House doctors and GK

[Jeff]

There appears to be some shift in philosophy at House. If you check out this page, the additional team members are all House doctors: http://www.goodsam.org/clinical/gamma2team.html
Very interesting.
Jeff

[Mark]

It is very interesting that HEI has finally acknowledged radiosurgery as a viable option earlier this year after publishing many negative views of it in the past. It will be even more interesting as time goes on what people report on their experience with HEI is on this issue. Do they see the GK option as an equal / primary recommendation to newly diagnosed patients or limited to certain applications such as the very old or physically unable to have surgery. It could be a "if you can't beat them , join them " response to the increasing number of people chosing radiosurgery or just adding to their capabilities to handle folks even they won't operate on. They have been the premier surgical shop for AN's for a while and I have a hard time believing this has changed with the addition of the GK. Personally, I think they will still push surgery first but I'll certainly be interested when I hear the first person who goes to Brackman , Hitselberger or Friedman and gets the radiosurgery option suggested first.

Things can change, we'll see 

Mark

[Jeff]

I am treated for NF2 at House. My last telephone consult (we discuss my latest films every 6 months) was a bit surprising. I am in an unusual position in that while I have a 3+ cm tumor, my hearing (now my only hearing ear) is remarkably good. I have chosen to have the tumor removed at some point. My doctor won't do it at this time because my hearing is good. However, when I questioned the wisdom of allowing this tumor to grow, increasing the chances for facial nerve problems, Dr. Friedman said that they would remove part of the tumor and radiate the residual tumor. This was a surprising change from earlier conversations that  have had regarding this subject.

I am aware of two NF2 patients who either were recently treated with GK, or received a recommendation that their cranial tumors be treated with radiation, due to location and probable deficits that would be caused by invasive surgery. I tend to be optimistic in thinking that there may truly be a shift in philosophy, but that may indeed be one of my weaknesses. At any rate, it will be interesting to see what transpires.

Jeff

[Mark]

Jeff,

Thanks for sharing your experience with Dr. Friedman at HEI re: discussions with GK. The surgical debulking of a large AN and radiating the residual is certainly becoming a more common approach to provide a better possibility of nerve function preservation as opposed to total removal. It would seem to be a good option in your case and I'm impressed that Dr. Friedman offered that option. certainly need to see more examples down the road , but I'm encouraged that at least HEI is finally acknowledging radiosurgery as an option

Mark

[rambler]

I had a GK through House. I came in with films showing a 1.5cm AN. The preliminary recommendation based on both size and location was a translab surgery.  However, no decisions were to be made until after further diagnostic testing and GK was always presented as an option.  I did a battery of tests, essentially to understand the effect the AN already had on my various nerve functions, and was preparing myself to accept the translab surgery based on the initial consultation.  Interestingly, in the follow-up session after the diagnostic tests, the GK was presented as a very viable option.  The primary reasons that I understood to apply in my case were the size and location, the fact that I still have hearing (although diminished) in my effected ear, my lifestyle (pretty active) and age.  I am right in the middle ground, where either the GK or the Translab would have been options. If there is a protocol that still seems to be present, it is that if you are younger, the microsurgery seems to be the preferred course of treatment because it removes the tumor and there is no question about longterm effects of radiation treatment.  If you are older or frail, then the radiation treatment is the clear choice.  And if you are very old, wait and see seems to be the typical course.  I felt that I was presented with all of the available options and that me and my doctor took advantage of the best available diagnostic procedures to determine the best course of treatment. I did not feel rushed or pressured.

[pearchica]

Dr. de la Cruz @ House(translab for complete removal) called me every week or so to check in - when I told him that I was choosing Stanford for CK treatment- he asked that I send my 6 month MRI to him. I thought it was interesting at the time because all along, he was somewhat critical of the other doctor's treatment plans (McKennan/ Sacramento ENT who would debulk tumor via tranlab then radiate the rest with GK versus Jackler/ Stanford ENT who would to retrosigmoid and leave sliver of tumor, no radiation). To be fair to de la Cruz he was passionate about surgery ( he's been at it for 30 years and he was very good about pointing out pros and cons of each option).

I'm now wondering if they are thinking of incorporating CK into their treatment options.

Rambler, nice to know that you had GK at House.  Jeff thanks for the post.  Annie