i was scheduled for gamma knife at Mayo Clinic in MN when i got a call from an ENT who had been forwarded a letter from my initial neurosurgeon appt. the ENT told me that the chances of hearing loss/facial nerve damage was about the same percent w/ the gamma as it was with the surgery, but the long-term effects of GK have yet to be known...and because i'm only 29 that i (hopefully) will live long enough to see what long term effects are.
My ENT told me at 28 that I was too young to have to experience brain surgery, and that he felt I was making the right choice with CyberKnife. Funny how inconsistent the medical community can be sometimes, lol. But the "long-term effects" concern seems a bit hollow, in my opinion, as GK radiosurgery has been performed for over 30 years. I wonder what effects they are referring to? Future cancer? By 30 years we would very likely have seen an increase in cancer among radiosurgery patients by now if there was going to be one. The concern of future cancer is based on old XRT (x-ray therapy) statistics in which large volumes of healthy tissue were irradiated, which is not the case with radiosurgery. Without any real data to back up that concern, which should be widely available by now, it's just speculation. I personally find that "concern" to be very disingenuous, and a baseless tool to promote one treatment over another. Funny how a neurosurgeon will shrug off a 1-2% chance of death due to surgery, but will express great concern over a far lesser chance of future malignancy with radiosurgery, the only issue is really figuring out how much less, the legal paperwork you must sign before treatment gives the chances of 1:1,000 to 1:20,000, even though there have been very few cases of cancer in patients who had radiosurgery, and it's never possible to tell for sure if radiosurgery was the cause. Even with the "long-term effects" that are well known with standard radiaton therapy, in which large volumes of healthy tissue are irradiated, the chances of future cancer is only raised by 7% over the regular population.Ã‚Â Ã‚Â
As for the hearing/facial nerve preservation rates:
Comparison of Radiosurgical & Microsurgical Treatment for Acoustic Neuromas
ProcedureÃ‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Cure ControlÃ‚Â Ã‚Â DeathÃ‚Â Ã‚Â Hearing PreservationÃ‚Â Ã‚Â Facial Nerve Preservation
GK RadiosurgeryÃ‚Â Ã‚Â 94%Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â 0%Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Some/MostÃ‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â All
MicrosurgeryÃ‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â 98%Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â 1.5%Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â SomeÃ‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Ã‚Â Most
There are several factors, which influence the outcome of surgery. The most important is tumor size. Preservation of useful hearing and facial movement following open surgery is greatly limited by tumor dimensions. For example, useful hearing in the most experienced hands is unlikely in tumors over 2 cm in diameter. Other considerations include a 10 % to 20 % rate of minor complications and 2 to 4 % risk of severe complications following open surgery. This can be avoided by radiosurgery. Patients can be returned to work the day following radiosurgery!
Those stats are for gamma knife, newer forms of fractionated radiosurgery like CyberKnife are producing even better hearing preservation.
radiosurgery are equally viable treatment options, I sincerely hope DistressedDB will explore both options equally, and not be stonewalled into the surgery option without consulting a radiosurgery specialist first. Kristin's tumor was smaller than DistressedDB's, so one couldn't apply her good surgical outcome to DistressedDB's situation.
Here's a quote from Dr. Chang, a top neurosurgeon at Stanford who also practices CyberKnife, from the CyberKnife support website in which he was answering a patients inquiry:
I have been diagnosed with AN that is 2.1 cm. Is my tumor size too large for Cyberknife surgery? What are possible side effects?
This size is still within the size limits for radiosurgery, which typically go up to 3 cm in diameter. Furthermore, a 3 cm diameter tumor is almost 3 times the volume of a 2 cm acoustic neuroma (on average).
I personally think that tumors in the 2 to 3 cm range are best treated with radiosurgery and not surgery. Surgical risks are lowest for the small tumors, particularly those that are less than 1 cm in size, but these risks increase dramatically for tumors that are your size. The radiosurgical risks are not substantially different for a 1 cm and a 2.1 cm tumor.
As far as the risks of open surgery for a tumor this size, there is a 50 to 75% chance of hearing loss, and around a 25% chance of facial nerve injury. With radiosurgery, the chance of decreased hearing may be on the order of 30 to 40% with less than 5% of patients suffering complete hearing loss as long as they come into treatment with useful hearing. As far as facial nerve injury, the data from radiosurgery shows a 1% or less rate of injury.
So the bottom line is that for a tumor your size, the risks are much lower, in my opinion, with radiosurgery than with open surgery.