Translab Surgery vs. Others

[Bax]

As I have been told there are a couple of options regarding the type of surgery that I should consider.

What are the benefits of the translab surgery vs. others?

[jcc]

translab is the most direct route to the tumor. They go directly behind the year. It "guts" your "plumbing" (i.e. your hearing anatomy) so that you won't be able to hear afterwards; however, you'll also reduce complications such as facial never damage.

The other two are retro-sig and middle fossa. The middle fossa is usually done with small tumors that are not yet into the pontine angel. They go through the top of your ear.The retro-sig goes behind the head/ear. it's used for larger tumors like the translab. The downside to retro-sig is that they have to go through an area of the head with muscles and nerves.

There are no "great" methods. They all have their positives and negatives. Your presenting symptoms and tumor size would likely dictate the method used.

[Karissa]

I had middle fossa surgery on December 17, 2004 in Los Angeles. I am doing great! My hearing and facial nerve were saved!

[Kate B]

Hi Bax,

Let me refer you to this site: http://anworld.com/
It explains the differences between the surgery procedures as well as radiation and wait and watch information.

Good luck on your journey.

Kindest Regards,
Kate

[Steve_D]

Kariisa, I wonder if you could describe your recovery a bit. I'm having middle fossa surgery March 2, 2005 (next week) at Virginia Mason Hospital in Seattle (Dr. Backous). My tumor is small (4 x 7 mm) and completely within the inner ear canal. I've had no symptoms other than sudden hearing loss.

I satill have very usable hearing (about 75%) in my AN ear, and my goal is to preserve that. Do you still have the same level of hearing you did before the operation? Did you have balance problems? How soon did you feel like resuming your "normal" life? Did you do anything special to help speed your recovery?

Steve D.

[jcc]

Steve, if you use middle fossa you should have a very high chance of hearing preservation by an experienced surgeon. Dr. Brackmann at the House Ear would say that in their experience better than 75%. The most important factors being that you still have most of your hearing AND that the tumor is small. Make sure that YOUR surgeon is confident in such a high success rate or seek better treatment elsewhere.

But, everyone's tumor is different. They won't really know until they get in there. Yours could be easily removed or it could be sticky as glue and involve other nerves.

Best of luck!

[Joy]

Kate,  Thanks for listing the anworld website.  This is the first time I have seen it. There are so many things for me to learn.

[cecile k]

Hi All: One should be aware that with the suboccipital approach (is this the same as retrosigmoid?) there is a higher chance of post op headaches. I had the suboccipital approach as the surgeon was trying to save my remaining 60% hearing on the AN side - I did lose all my hearing on the one side, no facial paralysis, but had extreme post op headaches which finally waned after two years with extensive physiotherapy....

Cecile

[Becky]

I understand that suboccipital is the same as retrosigmoid.  I believe there is about a 35% chance of retaining hearing with suboccipital.
Becky

[bonehead]

As with anything, be forewarned on straight statistics.  As many have indicated on other posts there are many variables at play including the skill of the doctor and how "sticky" it is once they get in there.  With an experienced team that has specialized on retrosigmoid approaches I would say the real chances are better than 35%.  Such a skilled team would be able to better assess the chances for hearing preservation given the location and size of the tumor.  They may not even recommend that approach if the chances look low.  I would be leary of a doctor that could not explain the rationale for his/her estimate of chances just as much as I would question one who does not consider all approaches available (including radiation).  I was lucky to have one who did.  This was the main reason I chose him over the other two I looked at.

I had a 2.0 cm AN removed via retrosigmoid just about a year ago, maintained all of my pre-surgery hearing (the test showed it was actually better, but there's always variance in the tests), they were able to remove all the tumor, and had full facial function right after surgery.  I was able to smile at my wife in ICU when I woke up.  I was back running my kids to school after a month, and just last month I went snow boarding for the first time.  If I could only kick the tinitius I'd call it a slam dunk, but there's an equal chance of having that after translab.  So, don't be scared by that stats without reviewing all the angles.

Jon Bonesteel

[rich]

I am 30 yrs old and was recently diagnosed with a 1.8 cm AN on my right side. My job requires that I retain the hearing I still have. The doctors I have chosen (Dr. Mostidomos and Dr. Cueva from Kaiser in San Diego) have told me I have a small chance of retaining my hearing (about 10%). Now I am left trying to decide which surgery method I want to chose and I am unsure. I want to save my hearing, of course. But at a greater risk of facial paralysis I'm uncertain. Any advice?

[Kate B]

Hi Rich,

Let me refer you to this site: http://anworld.com/
It explains the differences between the surgery procedures as well as radiation and wait and watch information.  Usually when there is reduced hearing (lower than 50 ), translab is the  recommended surgery type. Honestly, giving you a 10% chance, sounds like it is the *hope* factor versus an expected outcome.

Good luck on your journey.

Kindest Regards,
Kate

[Mark]

Rich,

Based on your message I'm assuming you still have usable hearing which you are trying to preserve. My AN was roughly the same size as yours and I went to several top surgeons and got similar projections of 10-20% hearing preservation with surgery. Translab is obviously 0% and typically the middle fossa approach is limited to smaller AN's. That leaves the sub occipital route which from what I read has more probability of post surgical complications and headaches than the others. My understanding also is that approach doesn't present the facial nerve to the surgeon as well as the other two, but that is a question better left to a skilled AN surgeon. I opted for FSR with the cyberknife and have had zero facial nerve issues and have retained my pretreatment hearing SRT of 92-100% in the 3.5 years post treatment. It might be worth your time to explore that option as well. You'll have to get Kaiser to let you go elsewhere. I know in the bay area they do have an agreement with Stanford to do radiation for AN's so it can be done. Best of luck

Mark

[Monica]

I had retrosigmoid (also know as sub occipital) in Feb 04 at Johns Hopkins in Baltimore. I had surgery on a Friday and went home on Monday with Tylenol as my pain killer. My 2.5cm tumor was on the balance nerve. That was cut so I had to do some PT to retrain my balance. I lost the hearing in my ear and wear a transmitter behind my right ear that feeds into a hearing aid in my left. Works well. However, I spent the first year without any hearing on the right side and it was very frustrating. I do get headaches from time to time with them being the worst months 5 to 7 post surgery. Now they are infrequent, less intense and shorter in length.  My skull is still tender in spots - but not in the area of the surgical opening! Good luck with your decision.

[rich]

Thank you all for your input. I think I am going to roll the dice and go with the Retrosigmoid surgery method and hope for the best. My doctors advised me that because of my young age and the lack of medical knowledge with radiation beyond 5 yrs I should opt for the surgery route. I do feel like I just want to get this dang thing out of my head. It is a very togh decision to make unfortunately.