Bajaceresa ~
I'm sorry I logged in too late to submit a timely response to your queries. However, I'm going to take the liberty of offering my view, even if it does come tardily.
In my opinion, selecting the doctor to perform the surgery is the paramount consideration. Even more important than what surgical approach he may favor. Once you find and engage a doctor to perform the surgery, one that you feel comfortable and confident with, the rest is easier.
In May, 2006 I was diagnosed with a 4.5 cm AN that was pressing hard on my brainstem. I had been SSD for some time (years) and my symptoms were increasing almost daily. I was blessed to discovery (through a recommendation from another neurosurgeon who didn't perform AN surgery) a highly experienced neurosurgeon who had (literally) decades of AN removal surgery experience and was very cognizant of and concerned about his patient's quality of life, post-op. In my initial (45-minute, uninterrupted) consultation with this mature, compassionate physician, I expressed my concerns regarding facial paralysis and headaches. He respected my concern and, more importantly, he shared it. On that basis he proposed a two-stage approach to my AN. First, a debulking surgery that would, in effect, 'gut' the tumor down to a thin membrane making it more susceptible to the effects of radiation . Then, after a three-month 'rest period', he would team with a radiation oncologist to 'map' FSR treatments intended to destroy the tumor's DNA and effectively render it 'dead'. He chose the Retrosigmoid surgical approach and when I asked why, he explained that it offered him the best possible access to the tumor. I was satisfied with that logical explanation. I inquired about the possibility of post-op headaches and he assured me that he took great care to do everything necessary to avoid generating them due to the surgery and that his AN surgical patients "didn't get headaches". I was impressed - but still a tad skeptical. I also asked about nerve monitoring and he said that he had a 'top notch' person he would 'bring in' to perform the necessary nerve monitoring. I also asked about the use of interns. The neurosurgeon assured me that he declined to utilize interns and residents. He stated, (with a big smile) that when he was performing AN surgery: "the OR is no place for amateurs". This doctor had a 'hand-picked' team of technicians and nurses that he used exclusively for AN surgery. No students, although they could observe. He was assisted by a young woman neurosurgeon he was mentoring. She was part of his medical staff. Long story short: the operation went splendidly and I suffered no real complications. I was home in five days and recovered relatively quickly. The FSR sessions, 90 days later, were uneventful with no ill effects at all. Within two years the AN showed necrosis (cell death) and some minor shrinkage. I should mention that I had made it clear I was retired and cost was an issue. However, the doctor literally waved away my concern and told me to "focus on getting well and don't be worried about money". He volunteered to accept whatever the insurance company (Blue Cross) paid. He did so and I never received a bill from this doctor, although I ended up owing the anesthesiologist and the hospital about $2,000. Today, approaching the five-year mark from my surgery, I'm doing great! Incidentally, the doctor was true to his word in every respect; I never experienced a headache.
I state all this to help make my point that sometimes choosing the doctor is the key and the surgical approach, facility and other associated issues will fall into place once you have the 'right' doctor (for you). You appear to be doing your research and taking a pragmatic approach to making the crucial decisions so I think you'll make good choices. I wish you success and hope you'll let us know what your final decision is. Thanks.
Jim
