My ENT specialist, Dr. Steven Dear, at the California Ear Institute in
Palo Alto, California, is suspecting an acoustic neuroma. However, my
last two MRI reports indicate "Enhancement of the cochlea vestibule
... compatible with labyrinthitis". I am looking for a name(s) of a
top notch specialist(s), preferably from the San Francisco bay area to
receive a second opinion.

Dear elisternh-ga,

I?m sorry to hear of your illness.  An acoustic neuroma, if that is in
fact what you have, is a serious illness.  With modern treatment,
however, this type of disease can be treated, usually surgically or
with radiation.  Usually this type of tumor is treated by
neurosurgeons with the help of an ENT surgeon.  Usually the ENT
surgeons help with the surgical approach to the tumor, drilling
through part of the skull base overlying the ear canal.  The majority
of the procedure is performed by the neurosurgeon.  With that in mind,
I would recommend seeking the advice of a neurosurgeon with experience
in this area for a second opinion.

Fortunately, you are in the Bay Area, near one of the top neurosurgery
departments in the world at UCSF.  I spent two years at UCSF doing
research and am familiar with the faculty there.  While several of the
faculty have experience in acoustic neuromas, the two with the most
experience would likely be Dr. Lawrence Pitts (he also has an
appointment in the ENT department), who has performed over 700
acoustic neuroma resections, and the chairman of the department, Dr.
Mitch Berger, an expert on brain tumors.

Here is a link to Dr. Pitts website at UCSF with contact information:
http://neurosurgery.medschool.ucsf.edu/faculty_staff/department_faculty/pitts.html

Here is a link to Dr. Berger?s site:
http://neurosurgery.medschool.ucsf.edu/faculty_staff/department_faculty/berger.html

Another possibility, particularly if radiation therapy is considered
at some point would be Dr. McDermott, also in the department of
neurosurgery:
http://neurosurgery.medschool.ucsf.edu/faculty_staff/department_faculty/mcdermott.html

Here is a list of phone numbers for scheduling an appointment:
http://neurosurgery.medschool.ucsf.edu/top_nav/referrals.html

Here is a link to their brain tumor center:
http://neurosurgery.medschool.ucsf.edu/patient_care/br_surgery_adult.html


I hope this information was useful.  Please feel free to request any clarification.

          -welte-ga

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Request for Answer Clarification by elisternh-ga on 17 Mar 2005 23:22 PST

Dear welte-ga,

While I appreciate your sympathy and your prognosys and suggested
treatment, these were not what I was looking for. I may not have been
very clear in my question and if so, I appologize. As I indicated in
my question, the diagnosis was not clear cut. I therefor wanted to get
the name of top notch diagnostitian to get a second opinion.
Furthermore, I prefer not to get the second opinion from a surgeon
(when you are a hammer, everything look to you like a nail). I
therefor don't think that the names that you provided are satisfactory
to me.

Best regard,

Eli

---

Clarification of Answer by welte-ga on 18 Mar 2005 04:30 PST

Sorry - I posted my clarification under the comment section.

       -welte-ga

Dear Eli,

Part of the practice of neurosurgery is the diagnosis of disorders
like acoustic neuromas (also known as vestibular schwannomas).  Having
worked closely with many neurosurgeons across the country, I can say
that, while to some degree what you say is true about when you are a
hammer, everything looks like a nail, I haven't met a neurosurgeon who
was particularly gung-ho about operating on someone they didn't think
they could help.  In fact, it was more common to see neurosurgeons
trying to convince referring doctors (or patients) that surgery was
not indicated or that it was even contraindicated.  If a surgeon does
a procedure that's not indicated, there's really no defence if
something goes wrong.  A basic tenet of medical ethics is that the
patient should be presented with the risks and benefits of any
procedure and then they decide for themselves if they want to take the
risk (informed consent).  A misdiagnosis leads to risk without
benefit, which is in nobody's interest.  Another thing to think about
- neurosurgeons also work with radiation oncologists.  Often times
skull base tumors (if that's what you have) such as acoustic neuromas
can be treated with radiation, which spares the patient the risk of
open brain surgery.  I didn't really go into treatment in my original
answer, but this may address the issue that neurosurgeons don't
exclusively recommend surgery.


Also, ENT doctors are surgeons, both by training and culture.  For
better or worse, the way medicine is practiced in this country, the
doctors who treat a given disease also tend to be the ones responsible
for ultimately diagnosing it.  ENT surgeons don't generally treat
acoustic neuromas without the direction of a neurosurgeon.  Those that
do operate with the neurosurgeons have generally completed a skull
base fellowship.

The neurosurgeons at UCSF are world experts on both diagnosing and
treating all types of brain tumors, including acoustic neuromas.  They
probably have more experience in this area than anyone on the west
coast, including ENT surgeons and other neurosurgeons.  There is also
the advantage of being a large academic institution where individual
cases are reviewed at weekly conferences with all of the attending
surgeons, radiologists, residents, etc., to discuss both the diagnosis
and potential treatment of each case.  This allows many views to be
expressed and if someone says something unfounded (such as suggesting
nonindicated surgery), others will argue against it.  It's one of the
only settings where you would be able to get such diverse world-level
diagnostic input on your case.

The next best place on the west coast would probably be UCLA.  If you
were to go to some other institution, I would again recommend
evaluation by a neurosurgeon.

Best,

            -welte-ga