Which surgery is preferred?

[DarleneN]

With a 3.5 cm AN tumor, which surgery type is the best to get it completely out?

[Debbi]

Hi Darlene-

I think that this is an impossible question for most of us to answer.  It seems that the surgical approach is to some extent dictated by the actual position of the tumor - i.e. if they can tell from the MRI that the tumor is pressing into the facial nerve, they may choose the translabrathine approach because it provides clear access to the acoustic nerve with the lowest risk to the facial nerve. 

I would think that you would want to get more than one surgical opinion - some surgeons have a preference for certain approaches, so you want to get a balanced opinion.  Have you sent a copy of your MRI to House Ear Clinic yet?  If not, please consider doing that - they have a team of surgeons who perform all types of surgery and can give you a good opinion.

Sending you good thoughts.

Debbi

[Mark]

With a 3.5 cm AN tumor, which surgery type is the best to get it completely out?

I would agree with Debbi's points, especially since none of us are surgeons.

But in general, I would wager that most surgeons would opt for the translab approach for a 3.5 cm AN. It is too large for Mid Fossa, there is very little chance of hearing preservation so little reason to do the retro sub occipital as opposed to translab which typically gives better visibility to the facial nerve.

Mark

[Pooter]

I'm with the crowd.. it's impossible for anyone of us to recommend a type of surgical approach because a) we're not surgeons and b) we don't know the exact placement of the tumor..  As has been alluded to, most doctors will have an approach that they're comfortable with so they will likely recommend that approach over another that they have less familiarity with.

I had a 3cm tumor and surprisingly, my doctor did a retrosigmoid approach.. not for hearing preservation (even though I secretly hoped that would be the case) but because it provided the surgeons the best view of MY TUMOR.  Originally, they were going to go with a Translab approach but after the two surgeons (ENT and Neurosurgeon) consulted, they decdided that based on placement, a retrosigmoid approach gave them the best view so they went that route.

I'd consult several surgeons and go from there knowing they will likely "recommend" the approach that they are most comfortable with..  Then it will come down to WHY they say their approach is better and how YOU feel (comfort level with their manner, demeanor, experience, etc..). 

As we've said many times around here, treatment choice (including what type of approach) is a personal one and one that should only be made with yourself, your loved ones and your doctor(s).  You'd be hard pressed to find someone around here that will recommend one approach over another because they all have their merits given the circumstance, they all carry they own risks and they all have their upsides.

Good luck on your choice!  Let us know if we can help (aside from recommending one approach over another)!

Regards,
Brian

[epodjn]

Of course none of us is doctors but as everyone else has said, my guess would be for translab. My tumor was 3.2 facial neuroma and pressing on the brainstem and both docs agreed immediately that it was the best way to go for MY tumor. It all depends on where it is and what nerves etc. are involved.

[leapyrtwins]

Darlene -

as the others have said, and being no doctor myself either, I would guess translab - but a lot depends on size and location.  As Mark said, mid fossa is not an option.  Ultimately the doctor(s) your son chooses will make that decision unless they decide to give him some input.

My doc gave me the choice of translab or retrosigmoid, but my tumor was smaller than your son's and I also had fairly decent hearing all things considered.  My AN was on the 7th and 8th cranial nerves.

Jan

[texsooner]

Darlene, my AN was also 3.5 cm and I had the retrosigmoid approach. This was not done for hearing preservation as I had lost most of my hearing on the AN side before surgery. I agree with Brian in that I think it comes down to location of the tumor and also which approach the surgeons are most comfortable performing. I did question my surgeons about the approach and they assured me that this was the best approach for me. Since my surgeons had a good track record and considerable experience with AN surgeries, I put my total trust in their hands and it turned out well for me.

As you've probably read here many times, everyone's case is different and there are no guarantees. Doing your research and getting differing opinions is the right thing to do. Good luck.

Patrick

[epc1970]

Darlene
As others have said it's location, location, location. Mine was 3.8 cm and mostly in the CP angle with brain stem involvement and for me 3 surgeons all recommended retrosigmoid. The choice from my understanding is based on which approach gives the surgeon best access to the tumor and other important anatomical structures which for every  one of us is different. No matter which approach is used if the tumor is "sticky" the surgeon may not be able to remove it all without compromising facial function/movement or other issues.
Erin

[wendysig]

Darlene,

As everyone else has said, we're not surgeons, but based on our individual  experiences, all seem to feel translab is most likely the way to go.  The only other option would be retrosigmoid since middle fossa is only used for small tumors.  The trasnslabyrinthine approach offers the best chance of sparing the facial nerve, but sacrifices hearing outright.  The retrosigmoid approach allows the doctor to attempt to save your hearing if you think it is worth the possible risk to your facial nerve (a higher risk of facial nerve dysfunction) but there is no guarantee that attempt will be successful.  You really need to discuss this with your surgeon and weigh the pros and cons of each approach.

Wendy

[Jim Scott]

Darlene ~

As yet another non-physician/surgeon chiming in, I can agree with he the previous posters that the choice of surgical approach will necessarily depend on the location and shape of the tumor, as well as the surgeon's preference, based on his experience.  My 4.5 cm AN was pressing hard on my brainstem and my very experienced neurosurgeon chose the retrosigmoid approach to perform a debulking operation.  I'm happy to report that it worked out splendidly.  As the thread proves, there really is no 'preferred' surgical approach.  The reality is that your surgeon will make an educated decision on the surgical approach he'll take and you'll have to trust his judgment.  I  did that with my neurosurgeon and was rewarded with a very successful outcome.  I hope you'll have one, too.

Jim

[Kathy M]

My situation is the same as Patrick and Brian.  Postiion of the tumor is everything.  I had a few different opinions from others, though, and it came down to my comfort level with the surgeons, their explanations of why they were recommending a particular approach, and the research I did through good credible sources.  No regrets at all!  Best of luck to you - I'm sure you'll find the right fit for you.

Kathy

[cin605]

Mine was 2cm extending into cerabellapontine,I had some hearing loss before n the same after.I had retro.I have no facial issues
at the present time..knock.knock on wood.18 months out.