Different Surgical Approaches

[jo2014]

I'm new to this board and am writing on behalf of my sister who was diagnosed with a trigeminal schwanoma (which I know is different than an acoustic schwannoma).  One doctor (Dr. Gutin) is recomending surgery using a anterior transpetrosal approach.  Another doctor (Dr. Sisti) is also recommending surgergy but using a retrosigmoid approach (from behind the ear).  My sister is young (38 years old) and is otherwise healthy.  We are going to meet with the doctors again, but does anyone have any information regarding the two different approaches?  Also, if you have experience with the doctors, please let me know.  I've read really great things on this board about Dr. Sisti but have not read much on Dr. Gutin.  Dr. Gutin would perform this surgery with DR. Selesnick from Cornell.  As of now, she is leaning towards Dr. Sisti.  Thanks in advance!

[TexasSprinter]

I'm sorry that nobody has replied yet.  I had 2 AN surgeries--one middle fossa and one translab, different approaches than your sister is considering.  In both cases, the approach was the result of recommendations by the doctors and my objectives.  For my first surgery, middle fossa gave me the best chance of preserving hearing.  For my second surgery, translab gave the doctors the best view of the tumor and area to work with to finally get it out of my head.  Best wishes to your sister, whatever treatment option she chooses.

[LakeErie]

I never assumed I could determine the best surgical approach. I simply consulted experienced doctors and decided I would choose the one I felt the most confidence in, regardless of the approach he recommended and the tools he would employ. If that was going to be translab, so be it. If was going to be retrosig, so be it. Good luck.

[leapyrtwins]

I haven't heard of anterior transpetrosal approach.  I had retrosigmoid for my AN and had a very good outcome.

I know of Dr. Sisti - have only heard great things; I haven't heard of Dr. Gutin.

Jan

[cpchri1]

Here is what I know.  There are two categories; Anterior Transpetroal approaches which includes the middle fossa approach (and a version called extended middle fossa route or transKawase/Kawase approach) and the Transpetrosal approaches (which include the presigmoid, translabyrinthine and transcochlear, which is not very common).  Here is an excellent article from Barrow Quarterly which describes these surgeries from a medical perspective:

http://www.thebarrow.org/stellent/groups/public/@xinternet_con_bni/documents/webcontent/203562.pdf

(My neurosurgeon was one of the contributors when he was at Barrow; note also that Kawase, as in the Kawase approach, is a very famous neurosurgeon from Tokyo who often visted and collaborated with Mayfield Clinic in Cincinnati).  Some of the techniques discussed in this article may vary slightly depending on your medical center (as an example in the MFA the incision and retraction of tissue was different than my MFA done at House). Other than that it's an excellent reference.