To have Titanium mesh or NOT

[LizAN]

I talked with Dr. Slattery on Friday evening.  I don't know whether all the docs at HEI do this, but he does use titanium mesh to close up the skull.  It allows the bone to completely regrow, so that I won't have a soft spot.  He said that the risk of nerve entrapment from the mesh comes with retro, not translab.  He also said they use special mesh plates that are molded, not cut, so they have no sharp edges to cause pain.  It sounded pretty convincing.

Has anyone with titanium mesh later had a BAHA pedestal implanted?  I hate to think what would happen if they drilled through the mesh - that would definitely cause sharp edges.  How do they make sure they avoid it?  Does it show up on MRI, so they can plan accordingly?

Liz

[Mei Mei]

all I know is that at Cleveland Clinic, the doctor injected trough the Titanium mesh and nearly killed me.  I am still recovering from that mess   They injected 7 or 8 times through the med and then I passed out and my eyes dilated.  I was intubated and passed out.  That means I was a hair's length from death.   I still fell my mesh two year later.   I wish I had never had the mesh implanted.
Mei Mei

[LizAN]

all I know is that at Cleveland Clinic, the doctor injected trough the Titanium mesh and nearly killed me.  I am still recovering from that mess   They injected 7 or 8 times through the med and then I passed out and my eyes dilated.  I was intubated and passed out.  That means I was a hair's length from death.   I still fell my mesh two year later.   I wish I had never had the mesh implanted.
Mei Mei

That's scary, Mei Mei.  Did they know you had it at the time?

Liz

[pjb]

I talked with Dr. Slattery on Friday evening.  I don't know whether all the docs at HEI do this, but he does use titanium mesh to close up the skull.  It allows the bone to completely regrow, so that I won't have a soft spot.  He said that the risk of nerve entrapment from the mesh comes with retro, not translab.  He also said they use special mesh plates that are molded, not cut, so they have no sharp edges to cause pain.  It sounded pretty convincing.

Has anyone with titanium mesh later had a BAHA pedestal implanted?  I hate to think what would happen if they drilled through the mesh - that would definitely cause sharp edges.  How do they make sure they avoid it?  Does it show up on MRI, so they can plan accordingly?

Liz

I have the Titanium but the screws are up from the huge incision  now to get someone to get them out and I am sure that this is not normal ??

Best Wishes,

[leapyrtwins]

Liz -

I have titanium mesh and a BAHA implant.  My BAHA site is directly on top of my AN surgery site.

The same doc did both procedures so he knew what was inside my head and where it was located.  However, you don't have to have the same doc do both your AN surgery and your BAHA implant.  You just need to let him/her know that you had AN surgery and what approach you had (translab vs retrosigmoid vs mid fossa). 

BAHA implants aren't all that invasive.  Yes, a titanium rod is sunk into your skull, but AN surgery is much more invasive.

A BAHA site may or may not "interfere" with your AN surgery site.  If the doc thinks it will, the BAHA site can be located in a different spot on your skull.  The main thing with a BAHA implant is that the area in which it is implanted needs to have sufficient density to allow the titanium rod to calcify into your skull. 

The only issue I had with my surgery sites being on top each other involved one of the titanium screws from my AN surgery.  It ended up being very close to the surface of my scalp after my BAHA implant and 2 years after the procedure it had "popped up" enough to lead me to ask my doc to remove it (my doc told me that this might become an issue).  He removed the screw, which was extremely tiny (pics on the Forum somewhere - just search), and everything was perfectly okay.

No worries,

Jan

[Jim Scott]

I have titanium mesh and a BAHA implant.  My BAHA site is directly on top of my AN surgery site.

The same doc did both procedures so he knew what was inside my head and where it was located.  However, you don't have to have the same doc do both your AN surgery and your BAHA implant.  You just need to let him/her know that you had AN surgery and what approach you had (translab vs retrosigmoid vs mid fossa). 

BAHA implants aren't all that invasive.  Yes, a titanium rod is sunk into your skull, but AN surgery is much more invasive.

A BAHA site may or may not "interfere" with your AN surgery site.  If the doc thinks it will, the BAHA site can be located in a different spot on your skull.  The main thing with a BAHA implant is that the area in which it is implanted needs to have sufficient density to allow the titanium rod to calcify into your skull. 

The only issue I had with my surgery sites being on top each other involved one of the titanium screws from my AN surgery.  It ended up being very close to the surface of my scalp after my BAHA implant and 2 years after the procedure it had "popped up" enough to lead me to ask my doc to remove it (my doc told me that this might become an issue).  He removed the screw, which was extremely tiny (pics on the Forum somewhere - just search), and everything was perfectly okay.

Liz ~  Here's a link to the photo: http://i219.photobucket.com/albums/cc207/leapyrtwins/100_0693A.jpg 

Jim

[LizAN]

Thanks, ya'll.

Jan, are you saying they put the BAHA implant directly through your titanium mesh?  Maybe by 9 months post-op, there is so much bone on the mesh that it really doesn't matter?

I'm assuming the bone grows on both sides of the mesh and it becomes completely integrated into the skull.  It doesn't sit on top of the skull, right under the skin, does it?

Mei Mei, did they inject something into your skull itself, or just into your scalp?  How long after your surgery were these injections?  That sounds like a horrible experience.

I really want to understand this, as my surgery is a week from today.  On the other hand, I probably can't ask Dr. Slattery to change how he does the translab procedure just for me, and I'm too committed to cancel it now.  He seems very confident that the titanium mesh is a good idea.  He mentioned that titanium is used in facial reconstruction, with very good results.

What would happen if someone wanted to have the titanium mesh removed at a later date?

Liz

[Mei Mei]

I was having terrible headaches from the day after my surgery in 2010 Jan.   I started seeing a neurologist and he gave me Verapamil for 2 mos, Lyrica for a month and Lithium for a month with no impact on my headaches but many side effects.   He sent me to the Pain doctor and the pain doc said I was too complicated and to go to Cleveland Clinic pain center.   I did so and when the doctor came in the room he asked if I had any bone removed and I said I'm not sure, here is the op report.  He said I don't need to see that It has nothing to do with your headaches (but it did answer his question).   He then pointed to my x ray and said I see you have Titanium mesh and he said well I'm going to give you injections now.   I asked weren't we going to do this in the op. rm and he said that wasn't necessary.   Well that was why the doctor sent me to Ohio.    He had the nurse hold my hands and he injected the Kenelog with the Bipuvocaine.    He said he was done and then I said I feel dizzy,  he said to just sit there and I would be alright.   Then I said I can't breathe, and he said to lie down and I fell over.   Then I couldn't talk and they started racing the gurney the hall and that was all I remembered.   I passed out, stopped breathing and my eyes dilated.   My eye doctor said I was in the process of dying.   The next theing I  knew I was waking up with many people around me and a guy named Rafi Israel said he was an ER doc and I was in the ER and I had passed out and my eyes dilated.   They were keeping me intubated on life support and after a while they took out the tube.   Then they moved me to an ICU and observed me overnight.   Dr. Nagy Mekhail said that he didn't know I had bone removed and he injected directly into my brain and my eyes dilated and I stopped breathing so he intubated me.    Talk about having PTSD and knowing no one in Ohio.    I still think about the experience and the doctor never mentioned the episode in his letter to the primary care.   They didn't get a pre auth for the injections and they pursued insurance until they paid the $400 + for the injections and $10000+ for the ER.    It's all about money.
Mei Mei

[LizAN]

Good grief, Mei Mei, what a nightmare!  It makes me want to pass out, just reading about it.  I am so sorry you had such a terrible experience!

How long after your surgery did this happen at the Cleveland Clinic?

Li

[leapyrtwins]

Liz -

the place where my AN was is deep inside my head - basically my IAC (inner ear canal).  I doubt the titanium rod from my BAHA implant goes that deep; it's not that long.

Keep in mind that hundreds of people have titanium mesh in their skull after AN surgery and generally it's not a problem.  Mei Mei is definitely an exception. 

You are wise to ask questions and be informed, but don't worry so much 

Best,

Jan

[Mei Mei]

The injections at CC happened 12 months after my surgery.

In reading your responses I keep thinking about Tod and about the person up in Canada that didn't have the mesh and they are doing fine.  I'm just thinking it is overkill.   What did they do before it was invented?   Tod's surgery was 32 hours long and they closed without the mesh.   When I was and still am having the entrapment one doctor said he would remove it, but removing it is not so simple as the brain has grown through the little squares in the mesh.   There are also adhesions growing there, too.   To cut all that away is a tricky surgery and pretty risky.   I just feel like less is always better.
Mei Mei

[Jim Scott]

Liz ~

I'm not sure how helpful my experience is because I underwent the 'retro' surgical procedure and don't have a BAHA.  But, for what it's worth, I have the titanium mesh and I've never experienced any problems because of it.  None. It's use is fairly common with AN surgery and I doubt it would still be used if it posed a serious statistical risk to patients.  Doctors could be sued for willful negligence if they were using the titanium mesh and it was known to cause serious problems for patients. 

Unfortunately, as with most medical issues, one size does not fit all and for the unfortunate few, such as our friend, Mei Mei, the statistics don't mean much when you're the person who pulls the short straw, as it were, and have to deal with pain, suffering and numerous medical procedures in an attempt to rectify a situation (the titanium mesh) that you had no control over.

I would suggest that what it comes down to is taking a small but very real risk that the use of the titanium mesh will pose problems for you, post-op.  I believe that the skill and knowledge of the doctor performing the surgery is a major factor in securing a good outcome to AN surgery, with few or no complications.  Because many AN surgical patients have had the BAHA implant over titanium mesh with no real problems (e.g. Jan B.), I believe the risk is relatively small.  In addition, your HEI doctor seems to take very reasonable precautions with the mesh so on balance, I don't see any reason to fear it. 

Because AN surgery is invasive and complicated and thus, daunting for the patient, we can drive ourselves crazy playing 'what if?' Since we cannot know the future, we simply have to take some risk while doing whatever we can to minimize the chances of post-op problems.  Being informed is critical but using information that (inevitably) suggests possible risks, albeit small risks, can be counter productive and if we added up all the 'what ifs', few AN patients would ever agree to undergo surgery.  Of course, then we have the risks that come with radiation, so there simply is no panacea.  We do what we can to keep the risk of potential post-op problems small and much of that is linked to choosing a doctor/team with extensive AN surgical and/or radiation experience, as you have with Dr. Slattery at the famed HEI.  I know that you trust the HEI doctors and I'm confident that your trust will be rewarded with a good surgical outcome. 

Jim          

[nancyann]

what Jim said - I'm over 6 years post op & the titanium mesh has never caused a problem.

[texsooner]

I'll chime is as another one who had retrosigmoid surgery, with the titanium mesh. I'm almost 4 years post-op with never any issue with the mesh. I agree with Jim's analysis that the benefits using titanium mesh must outweight the potential problems, or it wouldn't be so widely used. I know this is no comfort for someone like Mei Mei who has had a bad experience, but I don't believe that is common. I would trust your HEI surgeon. 

Patrick

[pjb]

I have had problems with the titanium screws but I blame it on the surgeons not the titanium itself especially with many great outcomes with others definitely depends on the team that do it !!

Best Wishes,