Wow, quite a bit of confusion and conflicting information in this thread. As a veteran of both procedures (as well as having spent countless hours on the forum) I will try to share my understanding/perspective:
- Titanium mesh: My understanding is that it is commonly used in the retrosigmoid/suboccipital approach. I wasn't aware that it is also used for translab. From what I have read on the forum fat graft is commonly used after translab. The titanium mesh is used frequently after retrosigmoid, but not always; my surgeon put the bone back, and held it in place with bone cement. There have been occasional reports on the forum of headaches and other side effects caused by the mesh.
- Translab vs. retrosigmoid and hearing preservation: Generally, for both surgery and radiation, the better the hearing going in, the more the chances are that some useful hearing can be preserved. Typically surgeons will recommend the procedure they are most comfortable with, and the one they feel is more suitable for the case. If hearing is greatly diminished, especially when word recognition is not satisfactory they will often opt for translab: the common consensus is that translab provides a better view of the facial nerve, thus presenting better options for preserving it. For large tumors some surgeons (like mine) prefer retrosigmoid, even if there is no useful hearing left, because they feel that they can access the tumor better. My surgeon also told me that in his view translab exposes "too much of the facial nerve too soon", but I don't think this is the general consensus.
- Nowadays radiation is not considered a treatment suitable only for older patients. There is a long history at least for GK (since the 70s), and many younger patients have undergone noninvasive radiosurgery successfully. The criteria should be the size and location of the tumor, whether it presses the brainstem, whether swelling would be potentially dangerous etc. You should seek the advice of someone who specializes in radiosurgery (GK, CK or fractionated). With radiosurgery the same rule about hearing preservation holds: the better you have going in, the more chances you have to preserve some hearing. However there is a great chance that hearing will diminish years post-GK. Radiosurgery generally carries a lower risk for major complications, such as facial nerve and other cranial nerve injuries and a high percentage of control, especially in smaller tumors.
- I wouldn't worry about deaths - this is very rare with modern microsurgery.
There is a lot of valuable information on the forum, the most important thing is to be informed and ask your doctors the right questions.