microsurgery vs. surgery

[red]

We are knew to this AN stuff (1 week Diagnosed).  Was wondering if someone could explain the difference between microsurgery and surgery.  If there is a difference and what it is.  Is microsurgery only for certain sized tumors.  My husbands is 1.5cm x .8cm.  does the size and placement determine if microsurgery is an option? thanks.

[Boppie]

I'd assume the proximity of brain and small precision needed near the nerves require the use of a microscope in the surgery, therefore it is all microsurgery.

[Gennysmom]

Yup, that's it!!!

[Jim Scott]

Microsurgery is a general term for any surgery requiring an operating microscope.  The microscope is somewhat miniaturized and worn by the surgeon as an eyepiece.  Small AN tumors are generally removed via non-invasive radiation ('Gamma Knife' and 'Cyber Knife') but can also be removed by traditional surgery, using very small instruments and, of course, the microscope ('microsurgery').    The surgery involves working around very small, delicate nerves and sections of the brain that must be treated gently and carefully to avoid post-operative complications, requiring a very magnified field of vison for the surgeon to do this successfully.  Enter the microscope and 'microscopic surgery'.   

[Battyp]

Red are you trying to determine the difference between microsurgery and radiosurgery? 

[red]

Thank you all for clearing up the surgery vs. Micro.  Since we are new I am still trying to figure it all out.  I am assuming that the gamma knife and cyberknife are the radiosugery category right?  Anyhow we are headed to salt lake for our first consult on friday.  We don't really know what to expect.  We are to see a Dr. Warren, but after listenig to you all I have been trying to set up multiple consults.  One with Dr. Rieschman who we are told works with Dr. Shelton.  They told us that Dr. Shelton does the "approach" and that Dr. Rieshman takes out the tumor.  Anybody know what exactly that means.  Has onyone had experience with any of the doctors mentioned above.  If so we'd love to hear your opinions and information.  I have read that some of you have sent your MRI's to House and that they give you a phone consult.  Do they send back the MRI"s or do I need to get multiple copies.  Do the MRI's need to be film or does it work on disk as well.  I tried to call the house today and ask but they said I needed to talk to the nurses station and it was closed at that time.  Well if anyone has some answers, Thanks.
Red

[krbonner]

I don't know about the specific doctors (I live in Boston), but when I had my surgery the neuro-ENT (aka, neuro-otologist) is the one that removed all the ear structures to expose the tumor, and the nuerosurgeon is the one who actually removed the tumor.  In all, I had four different surgeons - those two, plus one initially who cut through the skull, and the fourth who did all the closing.

HTH!
Katie

[red]

Thank you- 
That does makes sense to have more than one surgeon.  Its slowly all coming together for me.  So Katie, you had the trans lab.  What were some of the deciding factors for you?  Thanks for clearly up the surgeon thing.

[Battyp]

Red you will find that you need to get copies of everything and hang on to them.  House will take an MRI copy for consult, in fact most places will.  I got an original cd copy and then burned extra ones to pass around.  It was easier than constantly asking for another copy and at some point I know they start charging for them  LOL  Some doctors use the team approach and some do it all themself.  My doctor did my surgery himself (retrosig).  The first consult I had the doctor was an ENT and he used a neurologist to assist. When you think about it, I know a few who's surgeries last a really long time so a team approach I think would be best.  Mine was 9.5 hours, some have been 17 hours, and some have been 4.  It all depends on the size, location and whether the tumor is sticky or encapsulated (which they can't tell until they are in the skull). 

Deciding factors are tumor placement,
tumor size
whether you want to try to preserve any hearing or not.

For me, I was first presented with retro and translab but after further review of my mri was told translab wasn't an option.  I know at first my thought was retro as I wasn't mentally ready to give up all my ear innards.  If it got rid of the tinnitus I'd probably of been more willing but was told that I'd be trading it for a different sound and wasn't comfortable with that.  Due to brain stem involvement, location and size of my tumor I was given retrosig as my only treatment option.  Makes the decision real easy )  With the size of your husband tumor all treatment options should be available to him.  Microsugery and radiosurgery options.  I think for most after you sort through them all you feel more comfortable with one approach than you do another. 

[krbonner]

Thank you- 
That does makes sense to have more than one surgeon.  Its slowly all coming together for me.  So Katie, you had the trans lab.  What were some of the deciding factors for you?  Thanks for clearly up the surgeon thing.

When I first diagnosed, I was actually a watch-and-wait which I was thrilled by.  My hearing was already gone (that was my only presenting symptom), so we weren't worried about stopping growth for hearing preservation.  My facial nerve function was still 100%, and treatment puts that at risk.  So, I did MRIs every 6 months.  After my third MRI, we found that my AN was growing at a much faster rate than average (7mm over a year) and was starting to press on my brainstem.  So, time to do something about it before it got even more complicated.

As for deciding between surgery and radiation, that was tough.  I talked to lots of AN patients, neurosurgeons, and radiation oncologists.  All the docs had experience with hundreds and hundreds of AN patients so I trusted what they said.  It came down to a few deciding factors:
1. The rapid growth scared me and a big part of me wanted it out for my own peace of mind.
2. With the AN already pushing on my brainstem, there was no room for swelling or other changes brought on by radiation.  And if it ever did start growing again years down the road, I'd probably quickly run into problems.
3. If I had to do surgery, I'd rather do it while I'm young (I'm 35) and healthy than risk having a radiated tumor regrow and then face surgery when I'm 20 years older.

For me, deciding which surgical approach to use was pretty easy.  I had already lost all hearing, so hearing preservation was not a concern.  Given that, everything I read and everyone I talked to said translab would be best b/c it givens the best exposure to the tumor and nerves once you're opened up. 

In the end, I'm very happy with the choices I made about my treatment.  Surgery has been relatively easy for me to recover from (though I'm only 3 weeks out and obviously not back to full form yet), and I have had no damage to my facial nerve (the biggest risk of surgery).  But I believe that's because I found a team that had so much experience in treating ANs.  Even the anesthesiolgist at my surgery had done hundreds of AN surgeries and had special protocols developed just for them.

Hope that helps!
Katie

[SuzeAN]

Now what about the "endoscopic surgery" approach, check out Choppers posts, very interesting.

Cheers,
Sue (Las Vegas)

[Battyp]

Chopper is brave!  That one scares me.  Heck as sick as I was flying to cali from FL scared me  LOL

[FlossKaos]

Hi Red.  I was really new to all this stuff to about 8 months ago, I didn't have a choice about radiation, micro-surgery etc.  I had surgery.  I was in hospital for 10 days.  I live in Tasmania Australia, so we probably don't have all the options that you have in the US.  I am only young (26) but even so it wasn't a concern for me to loose my hearing, I was more concerned about paralysis of the face.  With me they flew in a special machine that monitors that the facial nerves during the surgery and thankfully they were able to do the operation without damaging my face I have lost most of my hearing on the AN side.  There are a few  things both you and your husband should keep in mind before and after the operation: Get different opinions (as long as time permits), and ensure that the docs have experience in AN's.  After the operation, I found that my moods have not been normal (I have a very supportive family, thankfully), up and down like a yoyo.  I am also still suffering from very bad headaches, and my balance is not back to normal yet.  So really you  need to keep an open mind, so ppl will say that everything will be almost back to normal at about 2 months, others say six months.  BUT EVERYONE IS DIFFERENT, so don't get upset if everything doesn't get better overnight.  I hope this gives you a little more insight, let me know if you want some more suggestions

regards Fleur

[chopper]

Chopper is brave!  That one scares me.  Heck as sick as I was flying to cali from FL scared me  LOL

Lol, hardly.  Was sweating bullets and ready to bolt till they shot something in me to "help calm me down".  One of those magic shots, I was flying, had another before leaving the family and was completely bombed.  Maybe that's how they get you stay and go through with it, trick is to just get you high 

Please welcome your hubby to the club.  Not a totally awesome club to be in, but could be far worse! :-)