Author Topic: Retrosigmoid Approach Question  (Read 8802 times)

mindyandy

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Retrosigmoid Approach Question
« on: March 25, 2012, 04:40:54 pm »
For those who had Retro could you tell me where you feel or know the hole is? You know where they put the titanium plate? Behind the ear?
14mm dx 9/07. CK done Seattle  1 year MRI showed some shrinkage. 4 year MRI 2mm growth nothing conclusive. Trigminal nerve involvment Retrosigmoid Friedmand/Schwartz HEI March 7,2012

LakeErie

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Re: Retrosigmoid Approach Question
« Reply #1 on: March 25, 2012, 05:19:21 pm »
Retrosigmoid is behind and below the ear. The site of my cranioplasty, the flexible titanium plate,
is about level with my right ear lobe. In my case there is a small indentation there and easy to find.
4.7 cm x 3.6 cm x 3.2 cm vestibular schwannoma
Simplified retrosigmoid @ Cleveland Clinic 10/06/2011
Rt SSD, numbness, vocal cord and swallowing problems
Vocal cord and swallowing normalized at 16 months. Numbness persists.
Regrowth 09/19/2016
GK 10/12/2016 Cleveland Clinic
facial weakness Jan 2017

mindyandy

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Re: Retrosigmoid Approach Question
« Reply #2 on: March 25, 2012, 05:24:51 pm »
Hmmmm you say indent & I feel like a hump where it is.
14mm dx 9/07. CK done Seattle  1 year MRI showed some shrinkage. 4 year MRI 2mm growth nothing conclusive. Trigminal nerve involvment Retrosigmoid Friedmand/Schwartz HEI March 7,2012

LakeErie

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Re: Retrosigmoid Approach Question
« Reply #3 on: March 25, 2012, 05:38:09 pm »
Mine is close to 6 months old now, and I did not notice the indentation at first. I really did not notice the indentation until for some reason I felt both sides of head at the same time. The difference on the AN side was then obvious to me.
4.7 cm x 3.6 cm x 3.2 cm vestibular schwannoma
Simplified retrosigmoid @ Cleveland Clinic 10/06/2011
Rt SSD, numbness, vocal cord and swallowing problems
Vocal cord and swallowing normalized at 16 months. Numbness persists.
Regrowth 09/19/2016
GK 10/12/2016 Cleveland Clinic
facial weakness Jan 2017

mk

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Re: Retrosigmoid Approach Question
« Reply #4 on: March 25, 2012, 06:12:46 pm »
Actually I didn't have the indentation at the beginning; I think it wasn't obvious because of the swelling. I felt it for the first time about 4 months post-op - it seems like it appeared almost overnight. Thinking about it now, it must have been that the swelling subsided, and the indentation became obvious. I am now almost one year post-op and I still have a "dent" behind my ear.
By the way, I don't have a titanium mesh - my neurosurgeon uses some kind of "bone cement" to glue in the bone that was removed during surgery. But it seems that no matter what the technique is, the indentation is very common.

Marianna
GK on April 23rd 2008 for 2.9 cm AN at Toronto Western Hospital. Subsequent MRIs showed darkening initially, then growth. Retrosigmoid surgery on April 26th, 2011 with Drs. Akagami and Westerberg at Vancouver General Hospital. Graduallly lost hearing after GK and now SSD but no other issues.

mindyandy

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Re: Retrosigmoid Approach Question
« Reply #5 on: March 25, 2012, 06:25:41 pm »
MK I think it is swelling on the hole. Is yours located behind the ear? Mine is I think is located behind the top part of the earlobe. This is where I feel slight swelling.
14mm dx 9/07. CK done Seattle  1 year MRI showed some shrinkage. 4 year MRI 2mm growth nothing conclusive. Trigminal nerve involvment Retrosigmoid Friedmand/Schwartz HEI March 7,2012

Jim Scott

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Re: Retrosigmoid Approach Question
« Reply #6 on: March 26, 2012, 03:28:01 pm »
Mindy ~

As you know, I underwent the Retrosigmoid Approach AN debulking surgery in 2006.  I have a slightly uneven 'lumpy' ridge above and around my (left) ear with a 'depression' just past the ear, toward the back of my head.  It's not noticeable, even with my relatively short haircut and I don't think much about it, although I'm aware that its there.  Just a little reminder that I had the surgery...as if I would ever forget.

Jim
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.

mk

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Re: Retrosigmoid Approach Question
« Reply #7 on: March 26, 2012, 04:11:34 pm »
Mindy,

Jim did a very good job explaining about the "lumpy ridge" around the AN ear. That part felt swollen (and it still does, even though I think that oart if the reason is that the feeling is different there). The identation though is much lower, I would say at the level of the lower ear lobe. Certainly the two parts of the head feel different - I am sure nothing would show up though, and I have very thick hair to cover it. The scar, which was quite long has all but disappeared.

By the way, I must have missed that in one of your previous posts, but how long was your surgery? I guess since they didn't really mess with the nerves it wasn't as long as most retro surgeries are?

Marianna
GK on April 23rd 2008 for 2.9 cm AN at Toronto Western Hospital. Subsequent MRIs showed darkening initially, then growth. Retrosigmoid surgery on April 26th, 2011 with Drs. Akagami and Westerberg at Vancouver General Hospital. Graduallly lost hearing after GK and now SSD but no other issues.

mindyandy

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Re: Retrosigmoid Approach Question
« Reply #8 on: March 26, 2012, 05:21:29 pm »
My surgery was 6 hours. He didn't touch the others nerves but he did take as much tumor off especially the trigeminal nerve. I believe he put Teflon in to for the trigeminal like they do MVD surgery. Thanks for telling me about your incision. This helps me since I don't know how it should feel.
14mm dx 9/07. CK done Seattle  1 year MRI showed some shrinkage. 4 year MRI 2mm growth nothing conclusive. Trigminal nerve involvment Retrosigmoid Friedmand/Schwartz HEI March 7,2012

mindyandy

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Re: Retrosigmoid Approach Question
« Reply #9 on: March 26, 2012, 05:27:19 pm »
I just read Jim's post. Thanks Jim. Your description sounds right. I don't feel anything on the lower half. Maybe the indentation comes later after all is healed & swelling is gone. This is why I love coming here. All you guys are wonderful help. This AN journey is not a fun journey but im glad to have all of you here.
14mm dx 9/07. CK done Seattle  1 year MRI showed some shrinkage. 4 year MRI 2mm growth nothing conclusive. Trigminal nerve involvment Retrosigmoid Friedmand/Schwartz HEI March 7,2012

LizAN

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Re: Retrosigmoid Approach Question
« Reply #10 on: May 13, 2012, 12:00:05 pm »
My surgery was 6 hours. He didn't touch the others nerves but he did take as much tumor off especially the trigeminal nerve. I believe he put Teflon in to for the trigeminal like they do MVD surgery. Thanks for telling me about your incision. This helps me since I don't know how it should feel.

Mindy,
Can you explain more about the teflon for the trigeminal nerve?  I asked Dr. Slattery about the use of teflon, and he said it was usually only used for brain stem implants.

Has anyone else had teflon used in their surgical procedures?  I will be having translab soon, probably at HEI, but maybe in Houston.

Liz
8/20/2010 - 9mm AN on left side 
Fullness, tinnitus, mild hearing loss
2/20/2011 - 8mm
4/20/2012 - 12.4 mm
Moderate to severe hearing loss, LOUD tinnitus, deteriorating balance
Facial numbness and twitching, which subsided pre-surgery
Translab at House, 7/3/2012, Slattery and Schwartz

leapyrtwins

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Re: Retrosigmoid Approach Question
« Reply #11 on: May 13, 2012, 12:43:05 pm »
Wonderful description by Jim - sounds exactly like my surgery site except that my BAHA implant is directly on top of that area.

The "hole" where my AN was is packed with abdomenal fat plus I have titanium mesh, a plate (titanium ?), and titanium screws in that area - and the BAHA "rod" which is also titanium.

Guess I'm just a walking titanium mine!  ;D

Jan
« Last Edit: May 26, 2012, 10:27:44 pm by leapyrtwins »
Retrosig 5/31/07 Drs. Battista & Kazan (Hinsdale, Illinois)
Left AN 3.0 cm (1.5 cm @ diagnosis 6 wks prior) SSD. BAHA implant 3/4/08 (Dr. Battista) Divino 6/4/08  BP100 4/2010 BAHA 5 8/2015

I don't actually "make" trouble..just kind of attract it, fine tune it, and apply it in new and exciting ways

LakeErie

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Re: Retrosigmoid Approach Question
« Reply #12 on: May 13, 2012, 01:50:53 pm »
I should have written, to be clear, that while I underwent a retrosigmoid approach with cranioplasty,
it was a minimally invasive one. The surgical transcript states a 5 cm curvilinear incision was made in the skin and then a 2.5 cm craniectomy starting from the asterion. The tumor removal was from cranial nerves #'s 5 - 11, the brain stem, and two arteries. The cranioplasty followed reapproximation of the dura and employed a micro-titanium plate. The surgery, as extensive as it was, took less than 3 hours. I was discharged (with a minor CSF leaf which resolved on its own in a few weeks) in 48 hours.
4.7 cm x 3.6 cm x 3.2 cm vestibular schwannoma
Simplified retrosigmoid @ Cleveland Clinic 10/06/2011
Rt SSD, numbness, vocal cord and swallowing problems
Vocal cord and swallowing normalized at 16 months. Numbness persists.
Regrowth 09/19/2016
GK 10/12/2016 Cleveland Clinic
facial weakness Jan 2017

Crazycat

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Re: Retrosigmoid Approach Question
« Reply #13 on: May 26, 2012, 09:31:55 pm »
I had retrosigmoid. The titanium plate is at the back of the skull base beside the left ear; same as Jim's description. Compared to the right side, it is uneven and feels like a chunk of the skull is missing. It doesn't bother me and you'd never know it's there.
5cm x 5cm left-side A.N. partially removed via Middle Fossa 9/21/2005 @ Mass General. 
Compounded by hydrocephalus. Shunt installed 8/10/2005.
Dr. Fred Barker - Neurosurgeon and Dr. Michael McKenna - Neurotologist.

LizAN

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Re: Retrosigmoid Approach Question
« Reply #14 on: May 26, 2012, 09:42:41 pm »
Are titanium plates used for translab?
8/20/2010 - 9mm AN on left side 
Fullness, tinnitus, mild hearing loss
2/20/2011 - 8mm
4/20/2012 - 12.4 mm
Moderate to severe hearing loss, LOUD tinnitus, deteriorating balance
Facial numbness and twitching, which subsided pre-surgery
Translab at House, 7/3/2012, Slattery and Schwartz