help with types of surgery

[sher]

Hi there,
Can you tell me what the different surgeries are? My ENT described them but not the names of each type. And I am not even sure that he got them all.
Thanks so much,
Sherry

[Kaybo]

Sherry~
I would try to tell you, but I KNOW someone else is more knowledgable and more eloquent...Jim Scott, where are you??   

K

[sgerrard]

I think this is the standard list:

Translabyrinthine Approach: Often shortened to translab. Goes in behind the ear, takes out parts of the hearing and balance organs and cuts those nerves. This sacrifices hearing , but gives a good view of the facial nerve and clear access to the tumor, and the brain is not moved. Developed and preferred by neurotologists, who are otologists (ear doctors) that specialize in nerve related issues and surgery.

Middle Fossa Approach: Goes in over the top of the ear, avoiding the hearing apparatus, but requires moving  part of the brain aside (retraction). The top of the bony canal is removed, exposing the tumor and nerves, and the tumor can often be removed without damaging the hearing nerve, thus preserving hearing. Gives a fairly good view of the facial nerve, especially with smaller tumors.

Retro-sigmoid Approach: Comes in from the back of the head, along side the brain, which is moved aside (retraction). Gives the best view of the brainstem and CP angle, and is the traditional neurosurgeon approach. Often used on larger tumors, especially if they are in the CP angle or pressing on the brainstem. In some cases the hearing nerve can be preserved, though the view of the IAC canal is not as good.

Steve

[leapyrtwins]

Sher -

Steve did a great job of describing the types of surgery.

I just want to note, however, that IMO it's not a fair statement to say that neurotologists prefer translab.  My neurotologist let me choose between translab and retrosigmoid.  I chose retrosigmoid in hopes of saving my hearing and he was absolutely fine with my choice.  He typically does translab and retrosigmoid with a neurosurgeon, so retrosigmoid isn't limited to only neurosurgeons.

Unfortunately, my hearing couldn't be saved because my AN grew and the docs decided to sacrifice my hearing to save my facial nerve and also to remove the entire tumor.  I say "unfortunately" but being SSD isn't the end of the world.  Lots of AN patients live with it every day, or there are alternatives like the BAHA or the TransEar if you simply can't adjust to being SSD.

I am a "non-adjuster" and I chose the BAHA, which is another story for another topic 

Jan

[Jim Scott]

Hi, Sher:

My fellow Moderator, Steve, did a fine job of listing and explaining the three types of AN surgery and their relative pros and cons.  I hope this helped clarify the names and procedures for you. 

Surgeons tend to choose the type of surgery they'll employ based on the size and location of the tumor.  My neurosurgeon chose retrosigmoid because he said it gave him the best 'view' of my AN.  That approach uses mirrors and is familiar to AN surgeons but also very demanding of the surgeon.   In my case, the surgeon debulked the AN which cut off it's blood supply, then worked with a radiation oncologist to plot and utilize FSR (radiation) to shrink it and destroy it's DNA.  Check my signature for the results. 

Jim