Who does what during surgery?

[BlueSky]

I've only started researching my treatment options and I've seen usually people who go into surgery have a neurotologist and a neurosurgeon team. My question is who is in charge of doing what during surgery? What does the neurotologist do vs. the neurosurgeon?

[jenichol]

I am having a retrosigmoid approach, and the way understand it, the neurosurgeon will do the approach to the tumor and removal of the tumor from the vestibulocochlear nerve (hearing and balance nerve) in the area of the brainstem and pons.  The neurotologist will drill into the auditory canal to get the rest of the tumor from that region.  The neurotologists are specialists in surgery of the ear, which goes deep into your head and is housed in the temporal bone, that is, the outer,middle, and inner ear.   Whereas, the neurosurgeon specializes in surgery of the brain and nerves.   I would recommend looking at the anatomy of the ear and cranial nerves as it relates to acoustic neuromas.  There is a wealth of info on-line to check out.  Cleveland Clinic has a nice website with good pictures to help you understand. 

Somebody please correct me if I have this wrong.

Jan

[LizAN]

I am having a retrosigmoid approach, and the way understand it, the neurosurgeon will do the approach to the tumor and removal of the tumor from the vestibulocochlear nerve (hearing and balance nerve) in the area of the brainstem and pons.  The neurotologist will drill into the auditory canal to get the rest of the tumor from that region.  The neurotologists are specialists in surgery of the ear, which goes deep into your head and is housed in the temporal bone, that is, the outer,middle, and inner ear.   Whereas, the neurosurgeon specializes in surgery of the brain and nerves.   I would recommend looking at the anatomy of the ear and cranial nerves as it relates to acoustic neuromas.  There is a wealth of info on-line to check out.  Cleveland Clinic has a nice website with good pictures to help you understand. 

Somebody please correct me if I have this wrong.

Jan

That's my understanding as well:  the neurotologist makes way to the tumor, and the neurosurgeon removes the tumor.  That may mean that the neurotologist is the bone surgeon and the neurosurgeon works on the nerves.  I'm not sure it's quite that simple.  All that said, I think this is what they are trained to do, but not necessarily what they do in practice.  When I talked with a local neurosurgeon, he said they liked to trade off on the different jobs, and that made me nervous.

Liz

[leapyrtwins]

Pretty much the two docs take turns; AN surgery is a long procedure and docs like to give their eyes a break - as they are working through a window in the skull, using a microscope.  The tumor itself is peeled away layer by layer - as opposed to just being cut out.  I'd have to go back to my operative report to see just who did what; but I know in my case that my neurotologist stitched me up once my AN was removed.

Jan

[Jim Scott]

Perhaps I'm an anomaly but my 9-hour AN (Retro) surgery was performed by two neurosurgeons, working in tandem.  No neurotologist or otolaryngologist was present.  Both had extensive AN surgical experience and the operation was very successful with no complications. 

Jim

[nftwoed]

Hi;

  I agree with Jan. Jim is an "anomaly". Does that hurt, Jim? I'm kidding... Glad you came through well!

[BlueSky]

Thank you for your replies. From the what everyone has wrote, the most common thing is they both take turns removing the tumor so you want both an experienced neurotologist and a neurosurgeon who works with AN's.

[leapyrtwins]

Hi;

  I agree with Jan. Jim is an "anomaly".

Did the other Jan say Jim is an anomaly?  Because I didn't.

Jan

[Rob85616]

I also only had neurosurgeons for my Retrosigmoid approach also on a golf ball sized tumor.  I had one surgeon removing my tumor while 2 other surgeons monitored my nerves.  My outcome has been really good to date (surgery was 3/21/12).  Balance is back, no facial paralysis, no headaches to speak of, I have some minor numbness still on my cheek, lips and tongue (along with some loss of taste & a burnt tongue sensation of the right side) that is still improving, and of course some hearing loss - but not 100% loss.  I see the audiologist tomorrow to see what % that is currently.  I am hoping that will improve somewhat also!   I only had a slight hearing loss pre-surgery so I'm not giving up hope that it will get better with time!  Good luck to you!!
Cathy