Hello everyone,
My mother was recently diagnosed with ~2cm vestibular scwhannoma in left CPA. We are currently trying to decide on a neurosurgeon (and accompanying neurotologist). The three have all given roughly similar outlook and recommend retrosigmoid craniotomy with potential to drill into IAC (to be determined during surgery). But there are a couple of differences in their approaches leading up to surgery and for the cranioplasty at the end of surgery. I was wondering if others have experience with the different approaches and/or knowledge about which are more likely to provide the best outcome.
1) One surgeon wants to place a lumbar drain the day before surgery to help reduce pressure and relax the brain to improve visualization and access. The other surgeons say they very rarely use lumbar drain and don't think they will need it in this case. On one hand, an extra procedure (with risks) to place the lumbar drain something we'd rather avoid, but if it can really improve chances for an excellent tumor removal and outcome, it may be worth it.
2) Two surgeons use hydroxyapatite bone cement for the cranioplasty. They do not replace the bone that they took out, but it seems that they use the cement to fill the void where the bone was. They say this is an excellent technique to prevent CSF leaks and they have been doing it for a long time. The other surgeon says he hates bone cement - he has seen infections and also deterioration of the cement from patients coming to him from other surgeons. He prefers to replace the bone piece that is taken out during the craniotomy and secure it with small titatnium plates and screws (and minearized bone in the seam). Just wondering what other people have had, or what you know about the benefits/disadvantages/ risks.
I'd be grateful to hear any thoughts others may have on this. Then again, I know there probably isn't a "right" answer on which way to go on either procedure.
My sincere sympathy for everyone touched by this tumor type - and all of the mental anguish and stress that it can create for patients and loved ones.
Thank you.
