Jason,
I guess first I would make the same statement that "4 cm" did in a prior post. I think I know the AN "players" at Stanford pretty well and I've never heard of Murray. I checked the web site for both Neurosurgery and Otolaryngology and he is not listed. So, unless he is really brand new, he is not on the faculty at Stanford. Is it possible he works with Roberson at the California ear institute? Doesn't mean he isn't a good surgeon, but as "4 cm" said Jackler would be the most experienced AN surgeon at Stanford and he usually works with Harsh or Chang.
In terms of the surgical route being used, Clearly TL would make hearing preservation a moot point. The other traditional option would be the "retro sig" approach which is what I was considering. Jackler and Chang both gave me about a 10-20% chance of saving usable hearing with that approach for a 2 cm. Those odds drop as the tumor size increases with surgery. Radiation results , on the other hand, are not size dependent. If you have very usable hearing today and attempting to maintain it , then you should talk to someone who understands it well at Stanford which would be Adler or Chang. If you are more comfortable with surgery, then , in my opinion, I would not bet the odds on the hearing being saved at the expense of the facial nerve and most docs seem to feel the TL approach gives better outcomes in that arena.
As far as 2.5 cm being "too close to the brain stem", while I'm not a clinician by any means I've never quite understood why that gets used as an issue so often. I'm pretty sure every one with an AN has them essentially start in the same area, grow in the CP angle and begin to push on the Cerebellum. It's all size driven in my mind and that's one of the reasons radiosurgery is usually limited to 3 cm and smaller. At 2 cm, mine was just touching the cerebellum, at 2.5 it would be making a noticeable indent, etc. On the other side of the coin, I think it would be uncommon for an AN to be pushing on the cerebellum in any meaningful way below 1.5 cm. I have a hunch that some surgeons throw that one around to mislead people on radiosurgery like they do the malignant transformation issue. Just my two cents there, but in your case, a 2.5 cm would be impacting the cerebellum enough that a good radisourgeon needs to evaluate it.
At the end of all that, if your hearing is an issue for you, then yes, I would revisit the radiosurgery option with one of the folks I mentioned and make sure your comfortable going forward with surgery. If you do elect the surgery, I think the odds of hearing preservation are low and I would focus on the facial nerve preservation odds.
good luck
Mark
