ANA Discussion Forum
Pre-Treatment Options => Pre-Treatment Options => Topic started by: Windsong on July 08, 2007, 01:42:55 pm
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I thought I'd send this in as it is quite comprehensive with info about Ans (and has some mri examples at the end of small Ans and bilateral ones along with diagrams indicating where the bone is removed for the different surgical options). It covers other treatment options also. And mentions facial neuromas. It was written by Dr. Peter Roland in Texas. ( he is co -author of a book on ototoxicity which my neuro ent wrote with him).
http://www.emedicine.com/ent/topic239.htm
cheers,
windsong
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I'm sorry, but this article is not a balanced presentation of facts. When it says that "Surgical removal remains the treatment of choice for tumor eradication," this is an artful choice of words. By using the word "eradication" instead of "treatment," it is able to give the impression that doctors generally agree that surgery is "the treatment of choice" over radiation without actually lying. There is no consensus on this point, and these doctors should not try to mislead people to believe otherwise.
Are any of the following claims (listed under "Disadvantages of radiosurgery") true?
# has higher recurrence rates, sometimes requiring salvage surgery
What is the statistical basis of this claim? It is not consistent with anything I've seen in the primary medical literature
# Higher incidence of trigeminal nerve injury
The rate at Shands Hospital, U. of Florida is 0.7% with a LINAC machine (Journal of Neurosurgery, Nov. 2006). Is the surgical rate lower than that?
# Unknown long-term incidence of secondary malignancies
This is the usual sign that a surgeon is trying to discredit radiosurgery. The rate of malignant transformation caused by radiosurgery is either infinitesimal or nonexistent.
This article is NOT a peer-reviewed publication. It is a commercial for surgery.
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I would have to agree with Macintosh's view of Dr. Roland's "article". It is a very well written piece in terms of general history and information of AN's and does an excellent job of providing very detailed descriptions of surgical outcomes and approaches. However, it loses all credibility with the misinformation about radiosurgery and in the end, becomes an AN surgeon promoting surgery as a solution.
In addition to the points that Macintosh already raised, He was also erroneous in his claim that surgery is the more common treatment. In fact, radiosurgery has been used in over 50% of the AN treatments for the last 3-4 years according to an article in the Journal of neurosurgery I read several months back. Also, I found it interesting that he stated that regrowth after surgery is between 5-10% which is consistent with what I've seen elsewhere, yet, regrowth after radiosurgery continues to be in the 2-3% range. Either way it reinforces why a schedule of follow up MRI's is usually standard practice for either treatment option.
I have never heard of the trigeminal nerve being injured as part of radiosurgery and the occurrence of facial nerve injury is on the order of 1% which is less than the 6.7% he quoted for AN's removed smaller than 1.5 cm . He also neglected to quote any results for AN's larger than that. The irony with his claim on the trigeminal nerve is that the CK is increasingly being used over surgery for those individuals who suffer from the painful condition called trigeminal neuralgia.
So, from my perspective, if you are interested in some good general information on AN's or are looking for some answers on the surgical approaches, it's a pretty good source. In terms of a balanced and definitive discussion of all three options, it borders on the pathetic :o
Mark
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HI Mac,
Stats are always interesting aren't they?
I was impressed with the thoroughness of descriptions regarding the set up nerves within that IAC and how they run through the brain and from and into the brain stem and how they wander off and surprise surgeons in the operating room. It probably explains why some after surgery have the problems they do....( and probably even those who had rads).
I also was interested in the comments about headaches as I remember a couple of years ago when I read posts here, a number who had headaches post surgery but hadn't had much understanding from some docs etc., were really fumbling for answers, some of which were posted here by various Aners (like the one on bone dust for example).
I found this entire write up most interesting on a number of levels.
I did note that radiation did not have a lot of comment, yes, as I myself had radiation and I would choose it again if I had to do it over. In fact my neuro ent referred me for it. I do subsequently have some trigeminal involvement. The thing is that after reading this i am more aware of the intricacies of the nerves and Ans regardless of which treatment protocal is chosen. An An may be benign but the possibilities of problems affecting one is considerable. It is delicate and demanding microsurgery.
One thing I am becoming more aware of is the literature (abstracts) about long term effects of radiation on children for example. More recent publications are pointing out the later effects that are being diagnosed now.... again it's a delicate balancing act.... benefits vs risks.... and very long term effects are only coming out more recently. Lots of research into that.....
I am very pro radiation treatment. At the same time I am aware that the beam delivery protocals have changed, dosage has changed, machines have changed, imaging techniques have changed, all a fine tuning of this type of treatment, but , really, long term stats are not all that available unless you are in the business lol....in any case ten yr studies ( meaning the last ten yrs) do give good stats but depending on which you read (remembering that there is Gk and CK and linac (and variations) and 1 or 2-3 day or 5 day and 5 weeks or more etc. versions of treatment), comparing stats beomes a neat mathematical thing. They vary from 90% 95% 98% etc depending on which result one is looking at.... preusmably halting the growth of the An is the one most Aners are concerned about. But there are other effects that intrude on daily life too.
Another aspect I am personally interested in is the size of Ans and location? Some truly do not have a choice regarding treatment. They need open surgery. And I found this quite informative if anyone wishes to read about the intricacies of the nerves in the brain and how they may play into the various surgical choices... which is another reason why I posted it.
It's a good read about all sorts of things, too numerous to mention paragraph by paragraph.
The best thing is that these doctors keep investigating the entire An scenario. And we all ulitmately benefit.
We've come a long way from the sixties never mind the last hundred years.....
Bottom line may be that Ans need to be found early while radiation is a great choice and no one needs surgery. Then again there are those with NF2 and that's a whole other story.....
be well and take care,
Windsong