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AN terminology
Radiosurgery or radiotheraphy?
What does the 'R' in "FSR" stand for, radiosurgery or radiotheraphy? Most FSR practitioners and other leading AN specialists prefer to call it radiosurgery, including such luminaries as Dr. Lindquist in London and Dr. Adler at Stanford. However, some physicians think that it stands for 'radiotheraphy', for the reason that "one time is surgery, multiple times is therapy". Who should the AN patients agree with?
FSR, involving stereotactic radiation delivered in multiple sessions, is a new procedure, because it requires advances in computing that were not available until recently (see here). There are two related procedures older than FSR whose names are not up for debate, stereotactic radiosurgery, and radiation therapy.
Stereotactic radiosurgery, such as with Gamma Knife, is a single-session stereotactic treatment. It has a long success record of killing small tumors, and no one argues that the "surgery" term is appropriate for it.
Radiation therapy is an older multiple-shot non-stereotactic treatment, where the whole head was irradiated. Radiation therapy is not meant to kill all tissues it touches, for then the brain would be destroyed!
When deciding if FSR is "surgery" or "therapy", which way do we choose? The American College of Surgeons' definition of surgery is as follows:
Surgery is performed to structurally alter, revise, or destroy tissues. Surgical procedures are performed using a variety of methods and instruments, including the laser.
FSR is meant to destroy tumors, and it has a success rate at killing ANs that is as good as for Gamma Knife. Therefore, according to this definition, it should be called "surgery".
There are precedents for calling multiple-shot radiation treatments "surgery". For example, laser surgery to correct a torn retina consists many laser shots delivered over many sessions -- but it is not considered therapy. And lasers are basically a form of radiation (LASER = "Light Amplification by Stimulated Emission of Radiation").
Here is a comment from an FSR patient to those who still prefer the term "radiotherapy":
I wonder why the neurosurgeons (not radiologists) at Stanford tell me that I had Fractionated Stereotatic Radiosurgery? And does that mean that someone who is having repeat open surgery because of a re-growth really is having 'open therapy'?
IMHO, therapy is when I take an aspirin every night to lower my risk of a heart attack. Therapy is when I take immuno-suppresant drugs to try to reduce the swelling in my joints. Therapy is when I take steroids to try to reduce the swelling in my joints. Therapy is when I take an acid blocker to keep my ulcers from causing great distress.
IMHO, having a treatment applied to an area of my brain where cells have begun to grow uncontrollably in an attempt to kill the cells and prevent further wild growth is most definitely not therapy. It's surgery.
Just in case you thought another hole in the head was a bad idea, some people think it cures depression and other maladies and go so far as doing the deed themselves! It's called trepanation and there's an article in the Washington Post about it (Sunday, May 31, 1998, Style section).
Middle fossa decompression is the removal of the surrounding bone around the tumor, to allow the tumor room to grow. Ray Olsen has a story in our Patient Directory about it.
ABR or BSER = Auditory brain stem evoked response. It's a painless test where they put electrodes on your head and you listen to clicking noise for about 40 minutes. They get a reading on how your brain is receiving these signals. Apparently, if there is a mass, such as an AN, it would show a particular pattern and you get a positive reading. Negative would mean that it is clear of any growth or other mass. There is debate as to the efficacy of this test in picking up AN's; MRI's are still the best way to go. Here's a hyperlink which describes ABR's: http://www.glanclwyd.demon.co.uk/audiology/pabrt.htm
(by a patient) For about a year now I have had off and on problems with weird sensations in my arms and legs. The sensations vary and include a pins & needles prickly feeling, an achey feeling, mild pain, mild skin surface numbness, and an inner numbness type feeling. These sensations move around alot. I will have problems with one arm one day and the opposite leg the next day. Over the past year, I have had periods were these problems go away, but they keep coming back... I never had anything like this prior to the surgury...Some of us have discovered post-surgery we have ulner nerve entrapment in our arm and that a nerve conduction study done by a neurologist can confirm that. It is from having our arm over our head during surgery. Our fingers are sometimes numb and tingly, but don't know about the leg symptoms.
There is a vestibular symptom that is not uncommon with AN patients, referred to as a Romberg Sign or Romberg test. It most commonly happens with feet together, standing erect, and eyes closed. You can start to fall backwards without even having the sensation of falling backwards.
What are the differences between craniotomy, craniectomy and
cranioplasty?
A craniotomy is an incision into the skull;
a craniectomy is the excision or removal of
part of the skull, and a cranioplasty is the
surgical repair of the skull ("crani-" refers to the skull; the endings
"-otomy," "-ectomy," and "-plasty" are standard in medical
terminology, to be combined with all kinds of body parts). So a surgeon will
"do a craniotomy to perform a craniectomy, and will finish by doing a
cranioplasty". This is not always true -- in the translab approach, even though
a small section of the skull (mastoid bone) is removed, it is not replaced with bone, but
merely filled in with a fat graft taken from the abdomen or some other place.
For terms associated with procedures to alleviate post-treatment complications, see the
Follow-up Operations page of the Archive.
(by a patient) I've had an 8mm AN for four years and frequent serious dizziness for the past two of those years... it became so bad that I decided to have treatment. Neither the microsurgeon nor radiosurgeon were willing to say treatment would eliminate the dizziness. In the process of testing (MRI, balance, hearing) we found nothing had changed over the past year except hearing and that had improved. From this, the ENT concluded that (1) the small tumor should not be causing that kind of dizziness, and (2) it is probable that the dizziness is caused by Meniere's Disease which had been ignored because the tumor was there. I am now being treated for Meniere's disease.
NF2 stands for Neurofibromatosis type 2. Folks with NF2 have bilateral ANs, and can also have other brain and spinal tumors - nearly all are benign, though for this affliction, benign is a definite misnomer! NF2 is genetic; if you have it, you're born with it -- you don't get it later. NF2s are nasty because they destroy hearing in both ears, and are more likely to recur than other ANs. Here is our page about it.
Trigeminal Neuralgia (TN) is an irritation of the 5th cranial (trigeminal) nerve. It causes sharp, shooting pain up and down your face that has been described as the "worst pain known to mankind". It may be one of the symptoms of an AN (usually not the only one), though one can have trigeminal neuralgia from other causes. For AN patients, AN surgery stops the pain; radiosurgery has been successfully used to treat trigeminal pain as well. For others, Dr. Peter Janetta at the University of Pittsburgh may have the answer. TN Association's address is: P.O. Box 340, Barnegat Light, NJ 08006, phone # 609-361-1014
The occipital nerve lies just under the scalp at the back of the head; it is not involved with facial paralysis. Damage to this nerve during suboccipital/retrosigmoid surgery causes occipital neuralgia, which is a chronic long-term (2+ years) headpain. It often starts later, weeks or months after surgery, and tends to be persistent (daily) and very severe:
It begins in the back of my head and ends up across my forehead in tight band-like waves. At times, this pain is so intense I cannot stand.I am not sleeping through the night because of this ongoing, intractable pain.
We are not aware of effective treatments for occipital neuralgia, but here are some
tips for alleviating the pain.
Clinical Manifestations. Clinical: Denoting the symptoms and course of a disease, as distinguished from the laboratory findings of anatomical changes. Manifestations: The display or disclosure of characteristic signs or symptoms of an illness.
There are blood vessel tumors called hemangiomas; there are cases then they were thought to be ANs, until surgery showed what they were.
The cerebellum is the trilobed structure of the brain, lying posterior to the pons and medulla oblongata and inferior to the occipital lobes of the cerebral hemispheres, that is responsible for the regulation and coordination of complex voluntary muscular movement as well as the maintenance of posture and balance. For more terms associated with AN anatomy, see the AN Archive's anatomy course for dummies.
Another good place to look terms up is Stedman's Medical Dictionary. The 25th ed., defines neuroma as "General term for any neoplasm derived from cells of the nervous system." Neoplasm is defined as "a tumor... which may be either benign (benign tumor) or malignant (cancer)." So, neuroma, does not imply 'benignness' by definition; however, prefixing the word 'neuroma' with 'acoustic', does imply benignness, since the same dictionary says that acoustic neuromas are benign tumors.
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Last Edited: Friday, November 01, 2002