Dear Dr. Sheehan,
Eleven years ago I was operated on for an acoustic neuroma using a trans-lab approach because the likelihood of recovering useful hearing was deemed very low by all the surgeons I consulted. Original tumor was 2.5 cm x 1.5 cm. Results were fine in that it was believed the entire tunmor was removed and save for some facial nerve deficit (nothing obvious just looking at me), I was fine and have lived a very normal life (albeit with SSD) since then. Recent follow up after 10 years now demonstrates the tunor has regrown (10 mm x 7mm x 11 mm) and the MRI report states that it “appears the right glassopharyngeal and right vagus nerves are draped over this lesion.” Only symptoms I seem to have are occasional right ear stuffiness and/or pain, and some sensations in my tongue. My surgeon has commented that my three options are to wait, microsurgery, and radiosurgery. However he did say he was concernerd about any further damage to the facial nerve. I am scheduled for a follow-up high resolution MRI in early August. I am considering gamma-knife surgery but would like your opinion if I am a candidate for this surgery. I am 57 years old and otherwise in good health.
Thank you.
Delayed recurrence of an acoustic neuroma following microsurgery is unfortunately common. Even the most gifted microsurgeons may unintentionally leave behind a small amount of tumor typically adherent to one of the adjacent cranial nerves that will grow and may eventually become problematic. Acoustic neuromas are located in a region of the brain (i.e. the cerebellar-pontine angle) that has a number of important neural structures.
Gamma Knife surgery remains the gold standard for radiosurgical treatment of acoustic neuromas. Now, with long-term studies from the University of Virginia and other luminary centers, Gamma Knife surgery particularly when done at a center with a lot of experience has been shown to afford excellent long-term tumor control rates and a very low risk of post-radiosurgical complications.
In a recent prospective comparison of radiosurgery versus microsurgery for acoustic neuromas (Pollock et al., NEUROSURGERY 59:77-85, 2006), the Gamma Knife (GK) surgery group did significantly better than the microsurgery group in nearly all metrics.
I would be happy to review your most recent MRI to better determine if you are a candidate for GK surgery. Our web site lists the information for a review of your case under the “Make an Appointment” option towards the bottom of the home page. Lastly, I would recommend treatment sooner rather than later based upon your note that the recurrent tumor is in very close proximity to important lower cranial nerves.
Sincerely,
Jason Sheehan
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