A Fork in the Road
Following my trip to Boston and St. Louis, I've been busy- a quick four day work week followed by three day weekend and coastal adventure. Now, finally back to reality. Yesterday, I had my consultation with Dr. Fernandez-Miranda and his team at Stanford and this evening I spoke on the phone with Dr. Almefty at Barrow Neurological Institute in Phoenix. I'm getting so close to a plan, my final choice is definitely between these two surgeons. Both were highly professional, personable, and experienced. I will try to sum up their proposed treatment plans and philosophies then explain where I'm at in the decision process.
Dr. Fernandez-Miranda aka Dr. JFM
Dr. JFM offered two options: the first was called the combined approach and the second was endonasal. The combined approach goes in from the side of my head but in a way that spares the structures of my inner ear while providing a good surgical field. The second, and his more preferred, approach is the endonasal meaning he would be operating and resecting the tumor through my nose! The risks with first approach are a higher chance of nerve and blood vessel trauma, but would provide a larger resection. The second approach offers less risk to nerves/vessels but unfortunately less tumor removal and a risk to develop a leak of my cerebral spinal fluid which may require another surgery to patch. With the endonasal approach I may also need a second surgery down the line to get more of the tumor out. No one else has suggested the endonasal approach, likely because it is highly specialized and difficult to perform, but this is Dr. JFM's area of expertise.
Dr. Almefty
Dr. Almefty's approach was exactly in line with Dr. Bi's. Not a surprise as they had similar surgical training and share similar philosophies in how to treat these tumors. I learned the name of the procedure is actually called the extended retrosigmoid approach- the retrosigmoid approach with additional drilling of my mastoid process. If you feel the side of your head right behind your earlobe you may notice a protrusion of bone. That is the mastoid process. As with the other surgeons, there will of course be a risk for nerve damage to some of my cranial nerves including the ones for face movement/sensation, lateral movement of the right eye, and balance/hearing. However, with this approach they have the best chance at getting as much of it out as possible in one go.
Where to go from here?
There is a lot for me to think about, a lot of pro's and con's to consider. A great case can be made for either surgeon and for their proposed surgical approaches. This is not only a life changing diagnosis to endure but the treatment plan will be just as life changing, if not more. My plan is to let all these details settle in over the weekend, mull the options over carefully then make my final decision by next week. I'm both nervous and excited to have gotten to this point!
Now as for naming this beast- I think I have to go with my best friend Jessica's suggestion to call her Monica, as in Monica from the show Friends. After all, she is going to be my roommate forever because no matter who is operating, she's too close to blood vessels to get rid of all of her!
