Gamma Knife Radiosurgery for Glomus Jugulare and Tympanicum

Abstract

Objective: To establish the role of gamma knife radiosurgery (GKS) as a treatment strategy for glomus jugulare and tympanicum. Method: A retrospective review of 14 glomus tumors, including 11 glomus jugulare and 3 glomus tympanicum tumors, which were treated by GKS in Taipei Veterans General Hospital from 1993 to 2009, was conducted. Two of these cases had undergone prior surgery with partial tumor resection, and the other 12 cases received primary treatment with GKS after a thorough neuroimaging and cerebral angiography. The tumor volume ranged from 6.5 to 22.1 ml. The maximum dose at the tumor center ranged from 21.6 to 26.3 Gy. All 14 patients were regularly followed up by clinical and radiological evaluations. The median follow-up time was 40.3 months. Results: All 14 patients had significant tumor regression after radiosurgery. The median tumor volume reduction was 34.0% (range 3–79%). Only 1 patient had temporary tumor volume progression (24% increment 6 months post-treatment), accompanied with unilateral facial palsy (from grade III to grade IV) and hearing impairment (from grade I to grade II). The tumor volume of this patient had regressed by 12 months, but facial palsy persisted. The tumor control rate in the series was 100% (n = 14/14), and the preservation rate of cranial nerve function was 92.8% (13/14). There was no complication of lower cranial nerve damage after radiosurgery. Conclusion: GKS appeared to be a good alternative or adjuvant to microsurgical resection in patients who are not amenable to complete surgical eradication, with an excellent tumor control rate and little morbidity after long-term follow-up.

Treatment Outcomes for Single Modality Management of Glomus Jugulare Tumors With Stereotactic Radiosurgery

“…In general, patients either maintain function of their cranial nerves or have improvement in their dysfunction after treatment but many of these studies included patients treated with multiple types of surgical and/or radiation treatment types. 6,12,13,22–26 Our study demonstrated overall stability of cranial nerve function using single modality GKRS. Those with lower cranial neuropathies were rehabilitated well (i.e.…”

“…On average, the decrease in size of tumors treated in our study was 37% is comparable to other centers that have studied tumor response to GKRS. 9,12,17,21–25 These are slow growing tumors and it is important to follow these tumors over longer periods of time to assess for control of growth.…”

“…Decreased patient morbidity with lower rates of post-treatment cranial nerve dysfunction compared to surgery or fractionated radiotherapy have also been observed with SRS. 6,12,14–17 The effect of different treatment modalities on cranial nerves and functional hearing outcomes is essential in the management of GJT and many reported series have solely focused on those managed with a multi-modality approach. Furthermore, data regarding assessment of auditory function has not been reported using accepted reporting guidelines.…”

Stereotactic radiosurgery (SRS) and stereotactic radiation therapy (SRT) for neurooncological and neurological diseases: state of the art and future perspectives

“…Lee et al showed local control rates of 100% (n = 14/14) after gamma knife radiosurgery. All patients had a significant tumor regression with a median volume reduction of 34.0% [33]. The authors concluded that radiosurgery is a good alternative to a microsurgical resection of these lesions.…”

Long term surgical and hearing outcomes in the management of tympanomastoid paragangliomas

“…Though surgery has been the traditional treatment of choice for TMPs, suggestions of radiation as a primary alternative to surgery appear every now and then in literature [19][20][21][22]. We firmly believe that radiation has no role in the primary treatment of TMPs and this view has also been emphasized by many authors [10,19,23].…”