Author Topic: what kind of numbers (of AN cases) did your surgeon's report they do  (Read 13704 times)

neuroma_racer

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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
mild hearing loss - 12/'09
left 4x5x7mm, intracannicular schwanomma
MIDDLE FOSSA surgery 4/'10, Dr John McElveen, et.al.
was actually a FACIAL NERVE NEUROMA
hearing worsened 4/'12 - Tumor quadrupled to 9x9x15mm
cyberknife 8/'12
1.5yr MRI shows shrinkage % 85% necrosis
LEFT hearing & tinnitus SUCK

leapyrtwins

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Re: what kind of numbers (of AN cases) did your surgeon's report they do
« Reply #1 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
Retrosig 5/31/07 Drs. Battista & Kazan (Hinsdale, Illinois)
Left AN 3.0 cm (1.5 cm @ diagnosis 6 wks prior) SSD. BAHA implant 3/4/08 (Dr. Battista) Divino 6/4/08  BP100 4/2010 BAHA 5 8/2015

I don't actually "make" trouble..just kind of attract it, fine tune it, and apply it in new and exciting ways

lori67

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Re: what kind of numbers (of AN cases) did your surgeon's report they do
« Reply #2 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
Right 3cm AN diagnosed 1/2007.  Translab resection 2/20/07 by Dr. David Kaylie and Dr. Karl Hampf at Baptist Hospital in Nashville.  R side deafness, facial nerve paralysis.  Tarsorraphy and tear duct cauterization 5/2007.  BAHA implant 11/8/07. 7-12 nerve jump 9/26/08.

Cheryl R

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Re: what kind of numbers (of AN cases) did your surgeon's report they do
« Reply #3 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
Right mid fossa 11-01-01
  left tumor found 5-03,so have NF2
  trans lab for right facial nerve tumor
  with nerve graft 3-23-06
   CSF leak revision surgery 4-07-06
   left mid fossa 4-17-08
   near deaf on left before surgery
   with hearing much improved .
    Univ of Iowa for all care

Brendalu

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Re: what kind of numbers (of AN cases) did your surgeon's report they do
« Reply #4 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
Brenda Oberholtzer
AN surgery 7/28/05
Peyman Pakzaban, NS
Chester Strunk, ENT

Nickittynic

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Re: what kind of numbers (of AN cases) did your surgeon's report they do
« Reply #5 on: January 20, 2010, 11:19:55 am »
I think my surgeon quoted "over 400" total.
25 year old OBGYN nurse, wife, mother of two
5.5cm x 3.1cm left side AN removed via retrosigmoid 9/09 @ Hopkins
SSD, Tinnitus, Chronic Migraines, Facial paralysis (improving!)
Resolved - Left sided weakness, Cognitive issues
Gold weight, upper and lower punctal plugs, tarsorrhaphy

Debbi

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Re: what kind of numbers (of AN cases) did your surgeon's report they do
« Reply #6 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
Debbi - diagnosed March 4, 2008 
2.4 cm Right Side AN
Translab April 30, 2008 at NYU with Drs. Golfinos and Roland
SSD Right ear, Mild synkinesis and facial nerve damage
BAHA "installed" Feb 2011 by Dr. Cosetti @ NYU

http://debsanadventure.blogspot.com

Jim Scott

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Re: what kind of numbers (of AN cases) did your surgeon's report they do
« Reply #7 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
4.5 cm AN diagnosed 5/06.  Retrosigmoid surgery 6/06.  Follow-up FSR completed 10/06.  Tumor shrinkage & necrosis noted on last MRI.  Life is good. 

Life is not the way it's supposed to be. It's the way it is.  The way we cope with it is what makes the difference.

DHJ

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Re: what kind of numbers (of AN cases) did your surgeon's report they do
« Reply #8 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
3yr wait and watch on left sided 2.9cm AN is over surgery 11/4/2011 Mckenna/Barker at MGH one year MRI 11/12/2012 all clear

Lilan

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Re: what kind of numbers (of AN cases) did your surgeon's report they do
« Reply #9 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






Facial nerve hemangioma. Probable dx 7/2008 confirmed 4/2009. Combo middle fossa and translab to remove the blood vessel malformation and snip ruined hearing and balance nerves by Drs. House and Brackmann @ House 6/2009. Doing great!

rupert

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Re: what kind of numbers (of AN cases) did your surgeon's report they do
« Reply #10 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

leapyrtwins

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Re: what kind of numbers (of AN cases) did your surgeon's report they do
« Reply #11 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
Retrosig 5/31/07 Drs. Battista & Kazan (Hinsdale, Illinois)
Left AN 3.0 cm (1.5 cm @ diagnosis 6 wks prior) SSD. BAHA implant 3/4/08 (Dr. Battista) Divino 6/4/08  BP100 4/2010 BAHA 5 8/2015

I don't actually "make" trouble..just kind of attract it, fine tune it, and apply it in new and exciting ways

Wwoodian

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Re: what kind of numbers (of AN cases) did your surgeon's report they do
« Reply #12 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!
Diagnosed with 1 cm AN on 10-28-09
Middle Fossa surgery on left side 11-20-09
Dr. Friedman and Dr. Schwartz at House Clinic in LA.
No hearing loss or facial nerve problems
Severe double vision and bouncy vision
Yahoo!  Double Vision gone after 3 months!
Did a full marathon 1 1/2 yrs after surgery!

sues1953

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Dr. Seidman/Dr.Rock H. Ford Hosp, MI
« Reply #13 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
3.2 cm AN Right side diagnosed 12/4/09
Translab surgery May 2010 with Dr. Jack Kartush and Daniel Pieper at Michigan Ear Institute.
Successful surgery .5mm left on facial nerve.  Full facial movement. SSD, Tinnitis, tongue and lip numbness.  No headaches.  Back to living life.

TP

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Re: what kind of numbers (of AN cases) did your surgeon's report they do
« Reply #14 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....
4+cmm left retromastoid of cerebellopontine angle tumor removed 6/5/06; Dr. Eric Gabriel, St. Vincents, Jacksonville, FL
Left ear hearing loss, left eye gold weight, facial paralysis; 48 year old female. Dr. Khuddas - my hero - corrected my double vision