Does every AN surgery result in vestibular nerve removal????

[Patti UT]

I would love to know the answer to this question.  I know a guy who had a much larger AN tumor than mine, pressing on his brainstem more than disturbing his balance or hearing. Got it out Translab, lost his hearing and had some blaance issues immediately post op, but gott better pretty rapidly. He has had no residual balance issues ( or cognitive that he admits anyway), He doesn't remember them telling him if they actually had to remove the vestibular nerve or not.  Another guy I indirectly know, seemed to get his balance back pretty quick.  Even though I have read that it is normal proceedure to remove that nerve to get the tumor out, it makes me wonder if some patients luck out and get to keep thier nerve.

Patti UT

[russ]

Hi Patti

  I think in general the larger the tumor and closer to the brainstem the greater likehood the entire 8th cranial nerve is severed. This would include the vestibular portion and auditory portions.
  Seems in Translab, a gutting of the inner ear ocurs with oftentimes removal of the semicircular canals, some ossicles, and really obliteration of the vestibular nerves there. Of course there are 3, one from each semicircular canal and I think rare ( but have read of it happening ) is the surgery where just one of those tiny nerves can be cut and the other two left intact.
  The working area is quite small at about the size of an aspirin and the hole, a finger deep, although the skull opening may be a quarter in size.
  Regaining balance will occur according to how much good function was lost and how well the contralateral side is and whether it has already been compensating.

  Russ

[Patti UT]

Thanks Russ,

  Guess some folks jsut do better than others after this. Wishing for better days.

[russ]

Hi
  Yes, each are so individualized. I see you had mid-fossa which would give you at least a fair chance at saving the vestibular and auditory nerves . Your AN must have been mosty intracanicular and this is where they really get intwined with the facial, auditory and vestibular nerves.
  A tiny little tumer in the IAC can have the most debilitating effects. I know there's a push among Drs for watch and wait of those, but, during that time, the tumor is doing it's damage, physically and psychologically. Of course, trying to treat can cause further damage. There's risk either way but waiting in the younger pt. will most likelty result in eventual Tx. and furthered dysfunction.
  This is one of the reasons I like HEI so well is their experience in and willingness to perform Mid Fossa, but, alas, they have their failures also.
  Success rates for irradiation of IAC ANs are about the same.
  Russ

[wanderer]

If the nerve is already destroyed by the tumor and the signal to the brain has become unusable,  then your brain will already have adapted to it.   So those people will have less post op difficulty than those who still have balance functions.

IF you cut the nerve in a healthy person they get instant vertigo and spinning.

But for AN patients they may have little or no effect depending on the damage.

I had almost know dizziness or loss of balance from surgery.   

So I guess it depends on what you mean by lucky.   In this case,  long slow growth that destroys the nerve while allowing the brain to transition more gradually means less balance issues.

[nannettesea]

I concur with Russ.  I had trans-lab to ensure ALL vestibular nerves/fibers were removed, basically the entire inner ear.  With middle fossa, they can leave some nerves/fibers, as well as with retro-sigmoid.  This can cause problems however.  Read below the piece by rtigger where the remaining nerve fibers from middle fossa kept causing her problems.  Me, have ongoing serious dizziness issues but appear to be something else (Mal de Debarquement).
Here's her story:
Hi Everyone-
I have been discussing Nan's dizziness with her off line but wanted to share my story.  I am not so sure of the MdD diagnosis.  I was diagnosed with an AN in my left ear in 11/03 (1.0 x0.9 cm but growing out of the EAC towards my brain stem). I had it removed by Dr Fayad/Hitz at House Ear in Los Angeles, CA on 12/3/03 via Middle Fossa approach. I was in the hospital 6 days because I developed a CSF Leak on day 2 and required a spinal drain for 3 days.  No more clear fluid from my nose at that time.   I had the usual balance/dizziness/fatigue problems before and then more so post surgery.  I recovered and for several months I was doing quite well. I lost my hearing in the left ear but minimal facial problems. I had a BAHA hearing aide placed 4/04 which has considerably assisted in my recovery and my return to work.  My balance was functional, not perfect but very functional.  I returned to work 7/04 as a nurse case manager in a community hospital.  Then in January 2004 I started to feel progressive balance and dizziness problems resulting in my inability to function/work, I felt awful. I went on disability again 5/05.   I had vestibular testing that was negative except for some mild nystagamus.  My physician stated because I had a middle fossa approach and they tried to save my hearing (unsuccessfully) they did not cut the complete vestibular nerve (the vestibular nerve has an upper and a lower branch, the lower branch does not always respond to standard vestibular testing).  Because I was cotinuing to get worse my physician started me on gentamycin injections into the affected ear.  The first one lasted about 2 months and then the dizziness started again.  We tried 3 more gentamycin injections which were not as helpful.  After working with my neurotologist and my nerurosurgeion we decided to procede with a laybrynthectomy and vestibular nerve resection which was done 7/05. The belief was that I was growing a neroma on my vestibular nerve that was damaged during my original surgery and this  was giving off bad signals to my brain, causing my problems.  After surgery I was told that I had vestibular nerve fibers growing in my hearing nerve (quite unusual, they discussed my case at grand rounds, Dr Hitz/neurosurgeon states he had not seen this before and he as done thousands of ear surgeries, talk about one in a million). Therefore, they also resected my hearing nerve since I was already deaf in that ear.  I was significantly more dizzing with very poor balance post op with  nystagamus,  my physicians felt this was a good sign,  if the nerve was completely dead then cutting it should not have made my condition worse.  I went to vestibular rehab for 4 weeks and progressively improved.  I was able to return to work in September 1995 with minimal balance/dizziness problems.  A success!!!

[Crazycat]

Not necessarity Patti. I remember hearing that they left my vestibuar system intact for some reason. I'll be visiting with my neuro-otolosist next week and I'll ask him.

                     Paul

[Patti UT]

Not necessarity Patti. I remember hearing that they left my vestibuar system intact for some reason. I'll be visiting with my neuro-otolosist next week and I'll ask him.

                     Paul

Paul,  what is the difference between a neurologist and a neuro otolosist?
Patti

[katmumof3]

as everyone else has already said, and from what i guess we've all read, it seems to all be decided by where exactly the tumor is and what nerves it has affected.  I had a 2.5 L AN pushing on the brain stem, but only balance as an issue. When they opened me up they found the tumor growing off the balance nerve, and luckily pretty much all of my hearing and my facial nerve were saved.  3 months post-op, i'm not far from being back to completely normal.  It's a lucky dip i gues  crack it open! hehe

[Patti UT]

as everyone else has already said, and from what i guess we've all read, it seems to all be decided by where exactly the tumor is and what nerves it has affected.  I had a 2.5 L AN pushing on the brain stem, but only balance as an issue. When they opened me up they found the tumor growing off the balance nerve, and luckily pretty much all of my hearing and my facial nerve were saved.  3 months post-op, i'm not far from being back to completely normal.  It's a lucky dip i gues  crack it open! hehe

So happy you are doing so well. Nice to hear of good results

[Crazycat]

Patti,

 Sorry for the typo. I meant: neurotology - Otology and Neurotology Division of the Department of Otolaryngology is a team of specialists who treat diseases of the ear and skull base. An otologist or neurotologist is a specialist with cranial nerves and the workings of the ear.

  A neurosurgeon is more of a brain surgeon than their otological counterpart. A neurotologist specializes in just one area of the brain. The two of them typically work together on acoustic neuroma patients. I know that sometimes that distinction can be somewhat indistinct! We often refer to the otologist on the team as an "ENT" - ear, nose & throat - specialist to simplify it. While this is true in a general sense it is not entirely accurate. Specifically, an otologist or neurotologist is usually a surgeon.

  Paul

     

[-rdh-]

New kid on the block - I've read a lot of getting better, improving type  comments with regards to balance.   It is my understanding that the nerve will be removed during surgery and in theory the other side of the brain will take over.  I guess my concern is in regards to recreational skiing, running and biking.  Have you been able to resume these sports?  Should I be buying a ski pass for this season? 
-rdh-

[Patti UT]

Dear RDH,

  The unfortunate answer is NO!  I would not buy a ski pass for this season unless your ski area allows you to flow the dollars spent to the following year if you don't use it (ours does). I see your AN is pretty large so perhaps as posted here you may have already been having balance issues and the brain has been compensating all along. When I started this thread I guess I was curious becausse the 2 cases in I mentioned in the first post both seemed to recover their balance fairly well and quickly. I am 23 months post op and among many other post op issues the balance/vertigo continues to be a big problem for me. I was an avid skiier, mountian biker, outdoors person, etc. Now I'm lucky to go on  very moderate hikes.  I was hopeful that the second winter (2005/06 season) I could try skiing, and here we are coming up on the 3rd winter and I'm not even close. It would be a disaster waiting to happen. One turn of the head and I'd be down. Which is exactly what happened when I tried to ride my bike.  Swimming is allso different. I can't do anything that has a repetitous movement, it really gets the vertigo going.. I'm now thinking that scuba diving (although I didn't get to do it often) is probably out too because of the pressure issues.

Everyone is so different in how they do after this surgery. And the Docs really don''t know what your individual outcome will be. Although this forum can sometimes seem a little doom & gloom on some of us posties problems, It is a good way to gather good information and prepare yourself for some of the possibilities tha the doctors seem to downplay. There are also many stories of very good outcomes. This is a good place to be for support from really the only people who will truely understand what you are going through. This is a great bunch of folks here.

One thing I can tell you is that this is a life changing event.  I will be holding positive thoughts and sending hugs and prayers your way Sept 6

Patti UT