Author Topic: Help understanding Post-op report  (Read 5647 times)

msswartz

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Help understanding Post-op report
« on: January 29, 2010, 01:56:16 pm »
Hello,

Perhaps this is the wrong section for this, I don't know.  But if any medical professional can give me their opinion or explain what all this means, I'd appreciate it very much.

Pre-op MRI
http://www.itsupportnet.com/surgery/tumorpic.gif

Post-op report
http://www.itsupportnet.com/surgery/surgery_report.txt

Thank you,
Michael

Michael Swartz
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ppearl214

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Re: Help understanding Post-op report
« Reply #1 on: January 29, 2010, 02:55:29 pm »
Michael

In NO way am I a doctor... nor did I sleep at a Holiday Inn Express ;) last night.... I'm going to give it a shot but.... it really is up to the surgical team to discuss the Op Notes with you.

From what I can tell, in order to gain access to the AN, they had to drill a small hole in the IAC to get good access to it to get the best removal angle after looking at it on the 8th cranial (8th cranial was tough angle to attempt). They did fill the hole drilled in the IAC with fat and the 7th Cranial nerve was responsive during the procedure.

to me.. and again, NOT a dr... they tried from one angle... couldn't get at it from that angle, made another attempt from different angle which worked.

real laymen attempt for me.... but please discuss directly with the dr, as the team was "there" during the procedure and know exactly what they saw vs. typed notes.

Phyl
"Gentlemen, I wash my hands of this weirdness", Capt Jack Sparrow - Davy Jones Locker, "Pirates of the Carribbean - At World's End"

msswartz

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Re: Help understanding Post-op report
« Reply #2 on: January 29, 2010, 03:35:22 pm »
Hi,

Thanks for your good shot at explaining the report to me.  I wrote an email to the doctor and this was his reply

"I have no adequate recall of the operation, but have copied the operative report done immediately after the surgery. I hope it helps you."

And that's all I've got! :)

Michael

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ppearl214

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Re: Help understanding Post-op report
« Reply #3 on: January 29, 2010, 03:46:56 pm »
Michael, well, he must be a VERY busy man to respond to your email as such. 

As for my read on it... was hoping he would clarify better for you. If you see him for a follow up, quiz him. Your head and surgical outcome... ask him.

hopefully he'll be more responsive if he sees you face to face.

sorry can't be of more help.  From what I saw on the notes, it was pretty uneventful, no major issues... only concern was which angle to do the AN removal.... they attempted one way.. didn't work, attempted another and it worked.
Phyl
"Gentlemen, I wash my hands of this weirdness", Capt Jack Sparrow - Davy Jones Locker, "Pirates of the Carribbean - At World's End"

msswartz

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Re: Help understanding Post-op report
« Reply #4 on: January 29, 2010, 03:53:41 pm »
yeah,

He has been very business like and cold.  I don't know how to read him.  And his answers have always been very short, to the point and devoid of any compassion or understanding.  But be that as it may, I believed that he was the most skilled person available to do the procedure at the time in the healthcare system I belong to.  So even if he is very businesslike, as long as he did the best job possible in the circumstances, I'm pretty ok with that.

But I wonder what happened to the 8th nerve and what that means?  Also, if the 7th nerve tested ok, then why is my face so broken? I am a little confused about that part.

Michael

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lori67

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Re: Help understanding Post-op report
« Reply #5 on: January 29, 2010, 04:01:05 pm »
Here's my take on it, which differs a bit from Dr. Phyl's...and I didn't stay in a Holiday Inn Express last night either.  Although I wish I had... :D

Sounds like the doc tried to get the AN off of your 8th cranial nerve without damaging it (to spare your hearing) but apparently that was not possible  (AN's tend to be sticky).  Your 7th cranial nerve however, was left intact and responded to electrical stimulation, which would ideally mean it was still functioning normally after they stitched you back up.  I don't think the entry into the IAC was a "Plan B" but all part of "Plan A" to remove the portion of the tumor that was inside the bony canal.  They would have had to do this anyway even if they were able to free the AN from the 8th nerve.  My facial nerve tested fine during the surgery too and I wound up with facial paralysis anyway.  The facial nerve is very delicate and does not like to be manipulated, so even if it was intact, the fibers may have been damaged beyond their ability to repair themselves.   But sometimes it does - it just requires a lot of patience.

It also sounds like they expected to find a meningioma based on the MRI findings, but found an AN instead.  Surprise!

I would make an appointment with the doctor to go over the operative report with you if you really want to know the details.  That's part of his job, regardless of his lack of bedside manner.

Lori

Right 3cm AN diagnosed 1/2007.  Translab resection 2/20/07 by Dr. David Kaylie and Dr. Karl Hampf at Baptist Hospital in Nashville.  R side deafness, facial nerve paralysis.  Tarsorraphy and tear duct cauterization 5/2007.  BAHA implant 11/8/07. 7-12 nerve jump 9/26/08.

ppearl214

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Re: Help understanding Post-op report
« Reply #6 on: January 29, 2010, 04:02:31 pm »
Michael,

I wish I had answers....

I have a couple of dr's (non-AN related)... worst bedside manner around... not a compassionate bone in their body.... but, they know their stuff.  So, I tolerate their "cold" and when I see them, I try to crack jokes and such to lighten them up... never works, but in the long run, for the short amt of time I have to tolerate their "cold", if they make me well... then, heck, I deal with the "cold".

from my understanding (anyone with a MD degree around here, pls feel free to chime in!)... the 7th cranial is the facial nerve, the 8th is the vestibular-cochlear (hearing/balance).  Again... NOT a dr..... but if by going the 8th cranial and couldn't (some lose this nerve complex during surgery).............. and if they had to go to the 7th.... then, that may be your explanation. Please keep in mind that the area with all of these nerves are SOOOO close in proximity..... so, for those researching out surgical procedures for AN removals need to keep in mind that when the surgeons are in there... and based on the location of the AN and what is needed for them to get to it for the removal, there is a lot of critical structures in the area that can be affected.

I had radiation on my AN... a VERY targeted beam of radiation.  A few months later, I ended up with temp dry eye (eye dr told me my eye looked like an onion peel).  So, even though the radiation was highly targeted.... somehow, I ended up with temp dry eye.

So, since sooooo much is contained to such a small area where worked..... things can happen.

Again, I don't know if this helps in any way.... and I stick to my day job (selling semiconductors and.... moderating this place!)...... but hoping its a little insightful.

Phyl

(Lori, my halo-dropping friend... me likes your take on it as well! Thanks!)
"Gentlemen, I wash my hands of this weirdness", Capt Jack Sparrow - Davy Jones Locker, "Pirates of the Carribbean - At World's End"

msswartz

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Re: Help understanding Post-op report
« Reply #7 on: January 29, 2010, 04:56:28 pm »
Hey,

Thanks for the very thoughtful and detailed replies.   

So if I understand you correctly, the 8th nerve is the one for hearing and balance?   If that is true, then that would explain why I am stone deaf on the right, the remaining presence of ringing is interesting, and I have less than perfect balance.  When I can home from the hospital I needed a walker because I was just too wobbley to walk.  For a few weeks afterwards I could walk by myself as long as there was something to grab onto.  When I saw my doctor at 5 weeks for my follow up he asked me several times about my balance but I didn't understand why.  And fankly I was so sad to see him that I didn't ask him.  Now, 2/1-2 months later I am much more steady but still a little wobbly.  I also find that I have weakness on the right side.  My right arm is weaker than my left now, my handwriting is terrible and my typing accuracy is way off.  I am not however generally dizzy, have no headaches, hillucinations or other cognitive problems.  I am just a little unsteady, have to catch myself now and then but am more steady every week.  Is the 8th nerve the cause of this?  And if I am getting more steady is it because the 8th nerve is repairing or because the other side is compensating?

Michael

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sgerrard

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Re: Help understanding Post-op report
« Reply #8 on: January 29, 2010, 10:32:17 pm »
So if I understand you correctly, the 8th nerve is the one for hearing and balance?   
Yes.

Quote
if I am getting more steady is it because the 8th nerve is repairing or because the other side is compensating?
The other side is compensating.

Hi Michael,

You seem to be making your way around the forum pretty well. I took a quick look at your MRI and report. It does sound like they thought it was a meningioma until they got inside your head. That can happen (the other way around too).

Although the report says the VII nerve stayed intact and functioning, it also says "However, the VIIth nerve responded throughout the procedure with a relatively high threshold to electrical stimulation", which suggests that it was not completely happy (it took more juice than usual to get it to respond). When blood vessels are getting snipped, and the nerve is being separated from the tumor, it is not that unusual for it to be less than fully responsive for a while.

I'm sure it is no fun, but I think I saw in one post that you have good support from people around you, which should help.

Welcome to the forum, and I hope things continue to improve for you over time.

Steve
8 mm left AN June 2007,  CK at Stanford Sept 2007.
Hearing lasted a while, but left side is deaf now.
Right side is weak too. Life is quiet.

Jim Scott

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Re: Help understanding Post-op report
« Reply #9 on: January 30, 2010, 04:29:55 pm »
Michael ~

Your questions have been ably answered by the previous posters but I wanted to mention something that I've observed via the many posts I've read from post-op patients struggling with deficits in the weeks and months following their AN removal.

Neurosurgeons, otolaryngologists and neurologists are focused on successfully removing the tumor from your skull without endangering your life or doing any real damage to your cranial nerves beyond what the growing tumor has already accomplished.  This is why nerve monitoring is routinely used during AN resections.  Unfortunately, due to the nature of the hyper-sensitive, delicate nerves and the tiny area that the doctors have to work in (which is why the surgery is performed under a microscope) there is often some degree of nerve damage that manifests in the kinds of issues you're dealing with.  These problems are usually temporary but, as in your case, quite annoying, even life-altering.  The doctors that performed the surgery are very likely sorry you're having these problems and hope they'll be resolved soon but in their estimation, they did their job - they safely removed the AN - and subsequent issues are not really in their field of expertise so they tend to be unhelpful, even dismissive, in some of the more extreme cases.  This often frustrates the recovering AN surgery patient.  Some get very upset, and I can understand why.  What I don't understand is why these surgeons don't simply refer their post-op AN patients struggling with problems related to the surgery, to a doctor or physical therapist that might be able to offer the patient some relief.  I know some AN doctors do this but many don't.  They just tell their AN patient "that happens" and allow the patient to wrestle with his or her deficits.  The patient can easily become depressed at the glacial pace of their recovery and attaining the normalcy they quite naturally seek.  This is unnecessary, in my  opinion.

I would suggest seeking a doctor or therapist that may be able to assist you with some of the problems you're dealing with as you recover.  Being annoyed with your doctor is a normal reaction but won't get you anywhere because, even if he is sympathetic, he is not likely to be of much real help at this point, other than to monitor your overall recovery and check your MRI reports as they come due.  

You do seem to be recovering slowly but surely, which is a positive sign.  You may have to challenge yourself at some point in order to surmount the usual problems post-op AN patients often have but generally, from the content of your posts it appears as if you're doing relatively well just a few months out of AN surgery, which, as you know, is major surgery.  I trust you'll continue to recover at a good pace and of course, we appreciate your presence and contributions to the ANA website forums.

Jim
« Last Edit: January 30, 2010, 05:20:36 pm by Jim Scott »
4.5 cm AN diagnosed 5/06.  Retrosigmoid surgery 6/06.  Follow-up FSR completed 10/06.  Tumor shrinkage & necrosis noted on last MRI.  Life is good. 

Life is not the way it's supposed to be. It's the way it is.  The way we cope with it is what makes the difference.

lori67

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Re: Help understanding Post-op report
« Reply #10 on: January 30, 2010, 04:39:07 pm »


(Lori, my halo-dropping friend... me likes your take on it as well! Thanks!)

Thanks, Phyl...guess I did learn something in nursing and PT school afterall, huh?   ;)  But I still didn't get to stay in a Holiday Inn Express last night.

Lori
Right 3cm AN diagnosed 1/2007.  Translab resection 2/20/07 by Dr. David Kaylie and Dr. Karl Hampf at Baptist Hospital in Nashville.  R side deafness, facial nerve paralysis.  Tarsorraphy and tear duct cauterization 5/2007.  BAHA implant 11/8/07. 7-12 nerve jump 9/26/08.

msswartz

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Re: Help understanding Post-op report
« Reply #11 on: February 08, 2010, 11:05:44 am »
Hello all,

Your responses have helped me understand and come to terms with my situation much better.  I am very grateful for the time you all gave to communicate with me and to help me as I go through this.  Perhaps it will help others as well.

Michael
Michael Swartz
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msswartz

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Re: Help understanding Post-op report
« Reply #12 on: February 08, 2010, 11:59:32 am »
Hello all

I was able to get some more info from my doctor via email.  

This is what he said about the 8th nerve.

"I don't remember the details of what happened. However, my routine when trying to save hearing is that I cut the nerve once we have lost hearing as indicated by our electrical monitoring. The loss of hearing can occur from manipulation of the tumor, from the trauma of dissecting the nerve from the tumor, or from loosing blood circulation to the nerve. I cut the nerve at that point because it will not recover and  it makes removing the tumor easier and safer to remove. I don't think that I have more to say about it than that."

And here is what he said about the 7th nerve.

"I think that most of these questions have to do with the usual finding in these tumors and are not ominous, unusual or relevant to your understanding. Xanthomatous degeneration and vascularity are just variations of the gross pathological findings. The compression of brainstem is not significant in your case. The trauma to the nerve has to do with the necessary handling during dissection. The exact mechanisms are complex and debated and you might do a literature search of the research and perhaps take some advance course in biology and medicine to understand this. I am not up on the details myself and don't think that they will help you much. The response of the nerve to stimulation indicates that it was intact and working at the end of the procedure and that it will recover. Yes, the threshold to stimulation was higher than usual suggesting some early decrease in function, but I can make nothing more of this. It usually recovers better in cases where it responds well to low threshold stimulation throughout, but time is the only way to see how well it will actually work. The nerve is composed of a bundle of nerve fibres each surrounded by insulation. The insulation stays intact, but the fibres die off. However the cells from which the fibres arise are still alive and grow down the insulating sheath at 1 inch per month needing 6 months to reach their destination ( the muscles). They don't all grow to their original destination and this is why recovery is not perfect. I am going over information that I know that I have discussed before and I don't think that I will be able to help you understand any better in the future."

That pretty much covers it.  That along with your very helpful comments is all I know.   So now all I can do is wait and see what happens.

Michael
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Debbi

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Re: Help understanding Post-op report
« Reply #13 on: February 09, 2010, 10:19:00 am »
Hi Michael-

Wow, your doctor really does have a chilly bedside manner!  You are probably going to have to be your own advocate here.  You may want to inquire about both vestibular therapy (to help your balance) and neuromuscular facial therapy as you regain movement of your face.  I believe there is a test that can be done on the facial (7th) cranial nerve to test its viability.  Maybe someone here can comment on that?

It is unfortunate that some doctors seem to have missed the "customer service" part of med school. 

Keep us posted, okay?

Debbi
Debbi - diagnosed March 4, 2008 
2.4 cm Right Side AN
Translab April 30, 2008 at NYU with Drs. Golfinos and Roland
SSD Right ear, Mild synkinesis and facial nerve damage
BAHA "installed" Feb 2011 by Dr. Cosetti @ NYU

http://debsanadventure.blogspot.com

msswartz

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Re: Help understanding Post-op report
« Reply #14 on: February 11, 2010, 06:42:53 pm »
Hello,

Yeah, I am confident that he was quite skilled in his execution of the procedure but he has not been very nice to me since then.  Perhaps I annoyed him in some way, I don't know.  Otherwise he has a good reputation with both his abilities and post op care.

Thank you for your recommendations.

Michael

Michael Swartz
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