Stereotactic radiosurgery in patients with glomus jugulare tumors

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Microsurgical removal of glomus jugulare tumors is frequently associated with injury of the lower cranial nerves. To decrease the morbidity associated with tumor management in these patients, gamma knife surgery (GKS) was performed as an alternative to resection.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Between 1990 and 2003, 42 patients underwent GKS as the primary management (19 patients) or for recurrent glomus jugulare tumors (23 patients). Facial weakness and deafness were more common in patients with recurrent tumors than in those in whom primary GKS was performed (48% compared with 11%, p = 0.02). The mean tumor volume was 13.2 cm<jats:sup>3</jats:sup>; the mean tumor margin dose was 14.9 Gy. The mean follow-up period for the 39 patients in whom evaluation was possible was 44 months (range 6–149 months). After GKS, 12 tumors (31%) decreased in size, 26 (67%) were unchanged, and one (2%) grew. The patient whose tumor grew underwent repeated GKS. Progression-free survival after GKS was 100% at 3 and 7 years, and 75% at 10 years. Six patients (15%) experienced new deficits (hearing loss alone in three, facial numbness and hearing loss in one, vocal cord paralysis and hearing loss in one, and temporary imbalance and/or vertigo in one). In 26 patients in whom hearing could be tested before GKS, hearing preservation was achieved in 86 and 81% at 1 and 4 years posttreatment, respectively. No patient suffered a new lower cranial nerve deficit after one GKS session; the patient in whom repeated GKS was performed experienced a new vocal cord paralysis 1 year after his second procedure.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Gamma knife surgery provided tumor control with a low risk of new cranial nerve injury in early follow-up review. This procedure can be safely used as a primary management tool in patients with glomus jugulare tumors that do not have significant cervical extension, or in patients with recurrent tumors in this location.</jats:p></jats:sec>

Radiosurgery of Glomus Jugulare Tumors: A Meta-analysis

“…For these studies, 95% of patients (95% CI, 90-98%) achieved clinical control and 96% (95% CI, 92-98%) achieved tumor control. In contrast, 11 studies reported a mean or median follow-up time of <36 months (12,13,16,17,24,25,27,28,29,33,34,38,39,42,43). For this group, 98% of patients achieved tumor control (95% CI, 95-100%) and 95% (95% CI, 91-98%) achieved clinical control.…”

The management of head-and-neck paragangliomas

“…Neurological improvement occurs in 24-39% of the cases, and a few cases experience worsening of conditions (only 2.8% permanent; Gottfried et al 2004, Suarez et al 2013a). However, new hearing loss is reported in up to 19% of the SRS-treated JPGL cases (probably due to bone radiation injury; Pollock 2004). JTPGL tumour control with SRS or EBRT is not statistically different, but the mortality due to disease or treatment has been reported to be significantly lower for SRS (Suarez et al 2013a).…”

“…However, the median follow-up duration is short (2-4.8 years), so long-term true local control cannot be accurately assessed. Symptomatic improvement is frequent (29-70%), and a new CN deficit or worsening of a pre-existing CN deficit occurs rarely (0-15%) (Liscak et al 1999, Foote et al 2002, Pollock 2004, Lieberson et al 2012. In a recent literature review, the overall control rate has been reported to be 98% (mean follow-up duration of only 31 months) with a 3% overall complication rate (mostly mild: nausea, vomiting and vertigo) (Lieberson et al 2012).…”

Komplex nyaki és agyi érpatológia endovascularis kezelése

“…Emollitio cerebri és agyidegbénulások lehetnek az intervenciós beavatkozás főbb szövődményei [6,8]. Inoperábilis esetekben potenciális kezelési lehetőség a stereotaxiás sugársebészeti kezelés, amellyel általában jó növekedési kontroll érhető el [9,10].…”