Gamma Knife surgery for the management of glomus tumors: a multicenter study

Clinical article

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  • 1 Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;
  • 2 Neuro-Oncology Program, Massachusetts General Hospital, Boston, Massachusetts;
  • 3 Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota;
  • 4 Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;
  • 5 Division of Neurosurgery, University of Sherbrooke, Quebec, Canada;
  • 6 Hoag Neurosciences Institute, Hoag Memorial Hospital, Newport Beach, California;
  • 7 Department of Neurosurgery, University of Kentucky Medical Center, Lexington, Kentucky;
  • 8 Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada;
  • 9 Arizona Oncology Services Foundation; and
  • 10 Sections of Radiation Oncology and
  • 11 Neurotology, Barrow Neurological Institute, Phoenix, Arizona
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Object

Glomus tumors are rare skull base neoplasms that frequently involve critical cerebrovascular structures and lower cranial nerves. Complete resection is often difficult and may increase cranial nerve deficits. Stereotactic radiosurgery has gained an increasing role in the management of glomus tumors. The authors of this study examine the outcomes after radiosurgery in a large, multicenter patient population.

Methods

Under the auspices of the North American Gamma Knife Consortium, 8 Gamma Knife surgery centers that treat glomus tumors combined their outcome data retrospectively. One hundred thirty-four patient procedures were included in the study (134 procedures in 132 patients, with each procedure being analyzed separately). Prior resection was performed in 51 patients, and prior fractionated external beam radiotherapy was performed in 6 patients. The patients' median age at the time of radiosurgery was 59 years. Forty percent had pulsatile tinnitus at the time of radiosurgery. The median dose to the tumor margin was 15 Gy. The median duration of follow-up was 50.5 months (range 5–220 months).

Results

Overall tumor control was achieved in 93% of patients at last follow-up; actuarial tumor control was 88% at 5 years postradiosurgery. Absence of trigeminal nerve dysfunction at the time of radiosurgery (p = 0.001) and higher number of isocenters (p = 0.005) were statistically associated with tumor progression–free tumor survival. Patients demonstrating new or progressive cranial nerve deficits were also likely to demonstrate tumor progression (p = 0.002). Pulsatile tinnitus improved in 49% of patients who reported it at presentation. New or progressive cranial nerve deficits were noted in 15% of patients; improvement in preexisting cranial nerve deficits was observed in 11% of patients. No patient died as a result of tumor progression.

Conclusions

Gamma Knife surgery was a well-tolerated management strategy that provided a high rate of long-term glomus tumor control. Symptomatic tinnitus improved in almost one-half of the patients. Overall neurological status and cranial nerve function were preserved or improved in the vast majority of patients after radiosurgery.

Abbreviations used in this paper:CN = cranial nerve; GK = Gamma Knife; GKS = GK surgery; NAGKC = North American Gamma Knife Consortium; SRS = stereotactic radiosurgery.

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Contributor Notes

Address correspondence to: Jason P. Sheehan, M.D., Ph.D., Box 800212, Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908. email: jsheehan@virginia.edu.

Please include this information when citing this paper: published online June 8, 2012; DOI: 10.3171/2012.4.JNS11214.

  • 1

    Al-Mefty O, & Teixeira A: Complex tumors of the glomus jugulare: criteria, treatment, and outcome. J Neurosurg 97:13561366, 2002

  • 2

    Alford BR, & Guilford FR: A comprehensive study of tumors of the glomus jugulare. Laryngoscope 72:765805, 1962

  • 3

    Bianchi LC, , Marchetti M, , Brait L, , Bergantin A, , Milanesi I, & Broggi G, : Paragangliomas of head and neck: a treatment option with CyberKnife radiosurgery. Neurol Sci 30:479485, 2009

    • Search Google Scholar
    • Export Citation
  • 4

    Chen PG, , Nguyen JH, , Payne SC, , Sheehan JP, & Hashisaki GT: Treatment of glomus jugulare tumors with gamma knife radiosurgery. Laryngoscope 120:18561862, 2010

    • Search Google Scholar
    • Export Citation
  • 5

    Eustacchio S, , Trummer M, , Unger F, , Schröttner O, , Sutter B, & Pendl G: The role of Gamma Knife radiosurgery in the management of glomus jugular tumours. Acta Neurochir Suppl 84:9197, 2002

    • Search Google Scholar
    • Export Citation
  • 6

    Fayad JN, , Keles B, & Brackmann DE: Jugular foramen tumors: clinical characteristics and treatment outcomes. Otol Neurotol 31:299305, 2010

    • Search Google Scholar
    • Export Citation
  • 7

    Genç A, , Bicer A, , Abacioglu U, , Peker S, , Pamir MN, & Kilic T: Gamma knife radiosurgery for the treatment of glomus jugulare tumors. J Neurooncol 97:101108, 2010

    • Search Google Scholar
    • Export Citation
  • 8

    Gerosa M, , Visca A, , Rizzo P, , Foroni R, , Nicolato A, & Bricolo A: Glomus jugulare tumors: the option of gamma knife radiosurgery. Neurosurgery 59:561569, 2006

    • Search Google Scholar
    • Export Citation
  • 9

    Green JD Jr, , Brackmann DE, , Nguyen CD, , Arriaga MA, , Telischi FF, & De la Cruz A: Surgical management of previously untreated glomus jugulare tumors. Laryngoscope 104:917921, 1994

    • Search Google Scholar
    • Export Citation
  • 10

    Greer JA, , Cody TR, & Weiland LH: Neoplasms of the temporal bone. J Otolaryngol 5:391398, 1976

  • 11

    Gstoettner W, , Matula C, , Hamzavi J, , Kornfehl J, & Czerny C: Long-term results of different treatment modalities in 37 patients with glomus jugulare tumors. Eur Arch Otorhinolaryngol 256:351355, 1999

    • Search Google Scholar
    • Export Citation
  • 12

    Henzel M, , Hamm K, , Gross MW, , Surber G, , Kleinert G, & Failing T, : Fractionated stereotactic radiotherapy of glomus jugulare tumors. Local control, toxicity, symptomatology, and quality of life. Strahlenther Onkol 183:557562, 2007

    • Search Google Scholar
    • Export Citation
  • 13

    Heth J: The basic science of glomus jugulare tumors. Neurosurg Focus 17:2 E2, 2004

  • 14

    Hinerman RW, , Amdur RJ, , Morris CG, , Kirwan J, & Mendenhall WM: Definitive radiotherapy in the management of paragangliomas arising in the head and neck: a 35-year experience. Head Neck 30:14311438, 2008

    • Search Google Scholar
    • Export Citation
  • 15

    Ivan ME, , Sughrue ME, , Clark AJ, , Kane AJ, , Aranda D, & Barani IJ, : A meta-analysis of tumor control rates and treatment-related morbidity for patients with glomus jugulare tumors. Clinical article. J Neurosurg 114:12991305, 2011

    • Search Google Scholar
    • Export Citation
  • 16

    Jackson CG, , Glasscock ME III, & Harris PF: Glomus tumors. Diagnosis, classification, and management of large lesions. Arch Otolaryngol 108:401410, 1982

    • Search Google Scholar
    • Export Citation
  • 17

    Jackson CG, , McGrew BM, , Forest JA, , Netterville JL, , Hampf CF, & Glasscock ME III: Lateral skull base surgery for glomus tumors: long-term control. Otol Neurotol 22:377382, 2001

    • Search Google Scholar
    • Export Citation
  • 18

    Jordan JA, , Roland PS, , McManus C, , Weiner RL, & Giller CA: Stereotactic radiosurgery for glomus jugulare tumors. Laryngoscope 110:3538, 2000

    • Search Google Scholar
    • Export Citation
  • 19

    Lack EE, , Cubilla AL, , Woodruff JM, & Farr HW: Paragangliomas of the head and neck region: a clinical study of 69 patients. Cancer 39:397409, 1977

    • Search Google Scholar
    • Export Citation
  • 20

    Lalwani AK, , Jackler RK, & Gutin PH: Lethal fibrosarcoma complicating radiation therapy for benign glomus jugulare tumor. Am J Otol 14:398402, 1993

    • Search Google Scholar
    • Export Citation
  • 21

    Larner JM, , Hahn SS, , Spaulding CA, & Constable WC: Glomus jugulare tumors. Long-term control by radiation therapy. Cancer 69:18131817, 1992

    • Search Google Scholar
    • Export Citation
  • 22

    Liscák R, , Vladyka V, , Wowra B, , Kemeny A, , Forster D, & Burzaco JA, : Gamma Knife radiosurgery of the glomus jugulare tumour—early multicentre experience. Acta Neurochir (Wien) 141:11411146, 1999

    • Search Google Scholar
    • Export Citation
  • 23

    Mingione V, , Yen CP, , Vance ML, , Steiner M, , Sheehan J, & Laws ER, : Gamma surgery in the treatment of nonsecretory pituitary macroadenoma. J Neurosurg 104:876883, 2006

    • Search Google Scholar
    • Export Citation
  • 24

    Minniti G, , Traish D, , Ashley S, , Gonsalves A, & Brada M: Risk of second brain tumor after conservative surgery and radiotherapy for pituitary adenoma: update after an additional 10 years. J Clin Endocrinol Metab 90:800804, 2005

    • Search Google Scholar
    • Export Citation
  • 25

    Niranjan A, & Flickinger JC: Radiobiology, principle and technique of radiosurgery. Prog Neurol Surg 21:3242, 2008

  • 26

    Ojemann RG: Skull-base surgery: a perspective. J Neurosurg 76:569570, 1992

  • 27

    Oldring D, & Fisch U: Glomus tumors of the temporal region: surgical therapy. Am J Otol 1:718, 1979

  • 28

    Pareschi R, , Righini S, , Destito D, , Raucci AF, & Colombo S: Surgery of glomus jugulare tumors. Skull Base 13:149157, 2003

  • 29

    Patel SJ, , Sekhar LN, , Cass SP, & Hirsch BE: Combined approaches for resection of extensive glomus jugulare tumors. A review of 12 cases. J Neurosurg 80:10261038, 1994

    • Search Google Scholar
    • Export Citation
  • 30

    Reddy EK, , Mansfield CM, & Hartman GV: Chemodectoma of glomus jugulare. Cancer 52:337340, 1983

  • 31

    Rowe J, , Grainger A, , Walton L, , Silcocks P, , Radatz M, & Kemeny A: Risk of malignancy after gamma knife stereotactic radiosurgery. Neurosurgery 60:6065, 2007

    • Search Google Scholar
    • Export Citation
  • 32

    Saringer W, , Khayal H, , Ertl A, , Schoeggl A, & Kitz K: Efficiency of gamma knife radiosurgery in the treatment of glomus jugulare tumors. Minim Invasive Neurosurg 44:141146, 2001

    • Search Google Scholar
    • Export Citation
  • 33

    Sheehan J, , Kondziolka D, , Flickinger J, & Lunsford LD: Gamma knife surgery for glomus jugulare tumors: an intermediate report on efficacy and safety. J Neurosurg 102:Suppl 241246, 2005

    • Search Google Scholar
    • Export Citation
  • 34

    Sheehan J, , Yen CP, & Steiner L: Gamma Knife surgery–induced meningioma. Report of two cases and review of the literature. J Neurosurg 105:325329, 2006

    • Search Google Scholar
    • Export Citation
  • 35

    Spector GJ, , Gado M, , Ciralsky R, , Ogura JH, & Maisel RH: Neurologic implications of glomus tumors in the head and neck. Laryngoscope 85:13871395, 1975

    • Search Google Scholar
    • Export Citation
  • 36

    Thomsen K, , Elbrond O, & Andersen AP: Glomus jugulare tumours. (A series of 21 cases). J Laryngol Otol 89:11131121, 1975

  • 37

    Tuniz F, , Soltys SG, , Choi CY, , Chang SD, , Gibbs IC, & Fischbein NJ, : Multisession cyberknife stereotactic radiosurgery of large, benign cranial base tumors: preliminary study. Neurosurgery 65:898907, 2009

    • Search Google Scholar
    • Export Citation
  • 38

    van der Mey AG, , Maaswinkel-Mooy PD, , Cornelisse CJ, , Schmidt PH, & van de Kamp JJ: Genomic imprinting in hereditary glomus tumours: evidence for new genetic theory. Lancet 2:12911294, 1989

    • Search Google Scholar
    • Export Citation
  • 39

    Varma A, , Nathoo N, , Neyman G, , Suh JH, , Ross J, & Park J, : Gamma knife radiosurgery for glomus jugulare tumors: volumetric analysis in 17 patients. Neurosurgery 59:10301036, 2006

    • Search Google Scholar
    • Export Citation
  • 40

    Watkins LD, , Mendoza N, , Cheesman AD, & Symon L: Glomus jugulare tumours: a review of 61 cases. Acta Neurochir (Wien) 130:6670, 1994

  • 41

    Whitfield PC, , Grey P, , Hardy DG, & Moffat DA: The surgical management of patients with glomus tumours of the skull base. Br J Neurosurg 10:343350, 1996

    • Search Google Scholar
    • Export Citation

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