ANA Discussion Forum
Treatment Options => Microsurgical Options => Topic started by: Tobeycat1134 on February 17, 2017, 02:44:36 pm
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I have decided that I will do my surgery with Dr. Schwartz at House. However, I have not decided who I want to do the surgery with him. I know that both Dr. Brackmann and Dr. Slattery are excellent, however I would like opinions on who is the best with the facial nerve? Thanks in advance for your advise.
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I'm not sure, but I think that whoever does the surgery with Dr. Schwartz is usually another kind of specialist, a neurotologist. He will be responsible for opening up the hole in your head; Dr. Schwarz then moves in to remove the tumor. That is a highly simplistic description, but you get the general idea. Usually Dr. Schwartz works with Dr. Wilkinson or Dr. Slattery. I could be wrong, of course, but they'll tell you.
Dr. Wilkinson did my head-hole, and it was a lovely job. Of course, my hair covers it, so you wouldn't know. I just tell everyone it's lovely.
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My two cents on the "facial nerve damage". Being an avid reader on this site I don't recall an instance where the facial nerve was cut due to improper identification during the early phases of the surgery. Especially at the high volume centers, they are all extensively skilled at identifying and not mistakenly cutting the facial nerve. Before my surgery I read the internet for the horror stories with accidentally cutting the facial nerve. This is a minimal risk at the major AN center's. Normally the ENT opens the skull, identifies the facial and hearing nerves, cleans out the auditory canal, and closes the skull. The neurosurgeon will then work on the larger part of the tumor in the brain. Both the ENT and neurosurgeon will monitor the facial nerve
This does not mean facial paralysis is not a major risk of this surgery. As I understand there are several common reasons for facial paralysis:
1. Nerve may be functioning before the surgery but is so damaged that the stress of the surgery either permanently or temporarily causes facial paralysis.
2. As the surgeon removes the tumor, it slowly tugs on the tumor which causes stress on the nerves. The closer the surgeon gets to the nerve, the more potential stress on the nerves. The surgeons tries to minimize this impact and use many considerations for determining the proximity to the nerve. A nerve that has sufficient damage prior to the start of surgery, the surgeon may prefer NOT to remove the tumor near the nerve, however other factors such as the vascularity of the tumor may dictate the approach.
3. The surgeon may purposely remove the facial nerve. For example, in my case, my tumor was 4 5 cm, and the facial nerve was heavily damaged prior to surgery, and due to the vascularity of the tumor, it was decided, during the 17.5 hour surgery, to remove the facial nerve, due to the vascularity of my tumor.. NOT all tumors are the same and the vascularity and stickiness of the tumor may dictate different approaches.
For me, I picked the neurosurgeon and trusted his judgment on the ENT. I sincerely wish you all the best. The reason for selecting one of the high volume centers is so they have experience with all the factors that are NOT obvious from the internet. You have clearly selected one of the best, so you are in great hands. Best wishes, and these doctors are truly amazing..
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I had Dr. Schwartz and Dr. Slattery for 11 hour surgery on 4.7 cm cystic AN. There is also electrical monitoring of facial nerve done by a neurophysiologist. They have order sets and protocols, and almost no room for error left. If the nerve is compromised electrically they will stop before it is injured. Dr. Schwartz will remove as much tumor as possible, and the team will have discussion on when to stop. I woke up after surgery and my face and the eye were better than before surgery instantly.
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Thank you!
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All excellent advice here! I just wanted to pipe in as I am a Dr. Brackmann/Schwarz patient from over 7 years ago. Brackmann is the Neurotologist and Schwarz is the Neurosurgeon, so basically the Neurosurgeon opens the head up and gets to the IAC and then the neurotologist gets the AN out as they know all the inner workings of the balance / hearing / facial nerves. Like everyone said, there's a host of teams that help with monitoring and will all guide the procedure as things develop. As we always say, no two cases are alike and it sounds like you are doing your homework. It basically comes down to what your gut tells you, if it feels good then go with that and don't look back. Good luck with whatever you do decide!
Jay
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I had Lekovic (neurologist) and Luxford (neurotologist) in July of 2016. Fabulous beyond words. Oddly you only read about Slattery and Schwartz on here but I just thought I'd chime in that I really appreciated Luxford. I also know that the neurologist usually says who he's going to work with. I'm sure you could oppose but they are all so experienced. I've never read a bad thing about a Dr at House.