Endoscopic removal of AN

[jphua]

Have you heard of the Endoscopic removal of AN done in skull-base institute?  It's the latest treatment for AN and touted to be less invasive. 

[Jim Scott]

Have you heard of the Endoscopic removal of AN done in skull-base institute?  It's the latest treatment for AN and touted to be less invasive. 

Yes, we have.  There have been many discussions on this tropic.  Use the 'Search' feature (upper left-hand side of the screen) and type in:'endoscopic' then click on 'advanced search'.  You'll bring up approximately 15 separate threads where this surgery is discussed.  They should provide you with some of the information you're seeking. 

I'll add that endoscopic AN surgery is still considered 'new' and has not been fully embraced by the neurosurgeon 'community'. To the best of my knowledge, it is only being performed in two U.S. locations; Los Angeles, California (Dr. Shahinian) and Pittsburgh, Pennsylvania (Dr. Jho).   However, the few people who have undergone endoscopic surgery to remove their AN and have posted on these forums have been fairly pleased with the results so I would consider it worth looking into.

Jim

[leapyrtwins]

Jim is right.  Endoscopic surgery for ANs is still very new and not widely done by docs who treat ANs.  It may become the wave of the future, but for the present it isn't the norm.

Right now AN docs seems to be opposed to it - I know the last time my doc and I discussed it, he was.

Those on the Forum who have had endoscopic with Drs. Shananian or Jho seem to be very satisfied with their outcomes.

Jan

[nftwoed]

Hi;

  I've read the Shahinian story as to how he became dept. head and was under qualified to do such at the beginning. He was either a plastic surgeon, or general surgeon. He was sued by a Neurosurgeon at a point.
  On a different group, I read one very problematic outcome after the pt. arrived home 1300 miles away. Turned out total recovery time after additional standard neurosurgery, CSF leak, infection, and meningitis was 3 months of a 1 cm. AN.
  The procedure still intrigues me. I don't know for sure, but doubt this will catch on well. Especially after HEI Drs were invited to witness said procedure and gave it a thumbs down. It had to do with nicking an artery/vein and not being able to stop the bleeding. Other Neuros said a pt. could bleed out if they had to be opened in traditional fashion to stop the bleeding.

[jerseygirl]

If failure to repair a cut artery is a concern with endoscopic AN removal, then how come endoscopic versions of the following surgeries are mainstream:
  1) other brain tumors, like pituitary, for ex.
  2) abdominal surgeries, like appendectomy, gall bladder removal, hysterectomy, exploratory surgery, etc
  3) heart surgery ( no cutting through the ribs,  shorter surgery  and recovery times)
  4) AN surgeries around the world

They must also be concerned with the same thing.

When I was researching endoscopic surgery for my AN regrowth in 2007, I realized that this argument has no value and the issue of nicking a blood vessel is present in ALL endoscopic surgeries and, therefore, has been dealt with already. Just like any surgery, endoscopy can be done poorly, carelessly and simply not work out. It has to do more with the surgeon and his technique and attitude than the method itself.

            Eve

[leapyrtwins]

I know at least one of the reasons my doc was opposed to endoscopic removal of ANs had to do with the fact that you couldn't see if a bleed was happening.

Sounds like the docs @ HEI have the same concerns.

Jan

[jerseygirl]

Donnalyn,

You make it sound like AN surgery is the most complicated one of all possible surgeries and the only one that can result in severe side effects. If you speak to doctors, many would completely disagree. Pituitary surgeries can be very dangerous and difficult even now. Actually, that is a good question to ask of DRs. I will call a few. There are other brain tumors I learned about that were inoperable or extraordinarily difficult before the advent of endoscopy. Abdomen, by the way, is full of blood vessels nicking which can lead to rapid bleeding and death.  Abdominal surgeries were started to be done endoscopically to speed up recovery and, naturally, to avoid a big scar. Sometimes I think our society cares more about wearing bikinis than possibility of headaches!

               Eve

[lori67]

I'm not taking sides here but a laparoscopic procedure of the abdomen that could result in a bleed would be a much easier fix than one in the skull.  The vessels in the abdomen, especially those that cutting could cause rapid death, are large and easily seen, and also more easily repaired.  A bleed in one of the tiny vessels in the brain would be harder to locate and might not even be picked up until after the patient is out of the OR.  If that patient has a slow bleed and has already been sent home, that could be a bad thing.  Now they could be a plane trip away from the doc that did their original surgery and in need of emergency intervention by someone who has no idea what the heck the first guy did!

ANY surgical procedure has its risks.  I think in the future this endoscopy thing will catch on.  But there must be a reason why it hasn't become the best thing since sliced bread by now.  I can't imagine all surgeons would be hesitant to go this route without a good reason for concern.  And yes, some of them will avoid anything new because they're stuck in their ways, but not all of them.

I think in the end, it comes down to what the patient determines to be an acceptable risk.  I knew the risks involved in my translab and decided that for me, the benefits outweighed those risks.  I'm not sure endoscopy would have been the right choice for me.   I could find an issue with any surgeon if I really wanted to (I'm a nurse) - too old, too young, too far away, not the qualifications I'm looking for, ugly shoes, etc.  When it came down to decision time for me, I had to decide which of those things I was willing to look past.  (my surgeon was young AND had ugly shoes   ).

Bottom line, although we all tend to be passionate about our own doctors, everyone needs to do his own homework and make an informed decision.  No one should feel offended because someone makes a different choice.  This is not a one size fits all situation.  I think we're all just happy to hear of a good outcome, no matter how someone arrived at it!

Lori

[leapyrtwins]

Bottom line, although we all tend to be passionate about our own doctors, everyone needs to do his own homework and make an informed decision.  No one should feel offended because someone makes a different choice.  This is not a one size fits all situation.  I think we're all just happy to hear of a good outcome, no matter how someone arrived at it!

Lori

I couldn't have said it better myself

Jan

[GOIN2LA]

I actually had surgery at SBI with Dr. Shahinian as well as hundreds if not thousands of other patients.  If you do the research you will find that there are answers to most of the concerns that are raised about his technique.  The doctors that are against him have spent millions of dollars building their practice to perform surgery the traditional way so they feel very threatened by Shahinian.  As for the lawsuits that are against him again I would do your research, we all know how the media likes to report one side and I'm curious if the HEI or these other doctors have never had a lawsuit brought against them.  The proof should be in the surgeries that he has performed and how successful he is.  I did days of research and talked to several of his past patients before making my decision and none of them had any problems or regret choosing the endoscopic approach.

Everyone obviously has to make their own choice and research is key.  One thing I've learned from my experience is to ask questions. I always thought my doctors had my best interest in mind not realizing they were in business to make money too.  It was a real eye opening experience.

Good bless,

Sara

[nftwoed]

Hi;

  Do you suppose it's because a total mastoidectomy is required to open the inner ear well for a good visual with an operating microscope? Pituitary goes up through the gum line, and the other areas are not as delicate nerve wise near/in the brain as AN, or, bony areas.
  One thing about AN removal, they are working in a pretty small, finger deep hole on an area about the size of an aspirin for many ANs.
   Not sure the complexity of why or why not, jerseygirl, as am not a Dr. But; It doesn't seem really a hot issue at present.
   Maybe it will become more common in years to come. There has occurred endonasal removals of ANs also.
   I hope your day/eve is nice.  : )


 

If failure to repair a cut artery is a concern with endoscopic AN removal, then how come endoscopic versions of the following surgeries are mainstream:
  1) other brain tumors, like pituitary, for ex.
  2) abdominal surgeries, like appendectomy, gall bladder removal, hysterectomy, exploratory surgery, etc
  3) heart surgery ( no cutting through the ribs,  shorter surgery  and recovery times)
  4) AN surgeries around the world

They must also be concerned with the same thing.

When I was researching endoscopic surgery for my AN regrowth in 2007, I realized that this argument has no value and the issue of nicking a blood vessel is present in ALL endoscopic surgeries and, therefore, has been dealt with already. Just like any surgery, endoscopy can be done poorly, carelessly and simply not work out. It has to do more with the surgeon and his technique and attitude than the method itself.

            Eve

[james e]

What do you mean by "less invasive"? What is the benefit?

[Jim Scott]

What do you mean by "less invasive"? What is the benefit?

Because 'jphua' hasn't responded to the question as yet, I'll venture to guess that the term 'less invasive' is predicated on the fact that the endoscopic incision is much smaller than the typical incision used in conventional AN surgery.  A smaller incision exposes less of the skull interior and would pose a smaller risk of infection and related problems (i.e. bone dust) that a larger opening might pose to the patient.  Of course, I'm not a doctor and I could be wrong.     

Jim

[james e]

I don't understand why a smaller scalp incision would expose more of the brain. Maybe a smaller hole is drilled in the skull, and that might expose less of the brain. I have no idea how big the hole in my skull was for a translab, but there has to be enough room for the endoscope and any instruments to do the surgery. Anyone know how much skull is usually removed for a conventional surgery?

[nftwoed]

Hi;

  For Translab, the size is about a quarter. For minimially invasive, the size is about a dime. For Middle Fossa, I believe the actual entry point is 'extra-dural' after the skin flap is folded back. But, then again, if it is "extra dural", how could the necessary brain retraction be performed? Looks like a little research is necessary.
  Also; Drs will on occasion use modified versions to suit the need.
  My own feeling is too much attention is paid to this particular aspect considering especially the added, potential complication(s) of Minimally Invasive Endoscopy.
  Bone dust has been attributed to cause headache, but with continued suction while drilling, my feeling is it is applying an answer to an idiopathic question of "why a HA"? Actually, the HA could be caused by another reason as edema, stress, surgical trauma, trying to maintain balance, etc.