To have Titanium mesh or NOT

[Mei Mei]

Dear Friends and PreOps,
In March I had another surgery and I posted asking if anyone had ever heard of methylmethacrylate I received a very interesting and thought provoking answer from MK or Marianna from Toronto, Canada and the surgery was at Vancouver General:


I haven't heard about the procedure that you mentioned, but my neurosurgeon uses methylmethacrylate "bone cement" to put back the piece of the skull that he removes during retrosigmoid, without using a titanium mesh at all. That way it seems that he avoids lots of the related headache side-effects. It seems to me that what you describe is somewhat similar.

Good luck with your procedure and I hope you will find relief.

Marianna


When I asked my surgeon Dr. Frederic Schwartz about not using Titanium mesh but actually using your original skull bone to close up, he replied that's because they don't have as much money as we do in the United States.   ?
My PT said well it was paid for by your insurance company  ?

Since when is expensive always better?   Wouldn't you want to have your original skull bone piece instead of something foreign used to close up?   Just take a look at the Headache section of the Forum and notice all the complications of having something foreign in you head.   The last few months as I watch TV, I see a commercial from some big Malpractice firm asking if you've had Titanium mesh for Gynecologic surgery.   So it's not a problem with AN patients but with others.    I've only known two people that have not had Titanium mesh put in to replace their skull:   Tod down in Richmond at the Virginia Commonwealth University Medical Center and Marianna at the Vancouver General.   They don't have Post Op Headaches.   

Speaking from my side of the Posties, you don't want to EVER have these headaches.   They are worse than migraines and some on the Forum have talked of suicide.   Maybe you might get headaches from occipital nerve damage and Dr. Ducic at Georgetown can fix that.  He's good at that.   Let's hope that doesn't happen to you.   You want to come out of the surgery with the least possible post op damage.

With your list of questions when you go surgeon shopping, include the question of whether they would be willing to put back the bone your mother and father gave you and not put it in the trash.   Would they be willing to NOT use Titanium mesh as they do in POOR impoverished but better off Canada and Richmond, VA?   If not, my best advice to you is to pick yourself up along with your insurance card and continue shopping until you hear what you want to hear.

Titanium is expensive and more expensive than gold.  The only winners in this situation are the Titanium makers of America.   What I wish for all of you is that you come out a winner instead of the Titanium lobby.

In good health,
Mei Mei

[leapyrtwins]

Mei Mei -

it is my understanding from talking to my surgeons that I have both titanium mesh and the piece of my skull that was removed during my surgery.  The way my neurosurgeon described it to me, he cut a "window" in my skull and this "window" was replaced after my AN was removed - before I was stitched up.

The titanium mesh I have is in the place where my AN used to be (along with some of my belly fat).  I also have a titanium plate in my surgical area along with titanium screws.  I've never had a headache associated with my AN surgery.

Jan

[LizAN]

I'm scared about the idea of putting anything foreign in my head, too, but I was under the impression that the headaches from retrosigmoid surgery were due to bone dust in the CSF.   

Liz

[LizAN]

Jan, did they use titanium mesh to rebuild the IAC?  Otherwise, I'm not understanding why they would put titanium mesh where your AN was.

I'm scared to turn my head over to surgeons, when I don't know exactly what they are going to do to me. 

Liz

[mindyandy]

I have the mesh too. The only question that I asked is are people allergic to it? I was told no. I had Retrosigmoid and I have no headaches from my AN surgery.

[Mei Mei]

My MRI shows that the mesh is entrapping the nerves.   This is what it says in the radiology report.   The radiologist called me into his office to talk with me about this.   No radiologist has ever done this.    He said I've been watching you for the past two years and this must be driving you crazy.    He promised to research the problem and get back to me.   I was  so touched.   The nerves were cut in a two hour surgery a year ago.   It helped tremendously from the middle to the top of my head but the sub occipital area and the right side of my neck is still stinging, burning and in constant pain.   I can't got out to a restaurant and talk with someone for more than half an hour.    This mesh has been my Achilles heel ever since my retrosigmoid surgery.    No bone was placed.    That's why I was on life support after my occipital nerve block in Dec. 2010.

I'm going for a cervical nerve block. on June 13th and let your know how it goes.     

Jan, it looks like you had a great surgeon.     

Write to Tod to ask him about his 32 hour surgery in 2010.   I'm sure he said he has no mesh and he also was headache free.
I'm still on the conservative side    If I were a pre op. now, I would err on the side of caution and find someone that would  not use the mesh like Tod.     My tumor was only one cm and Tod's was over 5 hence the 32 hour surgery.      Look to Tod and Marianna up in Canada.    THey are doing well and I'm not.

Sincerely,
Mei Mei

[pjb]

I'm scared about the idea of putting anything foreign in my head, too, but I was under the impression that the headaches from retrosigmoid surgery were due to bone dust in the CSF.   

Liz

I also had retros. and that is what I have read was the bone dust if they are not doing the right thing with the gel foam to absorb it all can cause problems ... I have the titanium screws coming up to the surface of my huge incision and it bothers me along with constant headaches. But Liz you are going to HEI and so many many success stories I am sure you are going to be find.

Best Wishes,

[pjb]

Mei Mei -

it is my understanding from talking to my surgeons that I have both titanium mesh and the piece of my skull that was removed during my surgery.  The way my neurosurgeon described it to me, he cut a "window" in my skull and this "window" was replaced after my AN was removed - before I was stitched up.

The titanium mesh I have is in the place where my AN used to be (along with some of my belly fat).  I also have a titanium plate in my surgical area along with titanium screws.  I've never had a headache associated with my AN surgery.

Jan

Jan was it you that had the screws removed and showed a photo of them ? I went to a new surgeon and he said to take mine out would be a very complex surgery I am confused because his Oto partner stated it was easy and could be done in the office I am now assuming he just does not want to fix want another surgeon did ??

Best Wishes,

[Mei Mei]

We have a lot here in the Maryland DC VA and even further that went to Hopkins and come out with the same headaches.   They get treated  at Georgetown successfully.   These are small tumors with the retrosigmoid.    The doctors in DC said it wasn't necessary.   Dr. Friedman offered me Middle Fossa and so did three other doctors.   Right before I went under at my last surgery to fix this at GW, the resident asked me the size of my tumor and I told him it was 1 cm.   The resident looked at my doctor and said it was a small tumor and they both shook their heads.   What I'm saying is that this was not necessary.

What my main question is why do they even bother with the mesh when Tod had a 5 cm  without the mesh.    It's a big question.

Surgery was possible before the development of the mesh and in Canada.     What can't we have a choice.   Is the mesh absolutely necessary???

Mei Mei

[leapyrtwins]

Jan was it you that had the screws removed and showed a photo of them ?

I had one of the screws removed - but only because it was very close to the surface of my scalp (as the result of my BAHA implant surgery).

My BAHA site is directly on top of my AN surgical site and my doc told me the screw might become an issue.  About 2 1/2 years after my implant, it got to the point where I was scraping my fingertip the screw when I put on my processor. 

So I asked my doc to remove it - and he did during a very short outpatient procedure.  I was awake (lidocaine in my skull) and it took about five minutes once I was prepped; he used a screwdriver.

The screw is extremely tiny, and yes, I did post a picture of it on the Forum but now I can't find it - so here it is again:



The screw is next to a dime. 

Jan

[pjb]

Jan was it you that had the screws removed and showed a photo of them ?

I had one of the screws removed - but only because it was very close to the surface of my scalp (as the result of my BAHA implant surgery).

My BAHA site is directly on top of my AN surgical site and my doc told me the screw might become an issue.  About 2 1/2 years after my implant, it got to the point where I was scraping my fingertip the screw when I put on my processor. 

So I asked my doc to remove it - and he did during a very short outpatient procedure.  I was awake (lidocaine in my skull) and it took about five minutes once I was prepped; he used a screwdriver.

The screw is extremely tiny, and yes, I did post a picture of it on the Forum but now I can't find it - so here it is again:



The screw is next to a dime. 

Jan

I thought I remembered that just that this surgeon did not want to fix another persons work said it is very complicated and his partner said it was easy. Just have to find another surgeon it is up at the surface above the incisions indentation so even I can do it myself...lol....rather not, not sure if it is a flat head or Philips

Best Wishes,

[mk]

When I asked my surgeon Dr. Frederic Schwartz about not using Titanium mesh but actually using your original skull bone to close up, he replied that's because they don't have as much money as we do in the United States.   ?
My PT said well it was paid for by your insurance company  ?

Since when is expensive always better?   

Mei Mei,

This has nothing to do with cost, it depends on the surgeon. My understanding is that the titanium mesh is the standard technique everywhere, including Canada. I think that the reason for using it is to provide a "scaffold" to aid bone regeneration. As far as I know Dr. Akagami at VGH is the only neurosurgeon who doesn't use it in Canada. Dr. Akagami has developed quite a few unique procedures (he does retrosigmoid using a different incision than the typical one, uses gravity for brain retraction, uses the bone cement etc). He achieves very high success rates with his techniques. I think that the fact that he uses a different incision, might make it more feasible to replace the bone, without the mesh.
The titanium mesh does occasionally result in some problems, ranging from some minor discomfort, requiring minor readjustment of the screws to the more severe nerve entrapment like you are experiencing. Other reasons for headaches with retrosigmoid are damage to the occipital nerve, and the bone dust, as mentioned in this thread. But from what I have seen here, at the hands of experienced neurosurgeons, as in HEI, it is usually not a problem.

AN surgery has its risks, as we all know, and there are no guarantees.  Unfortunately there is always a percentage of patients who will experience problems. I do hope that you will eventually find some relief for yours.

Marianna

[leapyrtwins]

pjb -

the surgery to remove my screw very easy.  I was surprised that my doc didn't just do it in his office, but he said it wasn't a sterile environment.  Because the screw was so close to the surface of my skin, the procedure wasn't that invasive.  He simply made a cut in my skin then used the screwdriver to remove the screw.  I didn't ask to see the screwdriver - wish I would have.

I think you are right in your assumption that the surgeon who said it was "complex" just didn't want to do it.  I'd go with the surgeon who said it was easy.

Jan

[pjb]

pjb -

the surgery to remove my screw very easy.  I was surprised that my doc didn't just do it in his office, but he said it wasn't a sterile environment.  Because the screw was so close to the surface of my skin, the procedure wasn't that invasive.  He simply made a cut in my skin then used the screwdriver to remove the screw.  I didn't ask to see the screwdriver - wish I would have.

I think you are right in your assumption that the surgeon who said it was "complex" just didn't want to do it.  I'd go with the surgeon who said it was easy.

Jan

Thank you Jan that is what I figured when he said that I wish I would have had a camera I could imagine what my face looked when he said that my daughter was at both appointments with me so I know for sure of what I heard .. I am sure with the discomfort that I am feeling this is not normal he also said that the brain takes time to heal between 10 to 15 years but I do not think with those screws up at the surface is going to get any better !.

Best Wishes,

[Tod]

Mei Mei, I wouldn't use me as much of example of anything other than having a long surgery. There are a number of people who claim that I don't feel pain (or that I am an unfeeling *******, I'm not clear which ). I do in fact feel pain, I don't believe I have headaches associated with my surgery or FSR as any headaches I have now are no different than what I had at any other time in my life.

Seriously though, I'm not sure the causes of headaches in general are understood well enough to make strong causative relationships between surgery types and headaches as there are simply far too many variables at play. I also think the available data are too poorly assembled and unavailable for most of us to any real research. The selection of people of folks active on the forum is most likely not representative of the AN population and so any correlations we make are not generalizable.

Mei Mei, I wish you could find some relief for your pain, I really do. If nothing else, you should take comfort in the fact that your experience makes the case as to why wait and watch might be the best option for those with small tumors.

-Tod