Hi again, JCM's wife:
Steve raises a salient point: it isn't the size of the AN tumor, it's the location. Sort of like the old cliche about assessing the value of real estate: 'location, location, location'. My surgeon said that were the tumor in a different place, where it didn't compromise vital nerves, they would ignore it as it's small and, thankfully, benign. Surgery carries manifold risks, as you would expect, and some patients, like Nancy, do not have positive surgical outcomes. I believe that this unfortunate situation is often due to the exact placement of the tumor as well as the skill and experience of the surgeon(s) and surgical team involved. This is extremely delicate surgery and I believe it takes hundreds of such operations for a neurosurgeon (and his or her team) to become proficient enough to successfully deal with any and all possible problems he or she may encounter when the tumor is finally exposed. However, even the best surgeon cannot always foresee nerve damage that sometimes results from attempting to remove every last bit of the often-sticky tumor material from the vital nerves where it resides.
This is why my neurosurgeon, a doctor with over 30 years experience in removing AN tumors,, opted for 'de-bulking' the tumor, cutting off it's blood supply and making it small enough to radiate. We followed that surgery, which ended my symptoms, by 26 FSR treatments that seem to have been successful. The AN is shrinking and recent MRI scans show definite signs of necrosis (cell death). However, my AN was much larger than your husband's. I recommended my surgeon to another poster who lived in my state (Connecticut) and had a small AN. The doctor evaluated him and recommended radiation. That AN patient recently let me know that he had the radiation and is doing fine. With the small size of your husband's AN, I suspect most doctors will recommend radiation, be it Gamma Knife, Cyber Knife or FSR. As I've cautioned and any reputable doctor will verify, even with non-invasive radiation, facial nerves can be damaged and complications can ensue. However, most AN patients who undergo radiation treatment to kill their AN do just fine, as members of this forum can attest. Yes, an AN tumor can grow back and this occasionally happens. The tumor can be radiated again, in most cases. However,when this happens most patients become somewhat paranoid of another re-growth and opt for surgery. Yet, even surgery does not always remove every cell of the AN tumor and there are cases where re-growth has occurred some time after the surgery that was supposed to 'get it all'. This is why I went for the surgery + radiation approach. My doctor explained that the surgery would reduce the size of the AN (he described it as 'huge', and was alarmed when he saw the original MRI scan) and the FSR would kill the remaining tumor cells. It's a double-barreled approach that has proven successful.
Frankly, waiting can be risky, in some cases. AN tumors do tend to grow very slowly. My doctor estimated that mine was 'probably' growing for at least a decade. Yet there are cases - documented on this forum - where the tumor showed an almost exponential growth 'spurt'. Obviously, the bigger it gets, the worse your husband's symptoms will get and the harder it will be to either remove it surgically or kill it with radiation. While there is no need for panic, I would be careful about playing the waiting game. In most cases (not all) lost hearing does not suddenly return when the tumor is removed or radiated. It might improve, but some permanent loss is almost inevitable. This is a hard fact of acoustic neuroma tumors. I did fine on most counts but lost all hearing in one ear. Few AN patients escape the experience with a 100% recovery. I consider myself to be one of the lucky ones. My balance is good (about 90% of normal), I have no facial paralysis, no eye problems and you would never know I had a very large AN tumor inside my skull a few years ago. I credit God, prayer, a strong physical constitution, great support from my spouse and a splendid neurosurgeon and team of assistants along with a very skilled radiation oncologist that all combined to bring this aging fellow through a difficult ordeal that could have been a lot worse. It's behind me now and I just want you and your husband to know that while having an acoustic neuroma tumor can be what amounts to a minefield, it can be conquered and life return to normal. I trust this will be the case with your husband.
Jim
