Gamma Knife radiosurgery for glomus jugulare tumors: a single-center series of 75 cases

Ramez Ibrahim National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield; and

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Mohannad B. Ammori Royal Gwent Hospital, Newport, United Kingdom

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John Yianni National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield; and

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Alison Grainger National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield; and

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Jeremy Rowe National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield; and

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Matthias Radatz National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield; and

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OBJECTIVE

Glomus jugulare tumors are rare indolent tumors that frequently involve the lower cranial nerves (CNs). Complete resection can be difficult and associated with lower CN injury. Gamma Knife radiosurgery (GKRS) has established its role as a noninvasive alternative treatment option for these often formidable lesions. The authors aimed to review their experience at the National Centre for Stereotactic Radiosurgery, Sheffield, United Kingdom, specifically the long-term tumor control rate and complications of GKRS for these lesions.

METHODS

Clinical and radiological data were retrospectively reviewed for patients treated between March 1994 and December 2010. Data were available for 75 patients harboring 76 tumors. The tumors in 3 patients were treated in 2 stages. Familial and/or hereditary history was noted in 12 patients, 2 of whom had catecholamine-secreting and/or active tumors. Gamma Knife radiosurgery was the primary treatment modality in 47 patients (63%). The median age at the time of treatment was 55 years. The median tumor volume was 7 cm3, and the median radiosurgical dose to the tumor margin was 18 Gy (range 12–25 Gy). The median duration of radiological follow-up was 51.5 months (range 12–230 months), and the median clinical follow-up was 38.5 months (range 6–223 months).

RESULTS

The overall tumor control rate was 93.4% with low CN morbidity. Improvement of preexisting deficits was noted in 15 patients (20%). A stationary clinical course and no progression of symptoms were noted in 48 patients (64%). Twelve patients (16%) had new symptoms or progression of their preexisting symptoms. The Kaplan-Meier actuarial tumor control rate was 92.2% at 5 years and 86.3% at 10 years.

CONCLUSIONS

Gamma Knife radiosurgery offers a risk-versus-benefit treatment option with very low CN morbidity and stable long-term results.

ABBREVIATIONS

CN = cranial nerve; CSF = cerebrospinal fluid; GKRS = Gamma Knife radiosurgery; GTR = gross-total resection; RT = radiotherapy; SDH = succinate dehydrogenase; SDHB = SDH enzyme complex subunit B.
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