Mary,
Thanks for sharing your story on how you made a decision for surgery for your mom's AN. I can only imagine how difficult it was to consider that option given her age and prior surgical history. I'm glad to hear she came through the operation OK and you're satisfied with the outcome. Her initial size of 3.5 cm certainly put her on the extreme edge of what radiosurgery has treated to begin with and the sudden increase to almost 4.5 would have made surgery a necessary choice from my standpoint. I know Dr. Rosenberg has been using CK's improved targeting and accuracy capabilities to expand what has been considered the traditional limit in size for other machines. He has claimed some very good initial results, but there is not a lot of data at this point. While AN's do not grow in a linear fashion , they do average about 2mm per year as you noted. 7mm is the equivalent of a 3 year spurt which is dramatic and would certainly be a concern. Did the Doctors at HEI do a biopsy, just in case?
I did have a couple of other questions from your post.
Who is this ANAWAY group? You certainly seemed to put a lot of trust in their opinions and I would be curious to see what is said there. It appears to be a yahoo group but when I clicked on it it came back as nonexistent. If you have a link could you send to me, I would appreciate it.
In reading your comments about the visit to Dr Rosenberg / Shaefer it seems to me that terminology confusion came into play . CK is a machine, like GK is a machine. FSR is a protocol which means the dose is delivered in fractions as opposed to a single treatment. CK is a machine that can perform either single dose or Fractionated (FSR) treatment plans. I'm pretty sure they had the same opinion but were focused on different aspects. It's unfortunate that you left the visit feeling otherwise.
I think virtually all neurosurgeons who also use radiosurgery don't utilize it very much above on AN's above 3 cm . That is not an opinion unique to HEI. As some of the machine technology such as CK evolves that limit may change but at this point I think the 3 cm size is pretty standard. I was intriqued by your comment that HEI is not against radiosurgery. I am curious as to what leads you to feel that way. They do not practice it so it would involve sending business away. Their web site clearly dismisses it with very poor documentation. Every interview or panel discussion I have read from any of their doctors provides misinformation or what I would term a back handed acknowledgement of it. I've never heard of any patient going there for a consult being pushed to do radiosurgery. If something has changed in their view of radiosurgery I would value your feedback as to why and change my opinion. I certainly acknowledge and recognize their world class experience and expertise in surgical removal, but, to this point, not as source of unbiased or even accurate information on both options. I think HEI is a great place to contact after you've decided to have surgery or want to understand that option better.
Again, thanks for your excellent post on your experience and best wishes for your mom's continued recovery
Mark
