Things cant be worse. After operating for almost 24 hours, [stage one: 10: 45 am to 10 pm, stage two: 10: 15 am to 11 pm] it still isn't complete! The broad relation to the brainstem needs to be dissected and i am not even sure how much tumor is left.
Tumor was firm, fibrous and vascular [pluckable]. Dissection of the facial nerve took around three hours.
Just thinking of my 'dissection velocity' ... a tuberculum sellae meningioma of 3.0 cm maximum diameter took around 12 hours. The consistency and vascularity and general difficulty were comparable. The vestibular schwannoma with a maximum diameter of 5.2 cm, has a surface area that is almost three times that of the smaller tuberculum sellae meningioma. Its volume should be around seven times larger. [ surface area is a function of square of the diameter, volume is a cube of the diameter] .
tumor decompression must be a function of the surface area [the stretched out normal structures which one has to protect] and volume [the tumor one has to internally decompress], if everything else remain constant [like surgeon experience, location, consistency, vascularity etc]
i shudder to think how many more hours will be required. Wish i had a dedicated neuromicroscope. Every adjustment of the present microscope [borrowed from plastic surgery] takes 20- 30 seconds and can even extend up to a minute. The eyepiece is not tiltable and visualisation is poor. A good microscope should cut down the time by half. so will a CUSA and nerve stimulator.
I will put up the post op scan. This is indeed a long nightmare.
