|How is the operation done?
Will they shave her whole head?
Will Val have a scar and stitches all around her head?
There are three possible paths to the tumor site, two start behind the ear, and one above; which one is used is up to the surgeons involved and whether there is an attempt to preserve hearing, that is save the nerves from the ear to the brain. For a brief description of the surgical routes See: http://anausa.org/treat.htm
The opening will be about the size of a half dollar. The tumor is removed by scooping it out in small pieces, kind of like scooping out a melon to the rind. However, unlike a melon, the tumor has a very thin and delicate skin (if any at all), and the tricky part is how much it is adhered (which is actually micro-invasiveness) to nerves and brain tissue. For drawings of the technique, see: http://itsa.ucsf.edu/~rkj/Illustrations/ANSurg.html
Can Val's hearing be saved in that ear?
No. Because so much damage has been done to the nerves due to the pressure of the tumor, no attempt is made to save the nerves when the tumor is this large. It is much more important to remove as much of the tumor as possible to prevent regrowth, so the nerve fibers are removed with the tumor. Since the nerve sheath within the bony canal is the location of the origin of the tumor, there is no way to actually separate the tumor from the nerves in that location.
Will the extreme size of the tumor cause problems in the surgery?
Well, no and maybe. The surgical technique is no different nor is the opening larger, it just takes longer. The difficulty with it being so large is that pressure on and deflection of brain tissue and vascularization is much higher, and the adjacent facial nerve is more stretched and frayed, and therefore more difficult to salvage. See: http://itsa.ucsf.edu/~rkj/Illustrations/FNillus.html
Apparently this surgical team has not seen one this large, but again, the technique is no different. An MD in Italy that Val knows writes that his hospital has operated on ones that are much larger than Val's.
How long is the surgery?
The neuro-otologist said he expects the operation to last about 12 hours. (This is brain surgery after all!) About four hours will be preparation, anesthesia and entry into the skull, so the neurosurgeon will probably start his work about noon. Toward the end of his part is the most delicate work, after the bulk of the tumor has been removed and he is separating the last of it from the brainstem. The last two hours or so the neurotologist will return and close the opening. Please include both surgeons, the anesthesiologist, and operating room staff in your love and prayers.
Barring any complications, Val will be in in intensive care for a day after the surgery, and remain in the hospital for another five days. (She has a friendly bet with the neurotologist she can get out in three. He said "Well, maybe four.")
I thought you said ANs are slow growing. How can it be this large?
ANs seem to grow more slowly when they are small and somewhat faster as they get larger. But at an estimated 2mm growth year, the neurotologist said Val's has been there for at least 25 years, possibly a lot longer than that.
So for those of you who suggested that if Val had been eating meat she could have prevented this tumor, back when it started growing she was eating meat; McDonalds hamburgers in fact!
What causes ANs?
They don't know what causes ANs. This type is called "spontaneous" AN.
The size of the tumor may have reached a critical point in it's pressure on the brainstem, and as noted above, the larger it gets the faster it grows, so symptoms would increase at a more rapid rate. Also, in the MRI images there appears to be a dark area in the center of the tumor; the doctor said there may have been an internal hemorrhage in the tumor that caused it to balloon in size recently.
Will/can the tumor regrow?
Anything is possible. The likelihood of it depends on how complete the removal is, and that depends on how much the tumor adheres to the brain tissue. Those of you who are meditating for assistance to Valerie please envision the tumor separating easily and completely from all surrounding tissues.
In the medical literature I see mention of possible difficulty with neck muscles and other tissue as the entry site heals and scar tissue fills in. Can something be done about that?
This surgical team, unlike many others, takes care to save the bone that is removed and replaces it during closing. This helps greatly with proper re-attachment of tendons, and sealing of the skull against the pressure of cerebro-spinal fluid.
Are you going to do an "after" MRI series?
We'd love to, but at $1600 a set it's not something we'll do for amusement. With no health insurance we're going to have enough problems paying off the tens of thousands of dollars this will cost already. A follow-up MRI is necessary sometime within one to five years. If the website is still here and you still are interested, we'll put the images up here.
How handicapped will Val be after the operation?