Author Topic: Diagnosis of AN  (Read 2020 times)

MDuffer

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Diagnosis of AN
« on: May 29, 2018, 02:09:03 pm »
I was diagnosed with a AN on my right side in 2015 and have been in the wait and watch mode. My last MRI in January 2018 showed tumor growth from 9.2mmx4.6mmx5.8mm (May 2016) to 12mmx6mmx6mm (January 2018). My ear doctor in Harrisburg suggested I start thinking about treatment options. I have ruled out any type of radiation for several reasons but mostly because of the unknown long term health risks. To date I have consulted with 3 neurosurgeons and have received conflicting opinions. The surgeons are Dr. Rafael Tamago at John Hopkins, Dr.Jon Lee and Dr. Douglas Bigelow at Penn Medicine in Philadelphia and Dr. Francis (Nurotologist) and Dr. Ali Zomorodi (neurosurgeon) at Duke University Medical Center in North Carolina. The conflicting opinions are not making the decision making process any easier. I was wondering if anyone had any experience with any of these doctors or hospitals for treatment of a AN.

Blw

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Re: Diagnosis of AN
« Reply #1 on: June 04, 2018, 09:47:57 pm »
Radiation, such as gamma knife, has been used for decades and is very very safe and well characterized.

extropy

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Re: Diagnosis of AN
« Reply #2 on: June 05, 2018, 01:19:11 am »
J Neurosurg. 2014 Dec;121 Suppl:123-42. doi: 10.3171/2014.8.GKS141506.

Gamma Knife radiosurgery for vestibular schwannoma: clinical results at long-term follow-up in a series of 379 patients.

Boari N1, Bailo M, Gagliardi F, Franzin A, Gemma M, del Vecchio A, Bolognesi A, Picozzi P, Mortini P.

Since the 1990 s, Gamma Knife radiosurgery (GKRS) has become the first-line treatment option for small- to medium-size vestibular schwannomas (VSs), especially in patients without mass effect-related symptoms and with functional hearing. The aim of this study was to assess the safety and efficacy of GKRS, in terms of tumor control, hearing preservation, and complications, in a series of 379 consecutive patients treated for VS.
METHODS:

Of 523 patients treated at the authors' institution for VS between 2001 and 2010, the authors included 379 who underwent GKRS as the primary treatment. These patients were not affected by Type 2 neurofibromatosis and had clinical follow-up of at least 36 months. Clinical follow-up (mean and median 75.7 and 69.5 months, respectively) was performed for all patients, whereas audiometric and quantitative radiological follow-up examinations were obtained for only 153 and 219 patients, respectively. The patients' ages ranged from 23 to 85 years (mean 59 years). The mean tumor volume was 1.94 ± 2.2 cm(3) (median 1.2 cm(3), range 0.013-14.3 cm(3)), and the median margin dose was 13 Gy (range 11-15 Gy). Parameters considered as determinants of the clinical outcome were long-term tumor control, hearing preservation, and complications. A statistical analysis was performed to correlate clinical outcomes with the radiological features of the tumor, dose-planning parameters, and patient characteristics.
RESULTS:

Control of the tumor with GKRS was achieved in 97.1% of the patients. In 82.7% of the patients, the tumor volume had decreased at the last follow-up, with a mean relative reduction of 34.1%. The rate of complications was very low, with most consisting of a transient worsening of preexisting symptoms. Patients who had vertigo, balance disorders, or facial or trigeminal impairment usually experienced a complete or at least significant symptom relief after treatment. However, no significant improvement was observed in patients previously reporting tinnitus. The overall rate of preservation of functional hearing at the long-term follow-up was 49%; in patients with hearing classified as Gardner-Robertson (GR) Class I, this value was 71% and reached 93% among cases of GR Class I hearing in patients younger than 55 years.

CONCLUSIONS:

Gamma Knife radiosurgery is a safe and effective treatment for VS, achieving tumor control in 97.1% of cases and resulting in a very low morbidity rate. Younger GR Class I patients had a significantly higher probability of retaining functional hearing even at the 10-year follow-up; for this reason, the time between symptom onset, diagnosis, and treatment should be shortened to achieve better outcomes in functional hearing preservation.
2014 - at age 65 problems with left ear (tinnitus, imbalances, deafness, short-memory problems, etc).
2014 - MR found VS, 3.5 cm circa.
2014 - Exeresis, in Rome, RS approach,  followed by hydrocephalus ... and shunt.
2018 - AN has regrown, volume is 2.6 cm3.
2018 - GK (Humanitas, Milan)

rupert

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Re: Diagnosis of AN
« Reply #3 on: June 05, 2018, 12:50:19 pm »
The doctors and medical centers you mentioned have all been brought up on this forum as the names seem quit familiar.  A search on this forum if not already done will give you some feedback on those.  Maybe you could expand on what conflicting advice you were given.  Lots of people here that might be able to make sense of it.