ENDOSCOPIC SURGERY

[v357139]

Has anyone had surgery at the Skull Base Insititute, Dr Shahinian?  They make some great claims.  Wondering if it is for real.

[v357139]

Also, has anyone had with Dr Jho or Dr Fields?

[Jim Scott]

I suggest you do a 'search' using endoscopic and that will deliver all the posts regarding the subject including those from endoscopic AN patients who were quite pleased with the results.

Jim

[v357139]

Thanks Jim

[mesafinn]

I was diagnosed with an AN about two months ago, and I looked closely at the endoscopic surgery option.  I could only find two individuals in North America who did this procedure--Dr. Shahinian in LA and Dr. Jho in Pittsburgh.  I had a long conversation with a woman who did her procedure with Dr. Shahinian and sang his praises.

But I also must say that I spoke with nearly a dozen neurosurgeons, and I asked each one about this approach as I was quite interested in the possibility.  I can only share that 100% of them said to "turn and run" at this approach and that these doctors were "not to be trusted."  They would never elaborate when prompted but said that under no circumstances should I consider this approach for my AN.

That was my experience.  I opted for GK, but there was a disconnect between the claims of a few doctors (and the one patient I spoke with) and the strong feelings of all the others about endoscopic surgery.  Perhaps someday this will be a routine procedure but it is not widely accepted at this point.

[v357139]

Seems some people have had it, and done well.  I've heard there were bad results also, but only second hand.  All the traditional doctors seem to be against it.  I think they are too closed minded.  Makes it very hard to go for though, with all these regular doctors against it.

[PaulW]

You know what they say about things that appear to be too good to be true.
The cost... Why is it so expensive?

Ask yourself this.
Endoscopic surgery normally takes less time to recover because less muscles are cut, fewer nerves and blood vessels.

Now think about a craniotomy. Not many muscles or nerves to cut through at all.

Does making a slightly bigger hole in the head as opposed to a smaller hole actually change recover times or problems?
Probably very little. So what is the real advantage of a small hole?

Do other surgeons use endoscopic tools to remove the tumour? YES.
Most use snake like micro nibbling tool things.
Does having a camera on the end of the tool versus an operating microscope really help?

How do you do the nerve monitoring through a tiny hole, which is crucial to facial paralysis, hearing preservation, and maximum tumour removal?

What are the credentials of the Dr.
How long have they been a neurosurgeon or an ENT.

How many surgeons are present?

Typically there are a neurosurgeon an ENT, somebody monitoring and stimulating the hearing and facial nerve, a bunch of theatre nurses and an anaethetist.

I think it is worth asking some of these questions.

There is no doubt that endoscopic surgery is better in many situations. But is it better in this situation?

What happens if there is a large bleed, how is this handled.
Worth speaking to other surgeons too for their opinion.

Why are so many surgeons opposed to it... Is it the ethics and the money not just the procedure?

Is endoscopic AN removal at high costs just a sell job appealling, to the non medically informed, with little if any benefit?

[LakeErie]

I had a minimally invasive retrosigmoid AN removal. Because the tumor was large, the opening was the size of a quarter. For smaller tumors, my surgeon uses a dime sized opening. This is often referred to as "keyhole." My surgery was done completely with an operating microscope, no endoscopes. Some surgeons use endoscopes and some surgeons use both instruments combined when performing "keyhole" brain surgery.
I chose the minimally invasive approach because it involved far less time under anesthesia, no time in an ICU, faster recovery, less time in the hospital than "open" procedures, and a demonstrated success rate. My surgeon had used his own minimally invasive approach 600 times for AN's, and a similar number of times for C-P Angle meningiomas. I was in surgery less than 3 hours, in a regular neuro floor room less than 7 hours after the operation, up and walking in under 24, and discharged in under 48 hours.
The "keyhole" approach is used and described at neurosurgery centers like Johns Hopkins, UCLA, Cleveland Clinic, Mayo Clinic and around the world. I had no problem choosing minimally invasive surgery when it was presented to me, and I did have an open treatment plan presented to me by a House trained neurotologist and Barrow trained neurosurgeon team. If I had the same decison to make today, it would be the same.

[leapyrtwins]

As Jim mentioned, there are lots of posts on the Forum about SBI and Dr. Shaninian (who BTW is a somewhat controversial doctor).  Us "old timers" remember the posts well 

Those who have been to Dr. S and/or Dr. Jho all seem very happy with their outcome but endocopic surgery for ANs still isn't the norm.  Will it be one day?  Possible, but hard to tell.

Most docs - my neurotologist included - will tell you that they won't feel endoscopic is the way to go because it doesn't allow the surgeon to see a brain bleed should it occur.  It's not common in AN surgery, but it can happen and they feel that surgery involves enough potential risks in itself without adding to the list.

My surgery was the conventional retrosigmoid approach and I don't feel the hole in my skull is all that large.  Probably no more than a 2" x 2" square.  It's definitely not "key hole" but it's not horrendously large either.

Jan

[v357139]

I had a minimally invasive retrosigmoid AN removal. Because the tumor was large, the opening was the size of a quarter. For smaller tumors, my surgeon uses a dime sized opening. This is often referred to as "keyhole." My surgery was done completely with an operating microscope, no endoscopes. Some surgeons use endoscopes and some surgeons use both instruments combined when performing "keyhole" brain surgery.
I chose the minimally invasive approach because it involved far less time under anesthesia, no time in an ICU, faster recovery, less time in the hospital than "open" procedures, and a demonstrated success rate. My surgeon had used his own minimally invasive approach 600 times for AN's, and a similar number of times for C-P Angle meningiomas. I was in surgery less than 3 hours, in a regular neuro floor room less than 7 hours after the operation, up and walking in under 24, and discharged in under 48 hours.
The "keyhole" approach is used and described at neurosurgery centers like Johns Hopkins, UCLA, Cleveland Clinic, Mayo Clinic and around the world. I had no problem choosing minimally invasive surgery when it was presented to me, and I did have an open treatment plan presented to me by a House trained neurotologist and Barrow trained neurosurgeon team. If I had the same decison to make today, it would be the same.

My lord there are a lot of different choices and things to think about out there.  No one offered a minimally invasive approach here in NY, and I've seen 6 doctors.

[nftwoed]

  "No one offered a minimally invasive approach here in NY, and I've seen 6 doctors."


   Gee; Does this mean the approach is really not universally catching on except minimally in isolated areas of the country? It isn't.

   It is inherently more dangerous than the tried and true. It only requires one pt. bleeding out to hit the media, and bye, bye, MI! One can't repair bleeds with an endoscope through a dime size hole. For one thing, the field of vision is lost.

   Must admit there have been a few, very fortunate pts!

[euda]

I have just read your post on the dangers of endoscopic surgery in 2013 I think.  It was such a scary post that I am curious to know if you had actual stats on the number of patients who have died during this "bleed out" that can't be seen and corrected during the endoscopic approach?  Thank you.

[ANSydney]

In answer to your question regarding how many have died, for any reason, from endoscopic surgery, it appears to be zero (in 790 studied cases). The following table is from the meta-analysis at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375046/pdf/10-1055-s-0034-1383858.pdf



So although death from a "bleed out" may be a severe outcome, it just isn't likely. It's similar to a malignant transformation from radiosurgery; severe, but very unlikely. In fact, death from conventional surgery is more likely than death from endoscopic surgery or malignant transformation from radiosurgery.

What I like is the facial nerve outcome following endoscopic surgery (6% failures) compared to open retrosigmoid (33% failures). Open retrosigmoid is 5.5 times worse for poor facial nerve outcome than endoscopic retrosigmoid. Just about any other consideration favors endoscopic over open retrosigmoid surgery.