Middle Fossa Approach

[vjw1218]

Hi, all.

On January 30, I  was  diagnosed with a small AN on my left side. (4mm X 7mm) After being sent to neurotologist Dr.  David Eisenman at the University of Maryland, I discovered that while my tumor is very small,  it's extremely close to the inner ear. I have almost all of my hearing - with the exception of some high-frequency loss that was only detected by a hearing test - and have elected the Middle Fossa surgical approach. I'm 36.

This board has been very helpful on many issues. I've read about many who had the trans lab or CK/GK treatments; but I haven't read much from those of you who've had this particular procedure.

Any input from those who've had the Middle Fossa surgery would be appreciated.

Thanks.

[ppearl214]

hi vjw and welcome.

I do know that Capt'n Deb had middle fossa at House Ear Institute in LA.  When I spoke to her yesterday, she's laid up right now with a little touch of pneumonia. Hopefully, she'll be checking back here soon.  If you like, you can private email her here:

http://anausa.org/forum/index.php?action=profile;u=997

Also hoping, in the interim, others can chime in as well.

Again, welcome....

Phyl

[Desilu]

Hi vjw,

I had Middle Fossa approach done at House Ear Clinic. Middle Fossa approach is used when the doctors are going to try to preserve your hearing. I only lost about 15% of my hearing after surgery. Although your tumor is small like mine was, it all depends where it is positioned on your nerves. Mine was easy to remove because it was sitting on top of the nerves. Some AN's become all entwined between the three nerves (hearing, balance and facial) and is harder to remove. If you would like more info. just send me a personal email. I wish you the best on your AN journey.  Ann

[matti]

hi vjw - I had middle fossa done at Stanford in 1998.  The approach is generally used when the tumor is under 3cm and for hearing preservation. My hearing was perfect prior to surgery. My tumor ended up being 3.5cm and severly splaying the facial nerve, in order to save the facial nerve, my hearing nerve had to be sacraficed. Not much of my hair was shaved for the procedure and my scar is in the shape of a question mark, from behind the top of the ear to the bottom on the skull. I do have a quarter sized depression where a piece of my skull was drilled, but my hair covers it. The depression does not happen to all middle fossa patients. Belly fat was used as caulking when the tumor was removed.

When is your surgery?

Cheryl

[Jessie127]

Hello

    I also had middle fossa approach August of 2005 with a 1.2cm acoustic neuroma at the House Ear Clinic with Dr. De La Cruz and Hitselberger and they chose that approach with me because at the time I was 26 and their main goal was to preserve my hearing which they did.  For your size of tumor I would recommend the same approach. 

Jessica

[OTO]

I had a consultation with Dr. Slattery, House Ear Clinic last week.  He also recommended the middle fossa approach to attempt to preserve the hearing I have left (mild to moderate loss already).

I'm still deciding my final treatment options, but I did talk to the House Clinic Surgical Counselor this a.m.  The medical team would be Dr. Slattery (Neurootologist), Dr. Schwartz (Neurosurgeon) and Dr. Stefan (Internal Medicine).

OTO

[FlyersFan68]

It's great you that caught yours early without serious symptoms or losses. The better outcomes are sometimes associated with the smaller tumors regardless of treatment. However, all treatments usually do render new problems that otherwise may have taken some time to arise. Waiting and watching is a reasonable course of action considering your tumor size and having almost no symptoms at this point. If you rapidly lose your hearing one day call your doctor because sometimes this can be reversed with steroids. I didn't know this back in 03' and these boards were not so good then. If you decide to wait and watch then be sure to keep track of what's going on with your body and continue with your follow-ups and audiograms. No Doubt, one day you will need to take action but right now it seems you're still in the safe zone. When I acquired various and annoying symptoms I knew the path I was heading down and made my decision. No matter what you choose whether it be now or later we are all here for you. 

[Evan]

Oto:

Based upon the size of your tumor, I am wonderiing whether anyone recommended CK or GK instead of "surgery".  As you can see from the bottom of this post, they do not know what I have.  However, two separate doctors (one who does both GK and surgery) and the other one who only does surgery, have stated that even if my diagnosiis of an AN was "correct", they both would have not recommended any type of treatment at this point.  With a relative lack of symptoms and the small size of my tumor (yours is even smaller) they would have simply done a repeat scan in a few months.  As the other post has said, you have many options, and fortunately, due to the nature of AN's, they are so slow growing that you do not have to rush into anything.

Good luck.

Evan

[FlyersFan68]

Evan, I was replying to vjw and not OTo if I am "the other post". I usually respond to the original thread. My name is Steve btw.   

[FlyersFan68]

Oto, House is one of the finest places to go. I am east coast and House is west coast so wasn't so easy at that time with family. It's a shame they had to be that far distance away. I spoke with Dr. Brackman once or twice and he is the nicest man.

[targa72e]

I also have a small AN that is close to the Cochlea. I have been told that while a small AN in the IAC is generally a good thing (relatively) having it so close to the cochlea lessens the chance of hearing preservation regardless of the treatment choice (it also makes hearing loss due to growth more likely). That being said next month I will be 2 years watch and wait. In that time my hearing has gotten better; some other symptoms have gotten worse. Overall I am happy to be waiting and am very glad I did not rush into treatment.

john

[Evan]

Sorry about that Steve (even though you are a fliers fan).  My advice to vjw would have been about the same.  In fact his AN is even smaller than OTO's.  And I think as you have stated, the one thing that we should all remember is that for the most part AN's are so slow growing that in most cases, there is no reason to rush to decide treatment options.

Evan

[FlyersFan68]

No Problem & Nice To Meet You,
If I remember correctly I think 1cm. is the turning point for treatment with small tumors one size does not fit all. So many various situations not to mention mental stress. Unfortunately we gotta roll the dice at some point but certainly nothing wrong with waiting a while. Good Luck & Hope You Get Some Answers.   

[Larry]

Hi guys,

I had middle fossa around 4 years ago and regret that decision with a passion. My an has since re-grown. I am now in watch and wait mode.

Why my annoyance at it - I have had constant and debilitating headaches every day since the op (like Captain Deb) and the drugs - well, I have tried a raft of them including cortizone injected into the head - all to no avail - neuronting helps a bit.

My surgeon now doesn't do middle fossa due to the qty of after effects - headaches and recurrence. he advises me that middle ossa doesn't usually give you "as good a look at the tumor" as trans lab. He now only does translab and regrets the decision to ever do any middle fossa. As for hearing preservation - yeah, you might be lucky to retain some but don't count on it. I hear noise and tinnitus.

My surgeon's first recommendation is watch and wait until the tumour gets to an "impacting" size, that is, causing issues or pressing on the brainstem. he also recommends examining radiation treatment.

Everyone has different outcomes from different treatment. I have been in watch mode for 1 year now and as long as the tumor doesn't grow, I won't be touching it and then, I will be having radiation treatment.

Sorry to sound bitter but living with a sleadgehammer hitting your head for a fair chunk of every day, does make you feel, well, angry.


Laz

[vjw1218]

Thanks to all for your replies.  I should say that while my hearing hasn't been a problem, the debilitating dizziness has. Some days I'm fairly normal and some days I have trouble holding my head up. If I'm not dizzy, I have an earache. I do experience tinnitus, but it doesn't bother me. I'm not willing to "watch and wait" and live with it. It's exhausting and impacts other actvities.

I meet with the neurologist on Monday and will ask him about some of the concerns mentioned here.

Have a blessed Easter!

Valerie