first post and 7 weeks after surgery

[LakeErie]

I was diagnosed with a 4.7 cm right vestibular schwannoma on Aug 10. I had 2 opinions in Cleveland. One was a translab with 8 to 10 hours of surgery, ICU for a day or two, and 5 to 7 days in the hospital total. The other was from Dr Joung Lee at the Cleveland Clinic who uses a method he pioneered called a simplified retrosigmoid approach to C-P Angle masses. It is a minimally invasive approach and Dr Lee has done 600 CPA surgeries. I elected to go ahead with Dr Lee as he inspired great confidence in me,  and the surgery was scheduled for Oct 6th.
My almost 5 cm lesion was mostly removed through a 2 cm craniectomy behind my ear in a little less than 3 hours. Dr Lee operates alone and he left 2 tumor remnants on my trigeminal nerve as they were too adhesive to safely dissect from the nerve. Dr Lee feels risk of regrowth of the tumor from the remnants was less than the risk to facial sensation. We had agreed on this approach for all involved nerves before the surgery.
I was in a post anesthesia care unit until around 4 pm and than transferred to a regular neuro-care floor - no ICU. The next morning, Oct 7, Dr Lee walked with me around the neuro unit and said I was fine. By the next morning, 48 hours after surgery I was again wallking the floor with Dr Lee and he said I was discharged.
I did have a CSF leak via a right nostril drainage, but it resolved on its own in about 10 days as Dr Lee expected. Unfortunately for me, I developed bronchitis 4 days after discharge which set my recovery back and then had a couple other problems unrelated to surgery that delayed my recovery even longer, but now 7 weeks after surgery I am walking fine and driving.
I did, of course, lose my hearing and balance input, but that was expected given the tumor size.
The Vagus nerve was affected and I have some problem swallowing and my voice is hoarse, but the surgeon expects it to improve and says it takes months for vocal cord and swallowing complications to resolve. Both my voice and swallowing have improved already.
I have read this forum since last Aug and appreciate the information. I have read that there has not been much posted about minimally invasive approaches, so I thought I would add my experience in this area. So far I believe I made the correct decision to go with Dr. Lee. He will monitor the remnants to check for regrowth and if there is new growth will use radiation. I hope this adds something to understanding the minimally invasive approach in at least one case.

[Jim Scott]

Hi ~

First: welcome.  Second: congratulations on a successful surgery!  Third: thanks for offering your experience with Dr. Lee at the Cleveland Clinic and his less-invasive surgical approach to AN removal.  I can assure you that the information is appreciated. 

May your recovery continue with no further problems. 

Jim

[LisaM]

Glad to hear you are doing well!  Can you please elaborate on the minimally invasive technique Dr. Lee used?  Did he use an endscope?

[LakeErie]

Thanks for your reply. While I am no expert on the mechanics of the surgery, I assumed more than one endoscope was used in my surgery due to the tumor's large size. My tumor extended from the IAC ( Internal Auditory Canal ) across the space to exert a mass effect on my brain stem and cerebellum. Using an endoscope to visualize the tumor toward the brain would require a certain angled endoscope and looking toward the IAC would need a different angled one.
As far as elaborating further, the tumor was debulked and then dissected from the brain stem, cerebellum, and the V, VII, and Xth cranial nerves. The facial nerve ( VII ), which is normally cylindrical, was compressed by the tumor to the width of a sheet of paper, but so far only affects my tongue which was numb before surgery anyway, and dissection was successful. As mentioned above, the dissection from the Trigeminal and Vagus nerves was more difficult and resulted in some facial numbness around the corner of my mouth and right chin, and the already mentioned
vocal cord and swallowing problems. I'll add I still have some episodes of disequilibrium when outdoors or in large buildings like stores.
Sorry I cannot be more specific on the mechanics, but I was focused on the experience of the surgeon with his technique, and the facts of shorter operation time, shorter recovery time, lower morbidity than open craniectomies, and less hospital time. Hope this helps. Feel free to ask more questions if you want, maybe I will have answers.

[LakeErie]

Let me add, Lisa, that before surgery I read two 2004 articles from The Journal of Clinical Neurosurgery co-authored by Dr Lee reporting results of using his simplified approach to both vestibular nerve resection for chronic vertigo in Meniere's Disease patients, and in C-P Angle lesions like AN's. The  first article detailed the technique at length and used illustrations. I looked for both full articles before responding to your question. They were archived in the National Institutes of Health website and were free. But, only the abstracts are available now. To access the full articles now requires a subscription to the Journal itself or to Medline - whatever that is.

[LisaM]

Thanks for the prompt reply.  I'm waiting and watching at the moment.  There is a doctor here in LA, Dr Shahanian, that does an endoscopic procedure for ANs but the medical establishment has had some pretty harsh criticism against him.  I consulted with him early on but found that the patients he put me in touch with (all with SSD but other than that had successful outcomes) had tumors much larger than the one found in my head.  For this reason I decided to wait a bit before committing to treatment. Currently my symptoms are very faint, some tinnitus and a little hearing loss.  I have my next MRI in January to see if there is any change in size.  Are you a health care professional?  How did you come across Dr. Lee's paper?  Thrilled that you have had a successful outcome.  Wishing you a continued successful recovery!

[LakeErie]

To answer your first question, no, I am not a health care professional. As to the 2nd question, I was researching online for Dr Lee's name + minimally invasive skull base surgery and and came up with both articles as hits. But I found the articles in August. The NIH data base has millions of articles archived and if you can wend your way through the maze, it can be profitable in information terms.
Shahanian seems to be criticized more for his lack of neurosurgery accreditation than for his outcomes, but I am no expert on him. That said, there are many treatment centers today that do offer minimally invasive AN procedures when appropriate - and from brain surgeons. Dr Lee has 18 years of practice at the Cleveland Clinic and performs all skull base surgeries there.
 Fortunately for me, tumor size was not a barrier to having the type of procedure I wanted. And I found Dr Lee who, at the Clinic, is just 20 minutes from my house. My proximity to the Clinic was why Dr Lee discharged me in 48 hours even with a minor CSF leak. If the leak worsened, I wasn't far away.
Good luck with your situation and your research.