Long-Term Results of Gamma Knife Radiosurgery for Glomus Tumors: An Analysis of 32 Patients

Abstract

BackgroundGlomus jugulare tumors are rare slow-growing hypervascular tumors that arise from the paraganglia of the chemoreceptor system within the jugulare foramen of the temporal lobe. The historical standard treatment has been surgical resection, but because of their high vascularity and involvement with cranial nerves (CNs), Gamma Knife radiosurgery (GKRS) has been advocated as an alternative. The goal of this study is to update and report long-term results of GKRS to achieve local control and symptomatic improvement and to reduce morbidity and mortality when treating glomus jugulare tumors. Materials and MethodsThis study retrospectively collected and reviewed clinical and radiographic data of 32 patients with glomus jugulare tumors treated with GKRS at the Miami Neuroscience Center, South Miami, FL, from 1995 to 2019. For the 32 patients, the mean volume treated was 13.9 cc (0.23 to 40.0 cc), with an average of 8.6 isocenters. The median prescription dose was 12.84 Gy ± 2.07 Gy (range: 10-20 Gy). Follow-up data were available for 29 out of 32 patients, with a median clinical follow-up time of 37.3 months (range: 4.3-169.1 months). At follow-up, patients were evaluated for neurological signs and symptoms and radiographic evidence of progression of disease. ResultsThe median age of the cohort treated with GKRS was 60 years (range: 14-83 years). There were three males and 27 females. Presenting symptomatology was available for 30 out of 32 patients. The most common presenting symptom was hearing loss (21/30) and the most common CN deficit was in CN VIII (19/30). Out of 29 of the patients followed up, 28 patients had improvement (20/29) or resolution (8/29) of symptoms. At the most recent evaluation or contact, patients were without symptomatic progression of CN deficits.Radiographic tumor control was achieved in 28 out of 29 patients. One patient had a recurrence seven years after GKRS, which was treated with surgery. There were no complications, radionecrosis, or mortality reported from GKRS. ConclusionThese data confirm that GKRS is a reasonable upfront treatment option for glomus jugulare tumors. GKRS should be considered more frequently given its excellent long-term local control with low morbidity and risk of complications.

Gamma Knife radiosurgery for the management of glomus jugulare tumors: A systematic review and report of the experience of a radioneurosurgery unit in Latin America

“…Regarding the complications reported, considering the total number of studies included, 18 cases of hearing impairment were reported;[ 3 , 5 , 8 , 13 , 25 ] six cases of vertigo;[ 20 , 25 , 31 ] five cases of transient facial paralysis;[ 5 , 9 , 16 , 18 , 25 ] four cases of vocal cord paralysis;[ 17 , 18 , 31 ] three cases of headache;[ 3 , 22 , 30 ] two cases of dysphagia;[ 31 ] two cases of transitory taste disturbance;[ 31 ] a case of transient ataxia;[ 20 ] one case of diplopia;[ 30 ] and one case of development of non-viable tissue within the medial external auditory canal that required debridement. [ 31 ] No cases of mortality attributable to treatment were reported.…”

Gamma Knife Radiosurgery as a Dependable, Effective Option for Glomus Jagulare Tumors: A Single Institution Long-Term Experience and Review of the Literature

“…All GJTs are highly vascular and develop within proximity to the pars nervosa of the jugular foramen, rendering gross-total resection (GTR) challenging with a relatively high risk of lower cranial nerve injury. [1,3] Thus, it is not surprising that resection entails a great deal of morbidity and often leaves behind large residual tumors and even may cause mortality [1,4,7,14,15,16 ].…”

“…summarizing the data and outcome of these series [1,2,6,8,10,11,12,14,15,17,24,[31][32][33][34][35][36][37][38]. …”