Is the balance nerve cut?

[HeidiC]

I have researched all the options, but I guess I was concentrating on hearing and facial nerves...because I was a little surprised when the Neurotologist said that my balance nerve would be cut during my Mid-fossia surgery.  I guess I just thought that they would remove the tumor and try to leave the nerve intact.  I knew I would be more dizzy after the surgery, but I thought that was just cause they would be messing around in there and bumping the nerves etc.

Did I miss something in my research-Is it normal for the balance nerve to be cut?  Or is this possibly something thats just particular to this dr and others will try and save it?

~Heidi

[Jim Scott]

Heida ~

Acoustic neuromas usually grow from the 8th (balance) nerve sheath and thus that nerve must be severed to remove the tumor.  This is the common approach.  Fortunately, our brain is usually able to compensate for the loss and it is not a huge problem.

Jim

[mk]

Heidi,

vestibular schwannomas grow on the vestibular  branch of the vestibulocochlear nerve (8th cranial nerve). So whereas in hearing preservation surgeries sometimes it is possible to save the cochlear branch (responsible for hearing),  I don't think it is possible to spare the vestibular portion. Typically the more vestibular function you still have on the affected side, the more prone to have dizziness and balance problems after surgery. This leads to the oxymoron that patients with larger ANs who have already gradually lost most of the vestibular function may suffer less from dizziness after surgery than those with smaller ANs.

Marianna

[LisaM]

In my research, I was told that are two vestibular nerves; a superior and inferior.  Apparently the superior vestibular nerve is where these tumors take root and this nerve is cut.  However some doctors preserve the inferior nerve and do not cut it while other doctors feel that cutting the inferior nerve along with the superior provides a better outcome post-op.

If anyone knows more specifics about this subject, please post. 

Thanks,
Lisa M

[HeidiC]

In my research, I was told that are two vestibular nerves; a superior and inferior.  Apparently the superior vestibular nerve is where these tumors take root and this nerve is cut.  However some doctors preserve the inferior nerve and do not cut it while other doctors feel that cutting the inferior nerve along with the superior provides a better outcome post-op.

If anyone knows more specifics about this subject, please post. 

Thanks,
Lisa M

Thanks to all for the replies, it reassures me a bit!

Lisa, that makes sense, since the Dr said both nerves are cut.  At the time, and when I researched it after, I just thought he meant that one would be cut, and the other side stops working.  I didn't realize that there are 2.

~Heidi

[PaulW]

As I understand it and please I am not a doctor....
Once your balance nerve is cut or damaged it does cause long term deficits.

The main deficit is the vestibulo occular reflex.

There is a test that you can do at home..
Its called the head impulse test.. or Halmagyi manouever..
Once your balance nerve is cut you will always fail this test, and no amount of vestibular exercises or time will bring it back.

The reason they cut the balance nerve is because normally surgery damages the blood supply to the balance nerve which can leave people with some pretty horrible balance problems, as a result they cut the nerve, to reduce balance issues.
You will however lose your vestibular occular reflex when your head is either rotated to the left or the right.

This is one reason why people can find driving more difficult after AN surgery.
Your balance nerve is like a gyroscope for your eyes, and you do lose that gyroscope effect, once the balance nerve is gone.

Without the reflex it takes time to manually adjust the eyes and get them pointing back in the right direction.
You learn to live without this reflex, but it will always take you much  longer to adjust your eyes to where you want them to go after the balance nerve has been compromised.

Anyway check out the head impulse test, get a friend, and do it at home..

http://www.youtube.com/watch?v=CZXDNLLGG8k

Plus more info

http://en.wikipedia.org/wiki/Vestibulo-ocular_reflex

http://headimpulse.com/knowledge-center/videos

[leapyrtwins]

Yes the nerve is cut.

Your body learns to compensate for the loss though - and it doesn't take forever either.

I have very minor balance issues from my surgery; they only appear when I'm overtired or stressed.

Jan

[tweety]

Heidi,  The balance nerve is the least problem when cut rather than the hearing and/or facial nerve.  Once they go in there they are able to determine exact position of the tumor and they try their best to avoid these nerves but if one is to be cut the balance nerve has the least problems as you have another balance nerve on the other side that will take over.  It requires you to do balance exercises post op but it does come back slowly.  DOn't be afraid of that,  with diligence it will return to almost normal.  Nancy  (Tweety)

[FlyersFan68]

Most AN's originate form the balance nerve. There are two branches being upper and lower. Surgeons won't know which one is more involved but mid-fossa renders better hearing outcomes with the tumor being situated on one over the other. MRI's won't reveal this. They don't sever one vestibular branch to save the other due to the importance of total tumor removal and brain/vestibular misfires.  Other senses such as our eyes and feet become more involved and ease the burden too along with your other "good" side. After seven years balance wasn't much of an issue until recently but I'm sure it's due to other reasons. Personally, and this is my opinion, I believe that anyone with an acoustic neuroma originating from the balance nerve which most do will eventually lose all or most of their balance on that side no matter what treatment including waiting and watching. Tumor doesn't even need to grow to lose more hearing and balance. Best radiation and surgical outcomes are with smaller tumors under 1cm. I remember asking my surgeon if there was ever a piece of tumor left behind to save the hearing nerve and he said no ...never because hearing monitors are not 100% guaranteed. Also,  If a piece of tumor is left, the hearing is likely to continue to deteriorate after surgery. This is true even if no tumor growth is seen. Furthermore, if the residual tumor grows, additional treatment will be necessary (i.e.,  radiosurgery) that in itself carries a significant risk of damaging hearing.  -Steve

[FlyersFan68]

Also, I noticed you might be having mid-fossa surgery. Important, this is more trickier than the other approaches being trans-lab and retrosigmoid so make sure you find a good team with good mid-fossa experiences. 

[nftwoed]

Hi;

  I believe re, Mid Cranial Fossa, having either of the branches of the vestibular nerve cut depends upon the extent of the ANs impact upon that nerve and the degree of difficulty getting the cells completely off the nerve.
  In no way do I believe it is routine procedure to cut either branch during MCF, but, only if the tumor cannot be resected off it w/o damaging it severely.
  There could commence a discussion of Antoni A or Antoni B cells here, but is complicated. I'm sure the Dr. knows what type AN (sticky, or firm ) he is going to be removing.

[jockieau]

My surgeon told me he is not able to tell precisely (or even roughly?) where the tumour is sitting in relation to the nerves - he won't know until they get in there - so I don't know that they can tell if it is "sticky" or otherwise until they are on the job...

[jockieau]

Oh and I was told by Dr Brackmann re: middle fossa (as I am looking at the same approach) that the vestibular nerve is cut during the surgery.

[Cindyswart]

Me again, I had retro sigmoid and when they tested me they could also tell that the balance nerve was just about toast. Good news was that my body was already dealing with the balance issues and at 4 weeks post op- my balance is fine. Just a little wobbly when I am tired.

[wwarr]

Heidi,

First of all, let me tell you I wish you the best with your upcoming surgery!  We all have been there and know what you are feeling right now.  Anticipation with a lot of questions and that is normal.  Hang in there and know that we are all thinking of you!!  When I had my middle fossa surgery, they did cut my vestibular nerve.  This is quite common as the tumor usually originates from this nerve.  You might find that your dizzy at first but they will get you up and walking and your body adjusts.  The more you walk, the better you become.  I would highly suggest vestibular therapy after surgery if it is an issue.  I only went once, and if I could go back in time, I would have stuck with it.  I just thought I could do it myself and frankly I think it would have helped alot.  Good luck 

Wendy