Hi, Bobbi:
Sorry to hear you have had to join our little club, but welcome.
The most common surgeries for a 4cm AN are translabyrinthine and retrosigmoid. Translabyrinthine approach (entering the skull through the ear canal) removes all hearing structures and the vestibular (balance) nerve on the affected side, so it is a given that you would lose 100% of your hearing on that side should you have this surgical approach performed on your AN. Retrosigmoid approach (entering the skull behind the ear) often preserves the hearing and balance nerves anatomically but the function of those nerves often suffers with this approach in removing a large tumor. So, you would probably end up losing your hearing anyway with a retrosigmoid approach. (Dr. Brackmann, famous brain surgeon at the House Ear Clinic in L.A., told me that a retrosigmoid approach to removing my then-1.9cm AN had an "almost non-existent chance of preserving any useful hearing" on the affected side.)
Endoscopic surgery is relatively new. There are concerns in the medical community over the risk of bleeding with endoscopic surgery. That is, important blood vessels have a higher chance of being ruptured, or so the thinking goes.
As I see it, you have two good choices if hearing preservation is a primary goal of yours: 1. tumor debulking (removing most but not all of the tumor surgically, so as not to scrape and therefore damage any important nerves such as the hearing nerve but more importantly the facial nerve), followed by radiosurgery (GammaKnife, CyberKnife or FSR); and 2. foregoing surgical resection and having FSR (fractionated stereotactic radiosurgery) performed by a medical facility that will agree to treat a large/4cm tumor with radiation. The only facility I know of that will treat ANs larger than 3 cm with radiation is Staten Island Hospital (SIH).
It's a difficult choice you face, especially considering you are so young and your hearing is still good. A couple of helpful things to know: first, the risk that radiosurgery will cause malignancy/cancer are deemed to be virtually no greater than the risk for the general population. Second, as Dr. Chang (esteemed Stanford University Medical Center neurosurgeon) told me, the primary goals for tumor treatment are the following, in descending order of importance:
1. tumor control (keeping it from growing, so it doesn't kill you)
2. facial-nerve function preservation (facial paralysis is deemed to be one of the most serious impacts on quality of life)
3. preservation of balance function (vertigo, oscillopsia and/or disequilibrium also have a significant impact on one's quality of life)
4. hearing preservation
So, you can see that hearing preservation is down the list a ways. Not to diminish your rightful concern over preserving your hearing, of course. But my point is that the two options I put forth above for potential hearing preservation should be considered in context of the larger picture.
Every treatment approach carries substantial risk. It sucks that there is no silver bullet. But everyone on this forum has been here, and the vast majority of us have come out okay -- if not unscathed -- after treatment. We're here to help.
Best wishes,
Tumbleweed
