RETROSIG OR TRANSLAB

[v357139]

Some doctors are recommending retrosig and others translab.  Mine is 2.7cm, and pressing on the brainstem.  I thought this was just a matter of doctor preference.  Today, a Dr Brem at UPenn said he thought retrosig was better when tumor is pressing on brainstem like mine.  Said it give a better view of brainstem.  Has anyone heard that?

[Tod]

Yes, both routes offer different views of the involved structure. Very rarely they will use both routes as they did with me.

-Tod

[Jim Scott]

FWIW: My neurosurgeon chose Retrosigmoid Approach surgery specifically because the large (4.5 cm) tumor was pushing 'hard' on my brain stem, actually bending it.   

I suspect 'Retro' is a common surgical approach for tumors in that position.   

Jim

[MMFlorida]

From what I have been reading, Translab, Retro and Middle Fossa have very distinct uses.  For example, my husband will have the Translab because they cannot save his hearing and while the operation is no "walk in the park", it is not as extensive as the retro or Middle Fossa.  So it is not the doctor's choice (ie: I think I will do translab today and if I am in the mood a retro tomorrow.)  It depends a lot on each specific situation such as hearing preservation, age, size of tumor, etc.

[v357139]

Well half my docs said translab and the other half retro.  Dr Schwartz at House even noted brainstem to me, and still recommended translab.  So that is what i meant by doctor choice, related to size, location, chance of hearing.  I have also seen other posts similar to Jim's, where they liked the retro angle to brainstem better.  Anyone else out there who had tumor pushing brainstem, and which approach the docs recommended?

[alabamajane]

Mine was about the same size as yours, was enhancing in the CP angle and pressing on the brainstem also ( indenting it also) ,, I had translab surgery. I also had consult with Dr Slattery at House and he also recommended translab,, even though I had very serviceable hearing in that ear.. It was deep and was told that approach gives best view of facial nerve. Good luck
Jane

[v357139]

Thanks.  Did you need facial nerve graft from the surgery?

[v357139]

Mine was about the same size as yours, was enhancing in the CP angle and pressing on the brainstem also ( indenting it also) ,, I had translab surgery. I also had consult with Dr Slattery at House and he also recommended translab,, even though I had very serviceable hearing in that ear.. It was deep and was told that approach gives best view of facial nerve. Good luck
Jane

And where was your surgery?

[alabamajane]

Yes I did get 12/7  nerve graft 4 days after surgery,, very successful . I had mine at UAB In Birmingham AL ,, excellent surgeons and hospital in this area. Just had 2 year MRI and Dr visit,, no regrowth and good facial movement ..

One thing you must keep in mind in this journey, is that EVERYONE'S journey/ outcome is different no matter where it is preformed or what procedure is done,, there are no guarantees with these tumors,,, location of tumor is just as important as size and there is so much still unknown before Dr gets in there that is unable to be seen on the MRI,, so you do your best research and make your own decision on treatment ( or no treatment for some) ,, and you move forward ,,, best of luck to you ,, PM me if you have more questions,,
Jane

[MMFlorida]

Did they have to go in the same area that they had previously closed up to repair the facial nerve?  Did they remove the stitches and go back in?!?  I can imagine if you are already 4 days into healing and then you have to have surgery again it must be disappointing, but it sound like you had a great outcome!!!
Margie

[alabamajane]

Hi Margie,
No, they did not go into same area for nerve graft..it was a completely different surgery done basically from bottom of that ear down neck to throat area,,
But thank you for your interest and well wishes ,, I am doing well and still recovering,,,
Jane

[Tdenmo]

I had my 2.5 cm acoustic neuroma diagnosed at the end of August 2012 and had retrosigmoid done on Nov. 15th of last year. I had experienced facial numbness, but only a slight loss of hearing. The location of mine sounds comparable to yours. I was very lucky to be referred to Dr. Robert Spetzler at Barrow Neurological Institute here in Phoenix (we live in Phoenix, have several friends who are doctors here and in other places across the country and all describe Dr. Spetzler as a god!) and he and Dr. Weisskopf, who is also fabulous, did my surgery on Nov. 15th. They used the retrosigmoid approach and de-bulked the tumor, because the tumor was already pressing on the nerve which was why I was experiencing the facial numbness. I'll continue with regular MRIs and perhaps will need to have radiation at some point. I had no additional loss of hearing and although I still have some slight facial numbness, my smile is intact and absolutely no facial paralysis, which was important to me. I can't say enough great things about my experience with these two wonderful doctors, and everyone at Barrow and St. Joseph's. With the assorted possible outcomes, a lot depends on location of the AN, both in how much hearing you have lost prior to surgery and how much can be preserved once the procedure is done. Just keep asking questions and figure out what feels right for you. Some people can't stand the thought of having a tumor still in there.

[v357139]

Glad to hear your great outcome.  Shows how different doctors believe in different approaches and strategies (eg debulk).

[luke_simmo]

I have read quite a few stories about people with large (>= 2.5 cm) tumors getting the retrosigmoid surgery, which I don't really understand, based on my own discussions with doctors and research. From my understanding, the chances of saving useful hearing with tumors this size is in the 5-10% vicinity.

Also, my AN was pushing HARD on my brain stem, and my surgeons still recommended translab.

Here's what I learned -- please let me know if I'm wrong!

Translab
Pros: Great view of tumor and facial nerves, allowing complete removal and preservation of facial nerves. Lower chance of post-op headaches compared to retrosigmoid.
Cons: Complete loss of hearing on AN side.

Retrosigmoid
Pros: Potential to save useful hearing, especially if tumor is less than 2 cm.
Cons: Slightly longer/more complicated surgery and higher chance of post-op headaches, resulting in a slightly longer recovery compared to translab.

Middle Fossa:
Pros: Good chance to save hearing.
Cons: Only for small tumors (<= 1 cm).

[v357139]

Your info looks right.  The only other piece I know of is that some doctors just prefer Retro for larger tumors.  Some even feel its better for the facial nerve to not be exposed right away.  And some doctors prefer translab for larger tumors, and prefer to see facial nerve right away.  I guess I see it as different schools of thought, and each doctor has his preference as part of his craft or individual expertise.