So I'm technically in the watch and wait but I'm going to treat this soon either way after my next MRI scan in November. My vestibular schwannoma is currently 10.5 mmX 8.5mm X 6 mm in IAC on right side. I met with two different neurosurgeons so far with two very different opinions. I thought I'd share what their thoughts were in case this may help other people as well.
I first met with Dr.Friedman who said that he would absolutely not do gamma knife and would suggest the retrosigmoid surgery for my tumor if it grew. He stated that the risks for my situation with the retrosigmoid procedure would be less than 1% for facial nerve damage in his hands, and a 45% chance of hearing loss. He also stated that he thought the risks of gamma knife were 1 in 1000 for the chance of the tumor becoming malignant at some point, and for this reason, he never suggests gamma knife. He also stated that if gamma knife didn't succeed in controlling the tumor, it would make surgery more difficult.
The second surgeon I met with was Dr. Theodosoupolos from UCSF. He said that he would chose the gamma knife radiosurgery over the microsurgery for my particular case. He stated that the tumor control rate with radiosurgery is 92-93% and that there is less than 1% chance of facial nerve damage and that less than 1 in 10,000 patients have their tumor turn malignant. (So, this is a very different statistic than the 1 in 1000 chance Dr.Friedman listed)
He stated his risks with microsurgery are 5% or less chance of facial nerve damage, 80% chance loss of hearing, less than 1% chance of stroke. He also stated that the gamma knife surgery was more accurate than cyberknife because of it being bolted to your head and because it is accurate within 1 mm. When I said so it's your opinion that gamma is more accurate than cyberknife he responded that it wasn't his opinion, that it was a fact.
At this point I haven't decided which option I would chose. The nagging feeling I have about radiosurgery would be that the tumor control rate is 92-93%, which gives you a 8% chance that the tumor would grow at some point. If it is only 1% chance of facial nerve damage, then that is the same risk as retrosigmoid with Dr.Friedman but I have a much better chance of tumor control with surgery. So far I am still weighing the options and I have a few more consultations coming up.
I would be very interested to know what helped everyone else decide between radiosurgery and microsurgery. Everyone says it is an individual choice, and I understand that, but I'd be interested in what the factors were that helped you in making your decisions. Thanks so much for your input.