Capt Deb,
I also downloaded and read the Rutherford -King article and would agree with most of your post , but wouldn't draw the same conclusions as you on the facial nerve issue. It is an excellent study and well worth everybody's time to read who is exploring their options.
I would absolutlely agree that in the surgical option the best results tend to be limited to those who have done a tremendous amount of procedures, such as HEI. The large variabilty in surgical results is directly tied to the experience of the doctor involved. Radiosurgery on the other hand offers a more consistent outcome regradless of the expereince level
From Page 314
" A more pragmatic approach would be to recognize that most surgical units can not aspire to these figures, whilst radiosurgeons are able to reproduce their figures across different units with ever increasing consistency. Patients have been voting with their feet and having been given the option, radiosurgical practice for vestibular schwannomas has taken off in the last decade"In the next paragraph
" this may, however, mean that to continue to advocate surgery, one will have to offer patients surgical results comparable to the best published series"This would clearly indicate, to your point , that unless you go to someone such as HEI or a doctor of similar training and experience , surgery is a much riskier proposition than radiosurgery. No argument there.
I'm not sure I follow the "surgery was a better choice for facial nerve preservation" statement.
Referring to surgery on page 311
" The large series with the best reported facial nerve function consistently quote greater than 95% of patients with small tumours retaining Grade 1 or 2 function. However it is well regarded that such figures are not reproducible in larger tumors or in the early part of a surgeon's learning curveAgain this reinforces to get the most experienced surgeon for the best facial nerve results but that even with the best the odds go down as the AN size goes up.
In addressing radiosurgery preservation further down it references the "early days " of radiosurgery as having facial weakness between 8-32 % of the time which is what I suspect you picked up on. However, at the end of that paragraph after addressing the refining of doses and improved software it says
" More recent publications show rates of permanent facial injury under 5% and even as low as 1-2%. The fact that these results are now being consistently reproduced is a powerful argument for this technique"That sounds like the authors are making a case that radiosurgery has less risk to the facial nerve than surgery which is consistent with all the studies I've seen
In terms of tumor control
on page 310 referring to surgery regrowth the authors write
"one series that has assessed long term tumor recurrence rates reported a 9% regrowth rate 11.5 years after initial gross total resection. A further report published in 1996 ...... stated that 8% of patients had evidence of tumor on postoperative imaging"Further on that page in discussing radiosurgery
"Several large series quote the precentage of tumors that shrink or remain static to be 85-94%. The primary clinical endpoint is remaining free from surgery and this percentage is usually higher, between 92-98%. The most recent publications with the longest follow up data continue to support these figures in tumor control"In regards to Quality of life on page 313
" Comparative studies have more recently been produced , looking at surgery, radiosurgery and conservative management. These have confirmed that the greatest negative impact on quality of life is from surgery"So, I would agree that if one chooses surgery in the hands of a talented , experienced AN surgeon such as House, they can provide those with smaller AN's better outcomes for Tumor control,and hearing -facial nerve preservation. However, to suggest that was a better option than radiosurgery to achieve the facial nerve priority in general would not be accurate from my reading of the article.
I would never want to disagree with my cruise captain, but in this case, I have to take exception to a statement that "radiosurgery gave me a greater risk of facial weakness, even in HEI. The article and the percentages in other studies don't say that
Oh boy, now I'll have to walk the plank or be keel hauled
Mark
