryan and one I forgot to mention myself.

Doctors do generally work in teams and the teamwork is very important.  My doc and his partner (another neurotologist) only do AN surgeries with one neurosurgeon and only do GK with one radiation oncologist; this was a big factor in my decision.

Jan
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: Wwoodian on January 21, 2010, 01:29:55 am
I just had surgery done with House in November.  I had Dr. Friedman and Dr.Schwartz perform a middle fossa surgery.  I was told that they do about 200 a year at House Clinic.  There are a number of Doctors there, but Dr. Schwartz is the main Neurosurgeon.  If HEI is an option for you--they are very, very experienced and that Office is so efficient and organized.  They are definite professionals and the hospital that they use has a wing that is specifically for AN patients so the nurses, staff etc. are very familiar with the process. I have had some bad side-effects with my vision, but my hearing and facial muscles were preserved.  Waiting for the vision to improve.
Good luck with your decision!
Title: Dr. Seidman/Dr.Rock H. Ford Hosp, MI
Post by: sues1953 on January 21, 2010, 02:51:05 pm
HI 

I sent my films to House and should be hearing soon.  I want to get another local opinion.  Has anyone heard of these Dr.s out of Henry Ford Hospital in Michigan?

Thanks,  Susan
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: TP on January 21, 2010, 03:23:42 pm
When I hear numbers from Dr's quoted I go to my calculator and plug in these #'s. 52 weeks a year, which means they probably work 48 weeks (at least 4 weeks vacation) then a few weeks attending meetings, conventions, educational stuff which leaves about 46 weeks of work and within those 46 weeks there are some legal holidays which cuts the work week down so let's say that when a dr says he/she does 400 a year that would mean they would do two AN's a day? My AN surgery lasted 9 hours and my Dr actually visited me several times before and after my surgery, I don't think he could squeeze in another AN surgery. For some reason that just does not add up on my calculator the number of AN's performed by a DR in a given year. I find it hard to believe they can do an AN surgery every day of the week and still meet with patients prior to surgery and even do other types of surgeries. I don't know maybe the Dr's who do 400 a year don't take vacation, go home to spend time with their families, attend educational seminars or every get sick...just a thought. They make a lot of money it appears but no time to play any golf....
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: Lilan on January 21, 2010, 06:54:02 pm
I don't believe anyone has quoted a doctor saying they've done 400 a year!

House does 200 a year as an institution. Each surgery counts twice, if you want to look at it that way, experience-wise -- it adds "one" to each of two doctors who participates.

The doctors who have done 1,000 or more, have done so over, what, say 40 years? -- so that's 25 a year! Very doable.

ETA: The poster who said 400 said "400 total," not in one year.
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: TP on January 22, 2010, 06:47:06 am
I still go back to my calculator and 200 a year like many have quoted is an awful lot of AN surgeries. Hard to believe they have time to see patients during the week and  perform that many AN surgeries which are not "in and out" type surgeries. I know my Dr only performs surgeries specifics days of the week and he needs the other days of the week to see patients. This is not to argue with anyone only to suggest to folks who are considering what Dr to choose to look at the big picture and when your Dr tells you a # that large, it may need to follow up with another question, how can you perform that many surgeries and still treat all your patients? Just something to consider.....
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: leapyrtwins on January 22, 2010, 06:52:07 am
I totally agree with TP.

Only seems logical.

Jan
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: Lilan on January 22, 2010, 07:31:29 am
It is logical -- but not relevant since no one on here has said that any one doctor has done either 200 or 400 per year.

People have said institutions comprising a handful of doctors have done that many; and one poster said that her doctor had done 400 total over his career.
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: leapyrtwins on January 22, 2010, 08:03:32 am
If memory serves me - and it usually does - I remember the post TP is talking about.  I haven't been able to locate it on the Forum, but I'm hopeful I will.

I think the person who originally wrote it was confused and later clarified the post.

Any other "old-timers" remember the post I'm referring to?

Jan
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: lori67 on January 22, 2010, 08:09:41 am
Lilan,

There have been posts, maybe not on this thread, that suggest that large number of surgeries per doctor.  That may not be what was meant by the poster of the post, but I think that's how it may be construed and I think some doctors may give a false impression that it is actually possible for one doctor to perform that many of these type of surgeries in a year.  Patients interviewing doctors need to know to not just focus on the numbers, but there are many other factors to consider in making a choice of brain surgeons.

I completely agree with TP's line of reasoning.  Not only would doing only one AN surgery a day not leave any time for patient follow up or new patient appointments, but  even the absolute best doctor on the planet would suffer from fatigue and burn-out before lasting 40 years at that pace.  I've never done brain surgery myself, but I'm going to assume it's a bit mentally challenging to do it correctly.  Personally, I'd rather not have a doctor who is daydreaming about when he can get home to get some sleep, or planning for the surgery he has to do in an hour while he's got his hands inside my skull.  There's something to be said for recognizing and respecting your human limitations.  I like to think my surgery was more of a marathon than a 50 yard dash for my doctor.

So, I think it is relevant - people need to know the context in which these numbers are used.  If a doctor or facility doesn't specify if the numbers are for one or many doctors or for a long span of time, patients might make a decision based on their own interpretation of the statistics and that may not be accurate.  If I said I have done a million loads of laundry and you thought I did them all this week, you might be very impressed by that or you might think I didn't do a very careful job and everything is a wrinkled mess.  But if I said that number was over the last 25 years, that wouldn't seem to be so unreasonable and you probably wouldn't think my family is walking around looking like an unmade bed.

Lori
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: Kaybo on January 22, 2010, 08:37:27 am
You mean your kids aren't supposed to look like an unmade bed?    :o

K   ;D

*sorry for highjack - just a little levity!*
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: leapyrtwins on January 22, 2010, 08:37:57 am
Here is the post I was thinking of (by Ladida on page 4) http://anausa.org/forum/index.php?topic=10466.0

She clarifies her statement on page 5, I believe.

I'm old - but I'm not THAT old  ;)  ;D

Very well written post, Lori.  I think you explained exactly what TP and I were trying to say - and you said it much more clearly that I ever could.

Thanks for the "assist" (isn't that a hockey term or something?)

Jan
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: ppearl214 on January 22, 2010, 11:24:11 am
*sorry for highjack - just a little levity!*

forgiven :-* .... and watching this thread's discussion direction. Phyl
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: TP on January 22, 2010, 12:55:06 pm
Thank you Lori and Jan. I appreciate you understanding where I am coming from.
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: leapyrtwins on January 22, 2010, 02:34:53 pm
No problem, TP.

It's what we're here for  ;D

Jan
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: lori67 on January 22, 2010, 05:32:47 pm
You're welcome, TP.

I just don't want people to get the impression that if they were not treated at a specific facility then they did not receive adequate care.  As has been said before, the decision is a very personal one and what might be the right choice for one might not be the right choice for everyone.  I don't want anyone to feel that their choice was wrong or that their surgeon was incompetent just because it doesn't happen to be someone else's choice.  People shouldn't have to second guess their choice - that just adds more stress to what is already a stressful situation.

I'm happy with my choice and frankly, I wouldn't care if someone said horrible things about my surgeon or the hospital I chose, whatever.  But some people are bothered by what they see as criticism of their choices and I don't like to see people upset.  I know my surgeon was not the most experienced surgeon out there - heck, he was only 38 years old and alive for less time than some doctors have been operating, but the experience he did have and his credentials were enough to convince me that he was the man for the job.   

Bottom line: look at all sides - ask for numbers, ask for outcomes, ask for references, go on-line and check out credentials and schooling, go with your gut.  Trust yourself to make the right decision for YOU!  After all, you're the only one who should be making decisions regarding your own head.  Input from others who have been there, done that is great, but it should not be the only thing you consider in making your decision.

Lori, stepping down from my soapbox now...
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: leapyrtwins on January 22, 2010, 08:25:30 pm
I'm sure it will come as no shock to anyone, that I agree 100% with Lori - however, that's not just because we are friends (and partners in crime).

Since the day I joined the Forum I have made it one of my missions to reiterate all the points she just made - although not so eloquently - because I believe in them completely.

IMO, everything she said is true. 

Jan, stepping down right behind Lori

Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: lori67 on January 22, 2010, 09:22:02 pm
Don't worry, Jan.  I'm not friends with you anymore because you called me old!   :P
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: leapyrtwins on January 22, 2010, 09:25:01 pm
Et tu Brute?   ;D

Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: ppearl214 on January 22, 2010, 09:25:43 pm
Et tu Brute?   ;D



*ahem* back on topic folks. :)
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: leapyrtwins on January 22, 2010, 09:28:54 pm
Sorry.  We're trying.  Rough week on the Forum.  I may be abdicating soon.  The people on the Cochlear Community are very nice  :)

Last hijack from me, Phyl.

I can't speak for Lori, though.
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: ppearl214 on January 22, 2010, 09:33:25 pm
Sorry.  We're trying.  Rough week on the Forum.  I may be abdicating soon.  The people on the Cochlear Community are very nice  :)

Last hijack from me, Phyl.

I can't speak for Lori, though.

I have a cold, I'm cranky, no more hijacks and glad to hear about the Cochlear Community. I'm still a good person! ;)

So, this topic is done, right? 

Phyl
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: leapyrtwins on January 22, 2010, 09:35:22 pm
Yes and YOU are a good person.  No debating that one  ;)

Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: 4cm in Pacific Northwest on January 22, 2010, 09:56:26 pm
Well wishes for the GOOD person with the cold... and pearly whites. :-*

DHM

Was that just a hi-jack?  ;) :D
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: neuroma_racer on January 24, 2010, 07:04:46 am
wow,
hadn't checked back in on this thread in a few days,
WHAT A FLURRY!!
thanks for the notes

1st otologist said he did 4-6/year
2nd said 50/year for himself, and 20 for his partner.
i am going to raleigh.

Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: opp2 on January 24, 2010, 11:46:46 am
I meant to chime in on this before Jesse. 'My' surgeons (I haven't had the surgery yet) quoted usually one per week, sometimes two if there is an emergency. I would liken that, including annual leave, holidays etc thrown in there, that each does probably 45 a year. And I believe that Dr. Akagami does other neurosurgeries as well so this may be also slightly high. Realistically I think this is pretty experienced as far as VS surgery goes.
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: 20acrewoods on January 25, 2010, 08:56:26 am
My husband & I just met w/ Dr. Link & Dr. Driscoll (sp?) at the Mayo Clinic in Rochester MN on 1/19/10.   Dr. Link stated that they do 50 AN surgeries per year on average, along w/ other surgeries for cancer, etc.. 

The 2.5 cm tumor growing in my husband's head will be removed 2/1/2010.  Please keep our family in your prayers, especially my husband.

(Hey Jim, we have a pretty nice backyard here in MN w/ the Mayo Clinic 3 hours away.  Maybe not Yale, but pretty darn nice.  ;)
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: lori67 on January 25, 2010, 01:10:20 pm
Hi and welcome  "20"!

All you need to do is ask around here and you'll be getting prayers sent your way from all over the place!  We've gotcha covered!   :D  Keep us posted on your husband!

Racer,

Mind if I ask who you're seeing in Raleigh?  I'll be going down there for my 3 year follow up next month (wow, is it really coming up on 3 years????).  Just curious.

Lori
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: neuroma_racer on January 26, 2010, 05:45:56 am
Racer,

Mind if I ask who you're seeing in Raleigh?  I'll be going down there for my 3 year follow up next month (wow, is it really coming up on 3 years????).  Just curious.

Lori

Dr John McElveen, of Carolina Ear. (he trained at House Ear Institute)
he has a partner, Dr Calhoun Cunningham, (who ALSO did his fellowship at HEI).

they will (interestingly) do the craniotomy (1st part of the surgery), all the way to dissecting the facial nerve off of the tumor.

at that point, he has a neurosurgeon (whose name i forgot) remove the tumor,
Dr Hitselberger, (from HEI) will be guesting, in March, and assisting with the neurosurgical part of the procedure.

Dr McElveen says he does about 50 ANs / year
~25 of those are trans lab,
~15 are posterior fossa
~10 are middle fossa.

he says no more than 5-10% cahnces of facial nerve injury,  :)
he anticipates 40% chance of hearing preservation  :(
- as mine seems to be located on the INFERIOR branch of the vestibular nerve. based on my VNG results.


I am OFF te schedule for March, at work completely.
just anxious to find out WHEN in march it will be.

sister coming down from NY to keep the rugrats
kennel the dog,

and while this isnt exactly how i would have planned on a week away with my wife . . .
she'll be there.

still feeling weirdly melancholic about it all,
glad 95% of the decision making is over with.
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: lori67 on January 26, 2010, 08:07:50 am
Sounds like you've got all your ducks in a row - except for the actual date.

It is a relief to finally be able to make a decision - that's the hard part.

I think maybe next year you should take your wife to a more exotic location!   :D

Lori
Title: Re: what kind of numbers (of AN cases) did your surgeon's report they do
Post by: Kaybo on January 26, 2010, 08:10:50 am
Glad you are getting things in place - I know that makes you feel better.  Sounds like you are going to have some great EXPERIENCED Dr.'s working on you!

Oh yeah...glad your wife will be with you too!   ;)

K   ;D