two-staged resection of an AN? - a thought-provoking article

[hruss]

Hi everyone,

this (http://thejns.org/doi/abs/10.3171/2012.1.JNS111402) was an interesting read and I decided to share it with all of you. It concerns people who had big (>3 cm) ANs (aka Vestibular schwannomas) and how doctors found out that it might be a better idea to resect a tumor over a couple of stages rather than taking it out at once because it would save the facial nerve.

That was the case with me. I had a brainstem edema and the doctors put me on antibiotics because the swelling should have been shrunk before any surgical intervention. However, I underwent not two but three surguries and the first two could not solve the problem. So prof Samii in Germany told me that first two surguries in Bulgaria I had undergone made the situation for him even worse. So according to my expereince, having more stages of resection might comlicate the surgeries. After all these are two seperate interventions. The article suggests that the first surgery is done via retrosigmoid approach whereas the second - via translabyrinthine approach. I had all my surgeries done via retrosigmoid approach.

What do you think of mixing these two techniques when resecting a tumor? Have you personally had more than one surgery for AN? Do you know people who have had more than one surgery? What are the outcomes?

All such questions came to my mind and just felt the need to share. I hope you find this read informative and interesting too.

Hrissy

[rvb755]

Hrissy, the first doctor I saw, who is about 30 miles from where I live, told me that to remove my tumor, he would do a two stage procedure with separate surgeries one year apart.  Dr. Friedman at HEI told me they never stage procedures and Dr. Friedman and Dr. Schwartz were able to remove 100% of my tumor in a single 9 hour operation.  I am very pleased with the care I received and am glad I don't have another operation coming up this fall.

Rick

[Jim Scott]

Hrissy ~

I did not undergo a two-stage tumor resection but there have been a few of our members who did and, as I recall, it was somewhat traumatic, as you can imagine.  The majority of AN removal surgeries are performed in one stage and most are successful. However, this is simply an observation.  I'm not a doctor and cannot offer a credible 'medical' opinion on this issue.

Jim

[JanSchell@comcast.net]

My neuroma was pressing against my brainstem as well and causing edema.  I had one surgery with co-surgeons (Neuro ENT and Neurosurgeon).  One surgeon went in reterosigmoid and the other translabyrinthine all done at the same time.  Since I had some facial nerve damage going into the surgery, I am still dealing with a facial paralysis, however, since the nerves tested well during surgery, the doctors expect the paralysis to get better to, hopefully, 90%.  My biggest problem, however, is my eye.  I had a gold weight implanted to help close my eye, however, 7 months post-op, I have swelling on the affected side of my face and eyelid.  All the doctors I have seen, including an opthalmologist, agree that the gold weight has no bearing on the swelling.  I have a sinus x-ray and MRI of my orbits, face and neck but neither show any reason as to why this is happening.  Has anyone else had anything similar to this?