- and welcome. I'm sorry you have a reason to visit this site (an acoustic neuroma diagnosis) but I'm pleased to learn that the forums have been of some help to you in making a treatment decision. I'll attempt to answer your questions, although some are not definitively answerable because the answer is unknown (even to doctors) or the decision is yours, alone.
From the information that I have seen, it is my understanding that the radiation options are only recommended for the elderly and those who can not do surgery because the long term effects are not yet known. But, from the posts I have seen on this forum it looks like there are more of us deciding on that option then the two groups I mentioned. What is the deal?
I know that the MF approach may put my facial nerve at greater risk but since my AN is small I feel comfortable with the risk. However, I have read some opinions by Ã¢â‚¬Å“expertsÃ¢â‚¬? that claim the long-term preservation of hearing from the Ã¢â‚¬Å“preservationÃ¢â‚¬? approaches is not realistic even when good hearing is present after surgery. Their opinion is that one should enjoy their hearing until it is gone then have translab because of all the risks associated with the other approaches are not worth the short-term hearing gain. Anyone have info or thoughts about that? Is long-term preservation realistic?
Are the issues associated with taste, smell, and fatigue things that generally clear up with time after surgery?
Irradiation, which is non-invasive (no cutting) is an option when the AN is relatively small, usually under 3 cm, which would certainly include your AN. Some of the cautions regarding radiation treatment are based on the opinions of doctors who prefer performing surgery on AN patients, usually because they don't believe in radiation as a permanent, viable treatment for excising an acoustic neuroma. Some of that is pure bias, some is the result of outdated information. In AN patients much under 60, some surgeon's don't want to employ radiation because it makes any future radiation treatment (i.e. for cancer) that might become necessary, problematic. The human body can only safely withstand so much radiation and the radiation needed to effectively 'kill' an acoustic neuroma comes close to that maximum. However, many 'younger' AN patients (I'm 66 so anyone under 60 is 'young' to me) have successfully undergone radiation treatment for their AN. Beware of bias against radiation treatment for your AN. It's quite prevalent - and mostly based on wrong information and false assumptions.
Long-term hearing preservation is a tough one. There are statistics that show this is possible - and others showing it as a long-shot. Hence, the conflicting opinions. It's not my call but I would go for the Middle Fossa surgery and hope to preserve hearing. Life is a risk.
The issues involving taste, smell and fatigue almost always do resolve in time, post-op, especially fatigue, but not always - and not necessarily 100%. As much as I would like to be able to offer one, there is simply no definitive answer. My taste returned within 24 hours of my surgery and has remained intact. My fatigue dissipated within a few weeks but I don't feel I have the same level of stamina I had, pre-op, although I attribute some of that deficit to aging, which I don't think is unreasonable. Some of our members run marathons and such within a few months after their surgery. Some have lingering issues many months, even years, later.
Whether you chose MF surgery or a form of irradiation, it's a risk. That is the harsh reality of having an acoustic neuroma. I wish it were not...and I wish you all the best and hope my attempt at answering your very reasonable questions is at least slightly helpful. I'm sure others will offer useful responses. Oh, and you posted in the right forum. Jim