When it comes to acoustic neuromas it really does come down to personal choice and patient preference (for the most part, I do understand there are some cases where this isn't as true).
There are three approaches available surgically to remove acoustic neuromas Middle Fossa, Translabrinthe and Retrosigmoid, one is bound to work for you if surgery is what you choose. Each also has it's risks and it may come down to what you want to have preserved. For me the most important thing was to make sure my facial nerve receives the utmost attention and focus so as to not damage it permanently.
I did my research and had made my mind made up before I even met with the first doctor. I just had to hope they saw it my way and would make it easy. Based on my research my choice was to have surgery via the Middle Fossa approach.....WELL.....there is a reason why we see the experts because they know more about these tumors than any amount of research I could have done. Needless to day Middle Fossa wasn't an option. The reason Middle Fossa wasn't an option is due to the size of my tumor, it is only effective for smaller tumors.
When I spoke to both doctors they made their recommendations and both agreed that WW (watch and wait) as well as radiation (gamma knife) were not the option for me, thankfully I agreed, what I didn't agree on was that the approach I didn't want was the one they were recommending, the dreaded translab. With translab there is guaranteed permanent hearing loss but also the highest chance of saving my facial nerve.
During translab surgery part of the ear anatomy is damaged enough that hearing loss is caused. It is also the best approach for seeing the facial nerve first and being able to get it out of the way while removing the tumor and that means a better chance of protecting the nerve. In my case the surgeon will remove the tumor in it's entirety unless the facial nerve is compromised, and, because AN's are slow growing this may not even be a cause for concern in regards to it growing back. If the facial nerve is damaged it can cause facial paralysis of the permanent variety and a list of problems to deal with including being deaf in one ear (SSD= single sided deafness). With facial paralysis comes potential for your eye to become damaged since you won't be able to blink, you will need to add drops to your eye constantly and wear a patch at night. There is potential to fix it with surgery if need be though.
The translab approach enters just behind the ear so the scar will be well hidden by my hair. It is also one of the most direct approaches and estimated 8 hours in the operating room.
I am choosing surgery!