Stereotactic Radiosurgery for Glomus Jugulare Tumors

Abstract

Objectives/Hypothesis: Surgery is considered to be the mainstay of treatment for glomus jugulare tumors. A subset of patients are poor surgical candidates based on age, medical problems, tumor size, or prior treatment failure. The purpose of this study was to review our results with stereotactic radiosurgery (gamma knife treatment) in this group of patients, with particular attention to adverse reactions and symptom relief. Study Design: Retrospective review and phone survey. Methods: Charts were reviewed for size and location of tumor, history of previous treatment, symptoms before and after treatment, amount of radiation received, acute and late complications, and functional level before and after treatment. Pretreatment and posttreatment magnetic resonance imaging scans were also reviewed. Identified patients were then contacted for a phone interview. Results: Eight patients were identified. Phone interviews were conducted with four patients. Four patients had failed previous treatment. Follow‐up ranged from 7 to 104 months. One patient experienced an acute complication: intractable vertigo requiring hospitalization. No patient experienced delayed cranial neuropathies. No patient reported worsening of any of the following symptoms: pulsatile tinnitus, hearing loss, facial weakness, hoarseness, or difficulty swallowing. Three patients reported improvement in their pulsatile tinnitus. Two patients reported improvement in hearing loss, and one patient each reported improvement in vertigo and difficulty swallowing. Conclusions: Preliminary results suggest that stereotactic radiosurgery is useful to control symptoms and may be delivered safely in patients with primary or recurrent glomus jugulare tumors who are poor surgical candidates.

Efficacy and safety of stereotactic radiosurgery for glomus jugulare tumors

“…Reported complications include radionecrosis of bone, possible induction of secondary malignancies, and xerostomia. 13,14 The introduction of intensity-modulated radiation therapy has reduced the amount of normal tissue exposed to radiation, to avoid the side effects. Despite these drawbacks, the introduction of radiosurgery has offered a new technique to deliver radiation precisely.…”

Radiosurgery for glomus jugulare: history and recent progress

“…Jordan et al 17 included 8 patients; 1 worsened clinically, although all tumors were controlled and all of the other patients were stable clinically or improved. In Pollock's study, 35 nearly all of the 37 tumors analyzed were controlled, including 12 lesions that regressed.…”

“…This is in part due to the radioresistant nature of cranial nerves. 5 However, among affected patients, reported side effects include transient lower cranial nerve neuropathy, 17,37 transient nerve palsy, 9 and trigeminal neuralgia. 40 Although stereotactic radiosurgery has lower rates of morbidity than surgery or conventional whole-brain radiation therapy, some investigators have proposed that fractionated stereotactic radiosurgery would further reduce the risk of cranial nerve toxicity when treating brain tumors with radiosurgery.…”

Irradiation of glomus jugulare tumors: a historical perspective

“…[6][7][8][9][10][11]17,18 Foote and colleagures 8,9 reported their experience with GKS in 9 patients with glomus tumors and demonstrated tumor control with no long-term complications. Jordan et al 10 reported no tumor progression and no delayed cranial neuropathies in their series of 8 patients treated with GKS. The longest follow-up has been reported more recently by Bari et al, 1 who treated 8 patients with glomus jugulare tumors by using GKS, with a follow-up range of 52-97 months.…”

“…Patients can also present with cranial nerve deficits of the 9th, 10th, and 11th cranial nerves secondary to the mass effect on neighboring structures such as cranial nerves and vasculature. 10 Others present with thrombus of the nearby venous structures, whereas a small percentage of patients initially present with labile blood pressures and tachycardia secondary to catecholamine release by the tumor.…”