Saturday, June 15, 2013

A Short Q and A with Dr George Jallo - Answering Some Basic Questions About Schwannomas

This post I am very happy to share with everyone - Dr George Jallo of Johns Hopkins Hospital was kind enough to agree to answer a short Q and A to try to help us with some clear answers to fundamental questions about Schwannomas and what is typical for those who have been diagnosed with one or more of them.  Dr Jallo is Professor of Neurological Surgery, Pediatrics and Oncology, Clinical Director, Pediatric Neurosurgery, Director, Neurosurgery Residency Program at Johns Hopkins.  I told him that I hope that we can answer some of the basic questions about Schwannomas so that we may be able to fill a gap that there seems to be in people's knowledge of these tumors, and here are his answers to a simple set of questions I sent him.  - Neil

1)     Being diagnosed with a Schwannoma is a frequently confusing and upsetting situation for those who are affected by these tumors.  What would you say is the most important advice that you would give someone newly diagnosed with a Schwannoma?  What are, in your opinion, are wise first steps to take ?  
 The best advice if once diagnosed with a Schwannoma is to confirm the diagnosis and obtain all the details.  Where is the tumor, how large is it? Is it compressing by spinal cord or brain? Do I need to be screened for other tumors.  Fortunately the vast majority of these tumors are benign and do not require any treatment further than surgery. One needs to be certain it is a schwannoma and not another tumor type. However the only sure way to have the correct diagnosis is surgery and then histological analysis/biopsy of the tumor 
2) I have said to people on our FB page that, from my own experience, being diagnosed with a Schwannoma usually means that one will face surgery at some point, now or later.  I asked my own GP and neurosurgeon if they would validate that statement, generally, and they both said yes.  Do you also take this view that Schwannomas will, in most or almost all cases, require surgery at some point?  And what are some cases, if you can give any general or specific advice, in which one may NOT want to opt for removal of their Schwannoma?  Please share any specifics you can to shed some light on the removal or non-removal of Schwannomas.

Once diagnosed most people will require surgery as although these tumors are benign they do grow slowly. The only exception that surgery is not needed is when these tumors are very small or in a location which does not compress the spinal cord, brain or nerves.
 
3) In your own career as a surgeon, in the cases where you have had to help patients confront Schwannomas, approximately what percentage of those were removed by surgery?  I understand specifics may not be possible, but a general estimation would perhaps be helpful in helping people understand how many have to come out, and how many are treated or monitored by other means.

I would say that I have only observed 10% of patients as the remaining patients (patients that do not have their Schwannomas removed).  We do not operate on some smaller tumors in older patients.  Of the Schwannomas we see we operate on approximately 90% due to the fact that patients either have symptoms from the tumor or the tumor has grown on serial MRI scans. 


4) People are frequently confused and feeling a bit lost after diagnosis with a Schwannoma.  Are there any online resources that you would suggest for those who are newly diagnosed?  Anything to help them understand their situation better?    
No good sites as most focus on multiple schwannomas or neurofribromatosis.  *Note from Neil - we hope to remedy this!
5)  Do you have a suggestion as to what hospitals and research hospitals are the best when it comes to Schwannoma surgery?  We all understand that Johns Hopkins, your hospital, is one of the top facilities anywhere - but for those in other parts of the country who may not have easy access to JH, are there any other excellent programs that you would suggest? 

I do not recommend  any specific hospital but to ask your surgeon how many such tumors he/she has operated on and long term results.  You just want to have an experienced surgeon perform the operation.

Dr. George I. Jallo
Professor of Neurological Surgery, Pediatrics and OncologyClinical Director,  Pediatric Neurosurgery
Director, Neurosurgery Residency Program


CONTACT INFORMATIONThe Johns Hopkins Hospital
Department of Neurosurgery
600 N. Wolfe Street, Phipps 556
Baltimore, MD 21287
410-955-7851 (p)
410-955-7862 (f)