Different Surgical Approaches

Having decided that surgery would be necessary to make the tumor small enough for radiation, I now had to decide on what surgical technique to use. (The choices never end!)


To make things more reader-friendly I'll call the three different techniques or pathways as follows:



1) Above the ear approach

2) Behind the ear approach

3) Back of the head approach

Approach (1) was quickly ruled out because it was only for small tumors.

Approach (2) is usually performed by a 2-man team composed of a neuro-otologist (easier to think of as an EENT Surgeon) and a neurosurgeon. The EENT surgeon carves out a path through the back of the ear leading to the tumor. Then the neurosurgeon takes over and does the actual tumor removal.

Approach (3) is usually performed by neurosurgeons. While they may also work in 2-man teams, they do basically the same work of carving out a path from the back of the skull until the tumor can be seen and removed. I think of the 2-man team in Approach (3) as being Batman and Robin, while the 2-man team in Approach (2) is Batman and the Green Arrow.

Each of the approaches have their pros and cons. As a general rule, neuro-otologists will say that Approach (2) is better; while neurosurgeons who do not work with neuro-otologists will say that Approach (3) is better. I have come to believe that they are both correct. The better, safer approach for each of these surgeons is what they are used to. Surgery is a physical act, and therefore "muscle memory" comes into play. A surgeon will do a better job repeating a procedure that he has performed many times before.

In the end, I have chosen to believe that the advantages of one approach over the other is not so significant that I should let my choice of approaches dictate my choice of doctors. Rather, I should let my choice of doctors dictate my choice of approaches.