I am trying to decide between Gamma Knife treatment and surgery. I was diagnosed in April with an acoustic neuroma 2.7 x 2.2 x 2.4. I have brain stem compression and have gotten differing opinions as everyone does.
I've talked to 4 surgeons so far, 3 neurosurgeons and one neurotologist alll of whom also have access to Gamma Knife or Cyberknife. Two of the neurosurgeons recommend radiation (one prefers Gamma Knife, the other said Cyberknife or Gamma Knife). One surgeon and the neurotologist recommend debulking with surgery. I was really leaning toward the Gamma Knife with the idea that if it didn't work I could always do surgery later since studies seem to show that it was no more difficult to do after radiation. However, the neurotologist raised the issue of brain swelling and tissue damage that he said could lead to death or at least the need for an "emergency craniotomy". I called the surgeon who recommended Gamma Knife back and he said that he thought that debulking surgery with Gamma Knife after was a reasonable option, but he felt that the risk of swelling leading to death was so minimal as to not be a real concern and that he would personally choose Gamma Knife hands down. On the other hand, when I did ask him about the worst case scenarios for Gamma Knife versus surgery, they were death (Gamma Knife) and total paralysis (surgery). Clearly the risk of death is extremely small, but the neurotologist used the analogy that your risk of getting hit by a semi is very small, but if you do get hit by a semi, you get hit by 100% of it.
Since I have two small children (3 and 6), then I would say that total paralysis would be less horrible than death (though I know others might say the reverse), however, if the risk of death were so low as to be non-existent, then it does seem that maybe the risks of surgery might be greater. Then there is the lurking risk, with Gamma Knife, of a malignancy later on.
I am hoping that some of you may have a good source for information on the various risks and also what risk factors you considered. I understand that there is not a risk free option, but I would like to understand what choices I am making. Also, since the surgeons recommending surgery do a combination of debulking surgery followed by Gamma Knife, I don't know if the standard comparisons apply.