I was diagnosed with a 3cm AN (left side) in June, and have been researching treatment options ever since (including spending a lot of time on this website). I'm 31 years old, and currently have 5% tonal hearing loss (high frequency), and perfect speech discrimination in the affected ear. I have tinnitus, minimal balance problems, and minimal facial numbness as well. Like many, I've sought multiple consultations: Dr. Slattery at the House Clinic, Dr. Chang at Stanford, and Dr. Thompson at the University of Michigan (with UPMC and MEI coming up). Right now, if I were to go with microsurgery, it would be between Dr. Slattery and Dr. Thompson. It's important that I work with a surgeon who completes a "high volume" of AN procedures per year. My first question is, how many AN surgeries does one need to complete a year to be considered "high volume"?
Dr. Slattery completes 300 AN surgeries per year, including 150 translab procedures (his recommendation for me). He has been doing these surgeries for about 20 years.
Dr. Thompson completes hundreds of skull base surgeries per year, including 40-50 two stage sub-occipital/translab procedures for AN (his recommendation for me). He also has been doing AN surgeries for about 20 years and has completed over 900 AN surgeries in his career. Another fun tidbit: according to Dr. Thompson, House Clinic has twice tried to hire him.
Are both these surgeons high volume, or just Dr. Slattery? Is Dr. Slattery significantly more qualified than Dr. Thompson, or at some point is there some law of diminishing returns with AN surgical experience and they are about the same? U of M is 5 minutes from my house and in my insurance network. Is it worth it to fly to LA when I have Dr. Thompson in my backyard?
You can also see that each surgeon recommended a slightly different approach! Dr. Thompson said that recent findings have shown that a two stage approach (sub-occipital first, translab second) has a better likelihood of facial nerve preservation because you can see the nerve from two different angles. When I told this to Dr. Slattery he said he, "didn't understand" this strategy because the entire tumor could be removed with translab and a sub-occipital approach could damage the cerebellum. I then conveyed this back to Dr. Thompson, who said that there was no way "in modern surgery" one could damage the cerebellum with a sub-occipital approach, that it has not only never happened in his career, but never happened in the history of the neurosurgery department at U of M.
He went on to say that House Clinic is a great place with great surgeons and I would be in good hands if I chose to go there. However, he knows the surgeons personally and knows that they usually do just middle fossa or translab, and not the two stage at this time (which he says is best). He noted that U of M has the best hearing preservation outcomes for middle fossa (84%) with House Clinic Second (68%). I can verify that the U of M outcome data were published in the journal "Neurosurgery". Even though I'm not a candidate for middle fossa, the idea is that a surgical team can't be excellent at one approach and not the others. Thus in this case, does sheer volume of cases necessarily trump everything else when it comes to treatment recommendations?
Both Dr. Slattery and Dr. Thompson were incredibly nice. Both gave the "if it were my brother I would do X" statement regarding their recommendation. Its a very hard choice because I am not sure how to compare their level of experience and expertise.
What a long post! Sorry about that. I also have questions about radiation (what Dr. Chang recommended), but I will post those questions next week after I speak with UPMC. Thanks in advance for reading and providing any thoughts or feedback!
Adam
