I think it is a good idea to deal with the anxiety issues. Some of your symptoms might be anxiety related. SSD and ringing in the ears are bad enough and they can for sure cause a lot of anxiety, together with fatigue due to sleeplesness. And as many of us can know, anxiety and fatigue can worsen a lot of the other symptoms, such as fullness, headaches,vomiting etc. It becomes a vicious circle. From what I have read on the forum some mild dosage of valium, or other antidepressants can help enormously.
I don't think I have answered the original question regarding surgery over gamma knife, so here it goes, hoping that it may provide an alternative point of view:
I chose GK for several reasons. The timing was terrible for me to have surgery. My neurosurgeon suggested that I could wait (which I don't think was a good recommendation), but I wanted to get some form of treatment, before the AN became too large. I have two young children, without any extended family around for help. I was scared of all the possible side effects (mainly the debilitating headaches, diziness, fatigue) that wouldn't allow me to take care of the kids. I didn't have an experienced surgical team in my home town, meaning that I would have to go for surgery elsewhere. I was also scared that in the case that I needed follow up with specialists (for facial and vestibular therapies, etc. etc.) access to specialists would be difficult for me and I that I could be stuck with endless medical appointments out of town. It was hard to figure out the logistics, in the absence of immediate help. To make things worse my job is very demanding with a lot of responsibilities and already very neglected after two maternity leaves.
Although I was borderline, I was still within the acceptable treatment margin for GK. Brain stem distortion was not too bad, although I do have distortion of the 4th ventricle. The doctors described all the possible complications with GK, but I found that all these complications could also happen with surgery, and at a much greater probability. I read tons of the primary medical literature on treatment with stereotactic radiosurgery and was confortable that the probabilities of success are quite high.
I know that many choose surgery first, then radiation. My neurosurgeon suggested that if GK doesn't work, I can always have surgery. So I thought that I would give GK a shot first, hoping that at least I would delay the need for surgery (as I explained this was terrible timing for me). From the medical literature it is not clear if radiation makes surgery more difficult. The evidence is only anecdotal. There are cases where even without radiation the AN is very sticky, and cases where it peels off easily. Hard to draw any statistically significant conclusions.
My doctors also discussed the risk of developing secondary cancer. But again, it is unclear if the probability of developing secondary cancer is higher than the general population. My husband suggested that since I will be having regular MRIs for the rest of my life (which I don't mind at all) even if something comes up I will have the chance to catch it much earlier than everyone else in the general population would.
With radiation, you need to reconcile with the fact that the AN is always there. From my point of view, my AN has been there for years, growing slowly. The brain structures have obviously adjusted to its presence, since I haven't had practically any symptoms (other than the slight numbness in the face). It seems to me that it is a big shock for all the brain structures when the tumor is removed abruptly and everything must be readjusted suddenly. I hope that a long procedure of necrosis, followed (hopefully) by some shrinkage, may provide some relief to the compressed structures without causing any new symptoms.
I agree with Trish that it is something like a Russian roulette you have to take your chances and hope for the best.
Best wishes,
Marianna
