What's inside the IAC ? and contrast.

[bobster755]

Besides the 3 nerves that run through the IAC is there anything else like brain matter or muscle material or is it empty with only blood ? Reason for asking is my AN is very small but is causing plenty of symptoms which I understand can be normal. I figured it may be putting pressure on my facial nerve without really touching it. I'm in the VA system and I was not given any real information. I've only one had one visit with the ENT after my first MRI. My second MRI 6 months later came back as unremarkable. They scheduled my next MRI next year in Jan. I started with sudden hearing loss in march 17. Got 80-90% back. I lost 15% over the past year but still considered moderate loss mostly high end. My T is so loud I can't hear the high tones. My VA audiologist was wondering why I was not shown my MRI results. I've started having more frequent facial symptoms almost Daily coming and going. I was wondering if I could have facial symptoms without the AN actually touching the nerve but somehow putting pressure on it .   I did get copies of my MRI's . I don't see a measurement tool. It looks like a grain of rice.

2 . About 10 days after my second MRI w/contrast I woke up with sharp pain in my right temple (opposite side of AN) . Really weird symptoms of numb spots , red blotches, and getting sore bumps on my scalp with daily headaches which lasted for 3 months but has cleared up recently. I'm on blood thinners for AFIB so the VA advised a CT scan to look for blood clots or bleeding. Nothing was found. My gut says it's the contrast but of course it's speculation. But I'm a little scared to do contrast again and go through that misery again.  I see they scheduled my next mri with contrast again. Do they really need contrast again? I've read quite a few people refusing which I think I'm going to do.

[ANSydney]

Contrast is good for the first (diagnostic) MRI. I see no reason for it in any follow up MRIs. I don't have contract and the tumor is clearly visible.

[bobster755]

Thank you for your Reply AnSydney .  I've read quiet a few of your posts and looked at the articles you've posted. Some articles are difficult to understand and a bit long winded. Your AN is quite large. Your very solid in your approach and resolve. It's really a roll of the dice when it comes to treatment. It comes down to saving the facial nerve. Hearing comes 2nd. One abstract I saw had around a 50% stop growing after 4 years. I figure mine must be approaching that 4 year mark. So I figure it's 50-50. My age and health pretty much dictates CK if it comes down to it. I wish you the best of luck.

[ANSydney]

"Thus, tumor growth occurring beyond the fifth year of observation is very rare, but is, however, still observed" https://link.springer.com/article/10.1007/s40136-014-0064-7

[golfguy49]

I have consulted with 4 world-class surgeons and they all got a little upset with me because my #2 out of 4 MRIs did not have contrast (I refused it but then went back to it for 3 and 4).  It affects their ability to consistently monitor the changes from one scan to the next.

I am 48 and my Dr said no way would he do gamma knife.  Too many years for it to start growing again and then surgery can be very difficult if needed (texture of tumor makes it difficult after GK). 

[Greece Lover]

My understanding is that inside the IAC there is fluid along with the nerves.  I think its basically kind of like CSF fluid.  The tumor slowly pushes that fluid out.  One of the predictors of whether a surgical approach can save hearing is whether any of that fluid is still present in the IAC.  Google "Fundel fluid cap" and you can find articles on it.

My understanding is that most Docs will want contrast for the MRIs, at least that's been my experience.

[ANSydney]

I have consulted with 4 world-class surgeons and they all got a little upset with me because my #2 out of 4 MRIs did not have contrast (I refused it but then went back to it for 3 and 4).  It affects their ability to consistently monitor the changes from one scan to the next.

I am 48 and my Dr said no way would he do gamma knife.  Too many years for it to start growing again and then surgery can be very difficult if needed (texture of tumor makes it difficult after GK).

Take a look at your MRIs. You will be able to clearly see your tumor in any T2 image with fast spin echo or similar. My last referral to an MRI requested by a different doctors was with contrast so I wrote back asking for a different referral. I collected articles supporting my argument but they were not necessary as the doctor just changed the referral to exclude contrast. The MRI place receptionist had commented that the contrast number have declined.

[golfguy49]

I just can't play Dr. with this thing, and wouldn't encourage others to play Dr. either.  Radiologists and surgeons are super smart, they spend years and years and hundreds of thousands of dollars learning how to do it right.  I leave that sort of detail to them - reading MRIs is certainly one of many areas where I won't second-guess a Dr...especially 4 of them.

[ANSydney]

I just can't play Dr. with this thing, and wouldn't encourage others to play Dr. either.  Radiologists and surgeons are super smart, they spend years and years and hundreds of thousands of dollars learning how to do it right.  I leave that sort of detail to them - reading MRIs is certainly one of many areas where I won't second-guess a Dr...especially 4 of them.

I agree don't play doctor. However, don't be afraid to do your own research and have a peek yourself. The need, or not the need, for contrast agent is well documented.