Interesting website about ANs

[Tumbleweed]

Hi, everyone:

Here's an interesting article about ANs:
http://www.dizziness-and-balance.com/disorders/tumors/acoustic_neuroma.htm

There were a couple of things stated as fact that I think were inaccurate. Correct me if I'm wrong, but I  believe the cerebellum is not retracted when middle fossa approach is used in surgical removal of an AN (the article states otherwise). The author also states that complete hearing loss is inevitable over time regardless of the treatment type chosen (even with GammaKnife, with which other literature reports a 60 to 65% success rate of hearing preservation after 6 years). CyberKnife is not mentioned. But besides these quibbles, I found the article to be enlightening. I learned a few things.

Best wishes to all,
Tumbleweed

[sgerrard]

When middle fossa was described to me by my ENT/neurotologist, he said that there is brain retraction involved. I believe it is lifted up, rather than pushed to the side as in retro-sigmoid. According to the House web site, the shorter the period of retraction, the better the outcome.

The hearing result reported is interesting to me. It certainly seems to me that others claim better success than that with hearing preservation, and Mark, a member here, still has his hearing 7 years after CK. The cited reference examined only FSR radiation treatment. They may also be looking at results from the older higher dose protocols.

I always find it odd when some of these reports suggest that treatments that preserve hearing for only 5 years are not worth it - might as well lose it all now. To me, 5 years of hearing is better than none - a lot better, in fact. If we were talking about your right eye instead of your right ear, for instance, wouldn't you choose to keep seeing for 5 more years?

Steve

[Tumbleweed]

Thanks for the clarification on cerebellar retraction vis-a-vis middle fossa approach, Steve. I'm happy I was in error on that issue, because it gives the research more credence and makes it more valuable to us all.

That said, I agree with you about the hearing debate. My experience is that those doctors who are not practiced in CK are pretty clueless about the most current data regarding outcomes. And, yeah, having my hearing for even one more year is enough incentive for me choosing radiotherapy over resection which, in my case, would've meant being deaf on that side immediately post-op.

Best wishes,
Tumbleweed

[Sue]

The radiation oncologist that coordinated with my neurosurgeon that did my GK told me that I'd probably lose all my hearing in my AN ear eventually.  I've wondered about that since.  How true that was, and if all of us would, over time lose more hearing because of nerve damage.  I know that's a downer, but it's just a random thought that floats by now and then. 

Sue in Vancouver USA

[Syl]

My ENT explained to me that when hearing is preserved with both the middle fossa and retrosig approaches, it remains that way for a long time. But she stressed that with age most of us lose our hearing anyway.

With middle fossa, the brain is moved--whether lifted or moved aside, I'm not sure. But, it does involve more moving of the brain than retrosig does, which makes the risk of stroke higher. That's how it was explained to me.

Syl

[cin605]

I found this very interesting as i have developed the titubation"head tremors"
Thanks Cindy

[HeadCase2]

Tumbleweed,
  For middle fossa approach the cerebrum is retracked up and out of the way, since they are trying to access the AN from above.  And for the retrosigmoid approach the cerebellum is retracked, since they are trying to access the AN from behind.  When I see mistakes like this in articles, it makes me wonder about the accuracy of anything in the article.
Regards,
  Rob

[Tumbleweed]

Okay, I've obviously made a mistake here. I went back and scanned the article again, and it said that the "brain" -- not specifically the cerebellum -- is retracted during middle fossa surgery. I guess I just assumed the author was referring to the cerebellum, as I wasn't aware that the cerebrum was retracted using any approach to AN surgery. Thanks to Rob for setting the record straight.

Sorry for the confusion, everybody.

I still question the author's assertions about eventual hearing loss after RS, and I hope he's wrong.

Best wishes,
Tumbleweed