1) As arizonajack states, there is no "one best place" for treating ANs because it will depend on the type of treatment. However, my research turned up this:
for open surgery - House Ear Institute and Clinic (HEI) in Los Angeles, California. They have more surgical experience than anyone if you want to go that route.
for CyberKnife radiosurgery - Stanford Medical Center in Palo Alto, California. They do more CK than any facility worldwide.
for GammaKnife - University of Pittsburgh Medical Center in Pennsylvania.
2) 3.5 cm is usually the maximum recommended size for radiosurgery, whether it be Gamma Knife or CyberKnife. Usually for large tumors, it is surgically debulked and followed up with radiation to avoid nerve damage. Facial paralysis will depend on whether the facial nerve gets damaged/injured during surgery but of all the treatment options, surgery will be the one most likely to cause facial paralysis.
3) Dr Clinton A. Medbery III, a radiation oncologist answers questions online at these sites:
http://www.cyberknife.com/Forum.aspx?g=topics&f=2572 and
http://patientforum.therss.org/yaf_topics3_Acoustic-Neuroma.aspxThere is a ton of very valuable information on this forum from AN patients. Read as many posts as you can and take special note of what treatment choices were made by the posters and what side effects they had to endure. When you seek professional advice, try to do so with physicians who do both surgery and radiation to get unbiased advice. Doctors tend to recommend only procedures they are comfortable with and that may NOT be in the best interest of the patient. I have read that surgeons at HEI tend to use radiation scare tactics to discourage patients from choosing radiosurgery so keep that in mind.
You Tube also has a good deal of AN information. Search for Acoustic Neuroma, Gamma Knife, CyberKnife, etc.
Here are some excellent videos that will help you on your AN journey:
http://www.myacoustic.org/http://www.youtube.com/watch?v=ZbS4K9ENMAghttp://www.youtube.com/watch?v=v_wJ2z_RXc8This forum provides excellent peer to peer experiences but there is no physician participation as in the 2 sites I noted above.
AN treatment is unlike most other medical treatments in that the patient will likely still have most or all pre- treatment symptoms so being treated does not make your symptoms go away. The anausa.org website has a detailed description of all treatment options as well as the advantages and disadvantages of each. Just pull down the "Overview" menu. It also advises you how to select a doctor and what questions you should ask.
