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Directory of AN Complications

This page lists various possible complications after AN treatments, with links to separate pages that provide more details. Your individual odds of having any of the complications listed below depend on your individual AN case, as well as on the treatment and the physician you choose. Prior to making any treatment decisions, AN patients owe it to themselves to understand just how likely they are to have these problems after their treatment. Here is our advice on asking your doctors the right questions.

If anyone has experienced additional symptoms, or has more information on these, they are encouraged to contact us at ANarchive@gmail.com .

The list of complications.

• Paralysis of half the face, which can mean:
• difficulty eating, drinking, blinking, smiling;

Something I was not prepared for [before surgery] is that half my throat is paralyzed, which makes eating difficult.  I choke on absolutely everything so my throat stays irritated. My Dr. is sending me to a throat specialist next week.

• severe droop of half the face;
• vocal problems due to one-sided weakness in vocal cord;
• lost or altered sense of taste;

It might need some of the following procedures:

• plastic surgery of the face;
• hypoglossal anasthomosis (facial nerve graft);
• transplanted soft tissue from roof of mouth to lower eyelid (7-12 graft);
• artificial sling in the jaw;
• botulism toxin (botox) injections;
• face lifts.

• Dental problems (caused by conditions due to facial paralysis)

• Eye problems (eyes are controlled by separate nerves from the rest of the face):
  • dry eye (this problem is quite common, even in patient without any facial muscle weakness);
  • double vision (not a common one, caused either by nerve impairment during surgery or by hydrocephalus after radiosurgery)

• Diminished or destroyed hearing in AN ear (100% loss guaranteed with the translab approach)

  • Beware: "hearing preservation" can either mean "preserving ALL hearing" or "SOME hearing".  Here is more.

• Hyperacusis -- a painful sensitivity to loud sounds (in the good ear)

• Sudden Hearing Loss
  A sudden drop in hearing level can happen to either wait-and-watch or post-radiosurgery patients. It may be reversible if addressed immediately. 

• Contralateral Hearing Loss
  Sudden hearing loss in the non-AN ear can happen after AN surgery. According to a Finnish study of post-surgery complications (http://ethesis.helsinki.fi/julkaisut/laa/kliin/vk/levo/vestibul.pdf), contralateral hearing loss after surgery can have immediate or delayed onset, occuring in up to 1.3% of the patients.  It might be reversible with an immediate course of corticosteroids such as Prednisone, preferably by injection. If your doctors don't know what to do and don't consider steroids a good idea, don't hesitate to get more than one opinion.

• Vestibular (balance) disorders (guaranteed with the translab approach):
• dizziness, vomiting, unsteadiness are all symptoms;
• can inhibit the ability to drive;
• fatigue (sense of exhaustion) is a part of this package;
• vestibular rehabilitation or exercises are helpful in most cases, but central vestibular neuropathy can be both severe and permanent.

• Tinnitus (can appear or become stronger after the treatment).

• Headaches and neck aches (often start later, weeks or months after surgery)
  • may be diagnosed as occipital neuralgia after suboccipital/retrosigmoid surgery

  • here are lots of tips, though it's hard to know in advance which ones will work for you

• Cognitive difficulties and emotional problems (usually temporary):
• short-term memory loss (can't remember things from moment to moment);
• inability to concentrate;
• sense of confusion (also a sense of "not being oneself");
• frustration and intolerance (becoming "anti-social");
• language difficulties (forgetting words or speaking ungrammatically);
• drop in IQ (drops of 20 points have been documented);
• can be confirmed by neuropsychological tests

• CSF leak: cerebrospinal fluid leak (20% risk with translab, 15% with retrosigmoid)

• Hydrocephalus

• Meningitus (brain infection). 
• Post-op meningitus develops 1-60 days post-op in about 3% of surgeries; more likely to occur after a CSF leak.
• AN surgery may also result in recurrent bouts of meningitis, when cold or ear infections may migrate into the cranial cavity and bloom into meningitis.  For those who would prefer a sense of "closure", repacking the surgery site with fat is a standard operation to try to take care of this problem.

• Blood clots, seizures, strokes (consequences can be serious, if not properly detected right away).

• Adverse reaction to steroids (prescribed to control post-op swelling).
  
• Ulner nerve entrapment  (diagnosed by doing a nerve conduction study).

• Incomplete tumor removal (not really a complication, but it does complicate life, since your AN is more likely to come back).

• Depression (usually induced by stress due to other complications; or steroid-related).

• Death

Nowadays, operative death is less common than post-op (2-69 days later).  Most common reasons are internal bleeding, blood clots, and infections.  On the average, there is somewhere around 1% risk of not surviving surgery; your odds depend on your doctor's experience and skill as well as your health factors.  Here is what the Michigan Ear Institute writes:

Careful tumor dissection, with the help of an operating microscope, usually avoids complications. If the blood supply to viral brain centers is disturbed, serious complications may result: loss of muscle control, paralysis, even death. In our experience death occurs rarely as the result of the removal of small acoustic tumors and occurs in less than 1% of the larger tumors.

(Note that this statistic is for their own outcomes only; outcomes from less experienced surgeons will be worse).

Multiple Complications

Multiple complications are often present together, as in these stories:

I severed a 40yr friendship after my best friend told me to "put it out of your mind and move on"! That's easy for someone to say that doesn't deal with the problem day in and day out. Eye problems... balance problems... tinnitus... memory problems... depression... fatigue. Day in and day out. Believe me I am no WIMP.

I had a 1.3 cm AN removed on right side 6 months ago... I still cannot work... Still have terrible headaches... they are very frequent and sometimes very severe. I am off balance a lot... Still having trouble with right eye... my sight is not as good as it used to be... the eye stays dry and I blink a lot. I do not sleep very much. My hearing is lost on the right side, no functional hearing at all... hearing aid will not help... My face is left with some facial palsy... My smile is not the greatest... drool out the right side... But I am alive and doing alright.

I had an acoustic neuroma... surgically removed almost five years ago. I still have slight Bell's palsy on the right side of my face, and of course there is no hearing in my right ear. I also have spasms in my right cheek that are quite uncomfortable... I have headaches every day. My memory isn't at all good either since the surgery. My right eye closes when I eat, watch TV, or read lying down. If I stretch, yawn, or move my head in a certain way, I lose the hearing in my good ear for a few seconds. The tinnitus is still in the dead ear; can it be stopped? I don't feel that my balance has ever returned to normal, I can't ride a bike now and have trouble on uneven surfaces or in a dark room.

When there is a combination of many problems, or for severe cases,  Social Security Disability can become necessary.  Here is a link to our section about Social Security Disability.

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Last Edited: Monday, November 17, 2003