Upcoming Mid-Fossa Surgery Questions

[Bbrown]

I am 53 yrs old & scheduled for middle fossa surgery on 5/28/09 at MD Anderson Hospital in Houston.  My 1.2 cm tumor is located in the left internal auditory canal.  Apologize if this info is common to all acoustic neuroma patients and should not be included.  I was diagnosed 5/ 6/09.  Symptons:  Severe dizziness, slowed comprehension, thought processes and communication have slowed.  When listening, must stop speaker & have information repeated slowly.  When talking (anything more than casual conversation), slow to think & turn thoughts into words.  Use family to help explain and complete sentences for me.  No longer able to multi-task.  Very little hearing loss.  Chance memory and concentration will improve after recovery?

Surgeon briefly explained he will cut behind ear toward top of ear removing section approx 4 cm x 4 cm above ear.  Is this size of incision considered average size to completely remove a 1.2 cm tumor in this location? 

How much hair will be shaved for this type surgery?  Will my head be completely wrapped after the surgery or just a bandage over the incision?  Is it okay to wear nail polish on fingers and toes to surgery? How long after surgery before I can wash my hair? 

Surgeon projected surgery to take anywhere between 6 and 10 hours?  Is the range actually 4 hour variance?

How will I feel the first 24 hours after surgery?  Assume I will sleep most of the time?  How soon do you sit on the edge of the bed and walk after surgery?  I was told to plan on being in the hospital for about 4 days.  Is this length of stay considered average?

When is therapy warranted (for balance, etc)?

I take medications for depression and have increased the dosage since diagnosis but still am easily frustrated, very impatient, and feel sad and gloomy all the time.  Is this common?  Since I have this history, can I expect the crying to stop or improve after recovery?

Thanks for your help with my questions.

Becky

[ppearl214]

Hi Becky,

wow, they scheduled you quickly after diagnosis!  Fast question... just for my own curiosity (as I cannot answer your questions fully since I had CK, not microsurgery)..... since your AN is only 1.2cm (12mm, deemed small AN), did the docs discuss radiation options with you and if yes, why did they rule it out?

As for the memory issue.... many here have noted short term memory deficits (myself included) and although not a common theme amongst AN'ers... there are many that report it.  With microsurgery (or even radio-treatment), there is no proof (to my knowledge, unless someone can produce scientific data to support it) that memory issues get better after treatment.  there are "brain exercises" that we have discussed here, such as reading, doing puzzles/sudoku, etc, to help with memory issues... but I'm not aware of any AN treatment that folks note improved memory after treatment.

Not sure if that helped. Pls hang in there.
Phyl

[Bbrown]

Mid-fossa approach is primarily used to preserve hearing.  Since the tumor is small and mainly confined to the auditory canal, this method was recommended by 2 separate neurosurgeons.  Hope this is the best plan.

I've been off work for about a week because of my comprehension problems.  I am an executive assistant in a very fast paced environment where excessive multi-tasking is the norm.  Obviously, I have been encountering problems with this for several months.

[leapyrtwins]

Mid-fossa approach is primarily used to preserve hearing.  Since the tumor is small and mainly confined to the auditory canal, this method was recommended by 2 separate neurosurgeons.  Hope this is the best plan.

This is the best surgical approach in your particular situation.

Good luck,

Jan

[Kate B]

Hi Becky,

I had middle fossa surgery in 2001 for a 1.5 cm tumor.  What is your hearing level now?
I can give you my experiences relative to your questions:

<Surgeon briefly explained he will cut behind ear toward top of ear removing section approx 4 cm x 4 cm above ear.  Is this size of incision considered average size to completely remove a 1.2 cm tumor in this location? >
Yes, mine is about the same size but it is above and forward toward the temple

How much hair will be shaved for this type surgery?  Will my head be completely wrapped after the surgery or just a bandage over the incision?
They kept the top layer of my hair and shaved around my ear. But with the thick hair I had, nobody noticed.  Your head is wrapped around your ears with your hair coming out of the top...at least mine was

Surgeon projected surgery to take anywhere between 6 and 10 hours?  Is the range actually 4 hour variance?
At House my surgery was between 4 1/4-4 1/2 hours...

How will I feel the first 24 hours after surgery?  Assume I will sleep most of the time?

My first 24 hours were in ICU and my least favorite part of the experience. You are pretty doped up though. I remember being hot because they have these sheets over plastic...I know that is an odd thing to remember. They also keep these air boots on your legs pumping your blood to prevent any clotting problems. I was dizzy during that time

 How soon do you sit on the edge of the bed and walk after surgery?
Before they let you out of ICU, you have to sit in the chair while they make your bed... My advice is to set goals for recovery and make the post operative time a focus on resuming your life.  After surgery, I worked through balance issues by setting goals. They told me I had lost 37% of my balance prior to surgery, so my other side seemed to have compensated and made the balance easier to regain. Once discharged to my room, I set goals relative to walking...such as to start once around the nurses station every three hours..at first with holding on to someone's arm. My surgery was Thursday and by Sunday I made it my goal to walk around the hospital floor 3 times per hour. 

 I was told to plan on being in the hospital for about 4 days.  Is this length of stay considered average?
yes, my surgery was on Thursday, I was in ICU for 24 hours, and discharged by Monday.

When is therapy warranted (for balance, etc)?
It depends on your case..I did not get therapy

I take medications for depression and have increased the dosage since diagnosis but still am easily frustrated, very impatient, and feel sad and gloomy all the time.  Is this common?  Since I have this history, can I expect the crying to stop or improve after recovery?
I can't help with this one

Kate

[Lilan]

Nail polish: House says OK on toes, not on fingernails. Different places may have different practices on this though.

[leapyrtwins]

Becky -

sorry for the short response earlier - I was @ work and couldn't elaborate 

Anyway, I didn't have mid fossa, I had retrosigmoid, but here are my responses to your questions (you'll find that we are all unique here, so you'll get lots of different answers).

Usually the surgeon just shaves as much hair as necessary - you won't have a completely bald head, like my children feared I would     Usually patients have enough hair left to cover the incision area and what is shaved tends to grow back very fast.  My hair was growing back before my stitches were even removed - which was about 9 days post op.

I had a very tight mastoid bandage wrapped around my head for the first 48 hours or so; most patients do.

The length of surgery generally depends on the approach, the location and size of the AN, and how "sticky" it is.  ANs are basically removed layer by layer (peeled, actually) - and that's after the docs actually get to it - so things take time.  My AN was 2.5+ cms and my surgery took 7 1/2 hours.

Honestly, I felt pretty bad the first 24 hours.  I woke up with the room spinning and I had double vision.  I wasn't doped up at all - didn't really require pain meds - but the anesthesia wipes you out.  Everyone has a different experience, but usually the first couple of days are the toughest.  Everything is generally downhill from there.

The game plan is usually to get you up and walking a few days post op.  I failed to do this because I had massive nausea and just putting my legs over the side of the bed wasn't pretty.  As a result, I spent too much time in bed and was in the hospital for an extra day.  Moral of that story - start walking as soon as you feel up to it; it will help in your recovery.

Hospital stay is generally 4 - 7 days.  I was in the hospital for 6, but my nausea and lack of eating were both big factors.  Some get out of the hospital in record time - some take a little longer.  It's important to remember that it's not a race - listen to your body and to your doctors.

My neurotologist had me doing vestibular exercises pre op and I continued them post op, so my balance adjusted pretty well without physical therapy.  But it was offered to me if I wanted it. 

I'd check with your docs about the medication you are currently taking.

My hospital had no restrictions on nail polish - fingers or toes.

Good luck,

Jan

[OTO]

I had Middle Fossa in May 2007 at the St Vincent's Hospital in Los Angeles.   Drs were from the House Ear Clinic.  AN was 1.0 cm.

- Incision - sounds the same.
- Hair.  They only shaved maybe a 3/4-inch strip along the incision line.
- Bandage.  They will have a compression bandage on the side of the head, but the wrapping will be around your head.  I think they removed the compression bandage after 3 days.  After that they just left a strip of bandage tape along the incision.
- Nail Polish - I don't know because I don't wear it...
- Surgery was monday morning (7 am).  I stayed in ICU until wednesday morning (they kept me a little longer because I had a slow heartbeat).  Other AN patients that I met there moved to regular room tuesday evening.   Checked out of hospital late saturday afternoon (5 pm).
- My surgery was 5-1/2 hours.   My AN was stuck to facial nerve, so it took some time.   Middle Fossa gives them a good chance to save hearing, but not as good a view of the facial nerve (compared to translab) so they take their time.
- First 24 hours, you will be groggy and uncomfortable.   Most of the time, you'll be sleeping on an upright angle.  I think they had me sit in a chair on tuesday, but with the slow heartbeat, they put me back in the bed.
- Your estimated length of stay is shorter than my actual stay.
-  When you move to a regular room, the Physical Therapist will come to visit you.   She made me walk around the ward using a walker twice a day.   Everyday would test me by making me walk heel to toe, and other walking exercises.   They also want you to walk around by yourself (if unsure, you can ask one of the nurse assistants or health aides to walk with you).   
-  After checking out of the hospital on satuday, I stayed in the Hospital guest house for another 6 days and flew home on saturday.    During the 6 days, I had a follow up with the doctors, and then they cleared me to go home.
- Therapy.  The doctor gives you a list of exercises.... follow your finger with your eyes.... turn your head side to side, up and down.   stand on one leg...    it's to help you regain your balance....
-  Depression is common.   Also sleep disruption from all the meds.   They prescribe ambien to help you sleep.   I was lucky and didn't need it.

[MissMolly]

Hey Becky,
I'll be right behind you in the mid-fossa surgery line.  Mine is schedule June 22nd and is about the same size as yours.  I hope it goes smoothly and uneventfully and that you get off to a quick recovery. 

Molly

[CHD63]

Becky .....

It looks like most of your questions have already been answered very thoroughly.

Just wanted to add that I think it is fairly routine for many hospitals/physicians to not want a patient to wear fingernail polish when anesthetized because this is another way they check for circulation in the limbs (color of the nails) during surgery.  You could always call the surgeon's office and check with the staff on this.

On the hair washing:  prior to my AN surgery I was given a bottle of Phisohex antibacterial soap and told to shower and wash my hair the morning of surgery using only the Phisohex.  If I remember correctly, I could not wash my hair during the 6 days I was in the hospital but had no restrictions after discharge.  On my MVD surgery 15 years ago I had to wait until the stitches were out 10 days after surgery.

Following my MVD surgery I was terribly nauseated and woke up with a ferocious headache and dizzy, no double vision.  Following my AN surgery I had some nausea but they quickly administered anti-nausea medication because my surgeon did not want me vomiting.  I had no headache at all, but had double vision and dizziness.  My two surgeries were basically the same retrosigmoid approach but done in two different states with two different neurosurgeons, so you see, it is hard to tell.

Cannot help much on the depression other than it is rather normal to have much anxiety pre-brain surgery.

I will be thinking about you and wishing you well as you approach your surgery date.

Keep us posted.  Clarice

[Bbrown]

Thank you for your reply.
Your information is very helpful.
Bec