Tumor debulking and Gamma knife radiation?

[LizH]

Hi All,

How are you all doing?
I met my new neurosurgeon yesterday. She wants to debulk my tumor using the suboccipital or retrosigmoid approach and give me Gamma radiation afterwards. What do you think?
I asked about cerebellum retraction (movement of the brain) and she siad that I am experiencing that now since I have a big tumor (about  3.8cm in diameter).
I read somewhere that when the retrosigmoid approach is used a retraction is also performed and that makes it difficult to regain vestibular functions. She siad that is not true. I am confused now. Effiya

[MAlegant]

Hi there,
My tumor was about the same size as yours.  They used the retrosigmoid approach and did not need to cut the vestibular nerve.  This, I think, was because of tumor location.  I seem to have retained much of my hearing in my AN ear. Also, my doctor intended to do the same--debulk first, then go back with GK--was able to remove the entire tumor.  I'm 4 weeks post-op and doing just fine.  Better every day.  Good luck.
Marci

[Pooter]

I think it more depends on location than approach taken.  I had retrosigmoid surgery about 3 months ago and I've never had any major balance issues before or after surgery.  I was told they may debulk and do radiation after the fact.  Jim had this done and by all accounts, he had a perfect outcome (after 2 weeks mind you).  He had FSR treatment afterwards not GK, but the result was great.  Let's hope that they can get it all during the surgery, and all this becomes moot.  I tend to agree with your doctor that whatever approach is used doesn't impact vestibular functions returning in the least.

Brian

[LizH]

Thanks to you Marci and Brian. I have major balance problems now. We will see. I go back to see the Neurosurgeon on Wednesday next week. She wants to have a discussion with the Radiation Oncologist who gave me FSR 7 years ago before she sees me.

[Jim Scott]

LizH:

HI!  I'm the 'Jim' Pooter referred to and I underwent retrosigmoid AN surgery followed by (planned) radiation. 

The neurosurgeon did have to retract my brainstem 'slightly' (his words) but assured me this would not have a deleterious effect on my recovery.  It didn't.  My balance was poor pre-surgery but did return, albeit slowly and with some work on my part.  I had already lost all hearing in the affected ear (my left) so that was not an issue.  The neurosurgeon used the 'retrosigmoid' approach mainly to better access the tumor.  He originally presented me with a plan that was largely based on saving my facial nerve from damage, as I had almost no facial symptoms, pre-op. That plan was simple: to debulk (hollow out) the AN, cutting off it's blood supply, then, after a 90-day 'rest period' (the doctor's words, again) have me undergo FSR to destroy the tumor's DNA and effectively 'kill' it. Using an MRI and a CT scan, He teamed with a very talented radiation oncologist to 'map' the FSR to avoid any radiation damage to crucial nerves or brain tissue but to 'hit' the remaining AN, which, by then, was about 2.5 cm (down from it's original 4.5 cm, pre-surgery).   The FSR treatments were spread over 26 days, approximately 20 minutes per day, done as an outpatient.  I had no problems with the radiation unless you count boredom and the 62-mile round-trip I had to take each day to get to the radiation center. 

I trust this account of my experience is of some help as you move toward a decision.  I would question your doctor on whatever you don't understand because this is a big decision and you need to go into the surgery with confidence, not ignorance or doubts.  I strongly suggest you attempt to do as much research as you can on this surgery/radiation approach.  It worked very well for me but that is no guarantee you'll have the exact same experience.  I understand that this approach - debulking/radiating large ANs - has been used effectively at Massachusetts General hospital for some time.  At the time I went into this (2006), my radiation oncologist said he had never seen a failure with this procedure, meaning, the AN always 'dies'.  That convinced me to go that route but you have to do your own research and satisfy yourself that this is the right way for you.  I can recommend it but only as a patient (not a doctor) and only in a very general way, because I had a splendid outcome (my neurosurgeon said I'm in his 'top 5%' for rapid recovery and positive results) and my own feelings on the efficacy of this approach on large ANs.  Again, I hope this information is helpful to you. 

Jim

[LizH]

Yes Jim, many thanks. Your account was very helpful to me, especially in view of the fact that you had a big tumor too and had balance problems pre-op, just like me. My neurosurgeon wants to debulk my tumour to save my facial nerves which she says are very sensitvve and does not want to touch them. She spoke of the 7th nerve a lot. I met with her yesterday and asked her a lot of questions, which she answered to my satisfaction. I think they are very good at Massachusetts General and wish I could do my surgery there. Unfortunately, I can't afford it. I don't know about the Toronto Western Hospital here in Toronto, Ontario, Canada. We will see how things go. I will consult with another neurosurgeon in another hospital mid next month. I will ask this doctor many questions too, that way I can compare notes based on his answers. I wish i could see him earlier. Thank you Jim. Cheers! LizH