Treatment Options

Once one begins researching treatment options for acoustic neuromas, he will quickly come to the realization, as I did, that there is still no "universally accepted standard of care" for the problem. There have been vast improvements in the medical techniques and technology used to deal with ANs in the last ten years, but a consensus on the single best method has yet to emerge, a fact which makes the search for treatment all the more difficult.

I loosely summarize the available options into four -

1) Do nothing.
2) Have surgery.
3) Undergo radiation.
4) Have a combination of surgery and radiation.

DO NOTHING

Since ANs are supposed to be very slow growing, those with small ANs have the option to do nothing and wait things out. Maybe it'll stop growing, or maybe it's growing so slowly that you'll be 95 years old by the time it starts to push on your cranial nerves/brain stem. Unfortunately, this is no longer an option for me because mine is already too big and already pushing against my cranial nerves and my brain stem.

HAVE SURGERY

This is the "cleanest" alternative in the sense that you'll be totally rid of the tumor. But completely removing the tumor also raises the possibility that with it, you remove portions of your nerves and damage the ability of your body to communicate with your brain. Your face might become paralyzed. You might be unable to swallow. You're guaranteed to lose all hearing on the affected side. I decided against this option precisely because I wanted the best odds possible of preserving all the body functions I currently have.

UNDERGO RADIATION

Under this option there are two sub-options -
Single-session radiation (like Gamma Knife) wherein the tumor is zapped with enough radiation to "kill" it in one single session. This sub-option can only be performed on tumors less than 3cm in diameter (which therefore rules this out for me), because anything larger would require a radiation dose that will prove harmful to the brain; and this is probably why the second sub-option was developed,
Multi-session radiation (like Cyber Knife or Fractionated Stereotactic Radiation technologies) which spread the radiation over the multiple sessions, from 3 sessions to as many as 30 or 50. These are relatively new technologies, very attractive in that there is absolutely no downtime. One can have it done during his lunch hour and not even take any time off work. Someday, this may well become the standard of care, but as of now the jury is still out on whether it can really be effective on large tumors. Because imagine this huge very angry bear running at you, and I tell you that you can either use a bazooka or the equivalent of one bazooka shot in as many 0.22 caliber bullets as you want, shot from a stub-nosed revolver. Which option do you think you'd have more confidence in? :-) I ruled this one out because of the uncertainty.

HAVE A COMBINATION OF SURGERY AND RADIATION

The fourth option made the most sense to me. Have a combination of options two and three so as to minimize the risks in the two extremes. With complete removal, we eliminate the problem of the tumor but at the probable expense of the cranial nerves. With radiation, the single shot is not an option for a tumor my size. The multiple-session option on the other hand, poses no risk to the nerves but the certainty of successfully "killing" the tumor is called into question. Having a combination of the two seems like an elegant solution: have surgery to make the tumor smaller such that a small bazooka can safely be used. The beauty is that to make the tumor smaller, the surgeon can carve out the "core" of the tumor and leave the shell. I compare it to an orange. They'll take out the actual orange but leave the peel. Since the peel is the part that is either actually attached to or sticking to the nerves, then there is (hopefully) no actual contact between the surgeon's knife and the nerves. After a few months, we shoot the peel with a small bazooka, thereby "killing" it so that it doesn't grow into another orange.

Sounds like a plan to me.