Stereotactic radiosurgery for jugular foramen schwannomas: an international multicenter study

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OBJECTIVE

For some jugular foramen schwannomas (JFSs), complete resection is possible but may be associated with significant morbidity. Stereotactic radiosurgery (SRS) is a minimally invasive alternative or adjunct to microsurgery for JFSs. The authors reviewed clinical and imaging outcomes of SRS for patients with these tumors.

METHODS

Nine participating centers of the International Gamma Knife Research Foundation identified 92 patients who underwent SRS between 1990 and 2013. Forty-one patients had prior subtotal microsurgical resection. The median interval between previous surgery and SRS was 15 months (range 0.5–144 months). Eighty-four patients had preexisting cranial nerve (CN) symptoms and signs. The median tumor volume was 4.1 cm3 (range 0.8–22.6 cm3), and the median margin dose was 12.5 Gy (range 10–18 Gy). Patients with neurofibromatosis were excluded from this study.

RESULTS

The median follow-up was 51 months (range 6–266 months). Tumors regressed in 47 patients, remained stable in 33, and progressed in 12. The progression-free survival (PFS) was 93% at 3 years, 87% at 5 years, and 82% at 10 years. In the entire series, only a dumbbell shape (extension extracranially via the jugular foramen) was significantly associated with worse PFS. In the group of patients without prior microsurgery (n = 51), factors associated with better PFS included tumor volume < 6 cm3 (p = 0.037) and non–dumbbell-shaped tumors (p = 0.015). Preexisting cranial neuropathies improved in 27 patients, remained stable in 51, and worsened in 14. The CN function improved after SRS in 12% of patients at 1 year, 24% at 2 years, 27% at 3 years, and 32% at 5 years. Symptomatic adverse radiation effects occurred in 7 patients at a median of 7 months after SRS (range 5–38 months). Six patients underwent repeat SRS at a median of 64 months (range 44–134 months). Four patients underwent resection at a median of 14 months after SRS (range 8–30 months).

CONCLUSIONS

Stereotactic radiosurgery proved to be a safe and effective primary or adjuvant management approach for JFSs. Long-term tumor control rates and stability or improvement in CN function were confirmed.

ABBREVIATIONS CN = cranial nerve; GKS = Gamma Knife surgery; IGKRF = International Gamma Knife Research Foundation; JFS = jugular foramen schwannoma; PFS = progression-free survival; SRS = stereotactic radiosurgery.

Article Information

Correspondence Hideyuki Kano, Department of Neurological Surgery, University of Pittsburgh, Ste. B-400, UPMC Presbyterian, 200 Lothrop St., Pittsburgh, PA 15213. email: kanoh@upmc.edu.

INCLUDE WHEN CITING Published online November 10, 2017; DOI: 10.3171/2017.5.JNS162894.

Disclosures Dr. Lunsford is a stockholder with AB Elekta and a consultant for Insightec, DSMB. Dr. Liscak is a consultant for Elekta AB.

© AANS, except where prohibited by US copyright law.

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Figures

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    Upper: Kaplan-Meier estimate of PFS curve after SRS in patients with JFSs. Lower: Kaplan-Meier curves comparing PFS after SRS for dumbbell-shaped tumor versus non–dumbbell-shaped tumors.

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    In the group of patients without prior surgery, Kaplan-Meier curves comparing PFS after SRS for tumor volume of < 6 cm3 versus ≥ 6 cm3.

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    Kaplan-Meier graph showing improvement rate of CN dysfunction.

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    Upper: Kaplan-Meier graph showing deterioration rate of CN symptoms and signs after SRS. Lower: Kaplan-Meier curves comparing the symptomatic deterioration rate after SRS for dumbbell-shaped tumor versus non–dumbbell-shaped tumors.

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