Does Retrosigmoid get all of the tumor out?

[nycnewbie]

But Wendy, what if you have great hearing and it is deep in the canal? i feel like doing trans would be giving up hope and the risk of facial stuff with middle fossa would not be worth it.
Is there anyone else on this board who was told they had a tumor deep into the canal but had retrosigmoid and got it all out??!!
Serena

Hi NYC,

Sorry I am chiming in a little late.

I assume that since House is suggesting middle fossa, you have decent hearing in your affected ear.  With a tumor the size of yours,perhaps House is recommending middle fossawith middle  because they feel they would be better able to fully visualize the tumor with that approach than with the retrosigmoid approach.  Also since your tumor is deep in the IAC, retrosigmoid approach may not allow full visualization of the tumor, middle fossa would.  My doc had planned a middle fossa approach until I had a sudden hearing loss that would have made middle fossa not worthwhile and so I had translab.  Many doctors trained here prefer to use the retrosigmoid approach because it it the approach they use most often.  My doc trained out in California and routinely used middle fossa when attempting hearing preservation.  If you would like to meet him, I'd be glad to pass his information on to you.  I had surgery at M.t Sinai Hospital last July and had a great outcome other than being SSD.

Best wishes,
Wendy

[wendysig]

Serena,

Sorry to just be replying to your question now.  If you have great hearing now, in my opinion, it would be worth going for retrosigmoid or middle fossa to try for hearing preservation.  Remember though, no one can guarantee an outcome, including hearing preservation.  These two approaches ATTEMPT hearing preservation.  The middle fossa approach does have a higher risk of temporary facial paralysis, but it would more than likely be temporary.  I know your tumor is growing deep in the IAC.  Do you know if it is growing laterally in the IAC?  If so, then it might be impossible to visualize the entire tumor using the retrosigmoid approach and the doctor might end up having to expose the IAC in order to be certain he got the whole tumor, and you would lose your hearing anyway.  And of course, even though the risk is lower, even the retrosigmoid approach carries the risk of  temporary facial paralysis.  The retrosigmoid approach also has a high risk of post-op headaches and CSF leaks.  A large part of what determines facial issues is whether the facial nerve is very involved with the tumor and how sticky the tumor is.  If it is very sticky, docs will usually leave a small piece of the tumor behind in order to spare the facial nerve.  I believe the same is true if the tumor is wrapped around the facial nerve.   

All of these considerations were what made me opt for middle fossa until I had a huge hearing drop.  Once that happened and the steroid taper didn't bring my hearing back back, the only thing that made sense for me was translab.  As it turned out, my hearing loss was due to a sudden growth spurt in my tumor (confirmed by MRI).  Luckily, my tumor wasn't at all sticky and I had only a very minor issue with my right eye which resolved within the first few weeks after surgery.

Wendy

Wendy

[leapyrtwins]

i feel like doing trans would be giving up hope and the risk of facial stuff with middle fossa would not be worth it.

I can understand your thoughts on this, Serena.

I had decent, though diminished, hearing in my AN ear prior to surgery and I had very, very good word recognition.  I was given the choice of retrosigmoid or translab (or radiation, which I decided against) and I chose retrosigmoid because it gave me the chance of saving my hearing.  I didn't want to just lose my hearing completely in my AN ear if there was a possibility - no matter how small - of saving it.  I told my neurotologist that I wanted him and my neurosurgeon to at least take the chance - and if my hearing couldn't be saved, at least we could say we tried.

Long story short, my AN was wrapped around the hearing nerve and they made the decision (which I fully support) to "sacrifice" the nerve in order to remove the entire tumor.  So I took a gamble and I lost.  But as I told my neurotologist, who felt terrible about the loss, at least we gave it our best shot.  I ultimately got a BAHA implant and that's worked out just great for me.

Jan