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

Clinical article

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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.


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).


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.


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.

Article Information

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:

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

© AANS, except where prohibited by US copyright law.



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    Progression-free survival after GKS.

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    Progression-free survival after GKS for patients undergoing upfront compared with salvage radiosurgery.

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    Progression-free survival after GKS as a function of Glasscock-Jackson grade.

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    Overall patient survival after GKS.


  • 1

    Al-Mefty OTeixeira A: Complex tumors of the glomus jugulare: criteria, treatment, and outcome. J Neurosurg 97:135613662002

  • 2

    Alford BRGuilford FR: A comprehensive study of tumors of the glomus jugulare. Laryngoscope 72:7658051962

  • 3

    Bianchi LCMarchetti MBrait LBergantin AMilanesi IBroggi G: Paragangliomas of head and neck: a treatment option with CyberKnife radiosurgery. Neurol Sci 30:4794852009

  • 4

    Chen PGNguyen JHPayne SCSheehan JPHashisaki GT: Treatment of glomus jugulare tumors with gamma knife radiosurgery. Laryngoscope 120:185618622010

  • 5

    Eustacchio STrummer MUnger FSchröttner OSutter BPendl G: The role of Gamma Knife radiosurgery in the management of glomus jugular tumours. Acta Neurochir Suppl 84:91972002

  • 6

    Fayad JNKeles BBrackmann DE: Jugular foramen tumors: clinical characteristics and treatment outcomes. Otol Neurotol 31:2993052010

  • 7

    Genç ABicer AAbacioglu UPeker SPamir MNKilic T: Gamma knife radiosurgery for the treatment of glomus jugulare tumors. J Neurooncol 97:1011082010

  • 8

    Gerosa MVisca ARizzo PForoni RNicolato ABricolo A: Glomus jugulare tumors: the option of gamma knife radiosurgery. Neurosurgery 59:5615692006

  • 9

    Green JD JrBrackmann DENguyen CDArriaga MATelischi FFDe la Cruz A: Surgical management of previously untreated glomus jugulare tumors. Laryngoscope 104:9179211994

  • 10

    Greer JACody TRWeiland LH: Neoplasms of the temporal bone. J Otolaryngol 5:3913981976

  • 11

    Gstoettner WMatula CHamzavi JKornfehl JCzerny C: Long-term results of different treatment modalities in 37 patients with glomus jugulare tumors. Eur Arch Otorhinolaryngol 256:3513551999

  • 12

    Henzel MHamm KGross MWSurber GKleinert GFailing T: Fractionated stereotactic radiotherapy of glomus jugulare tumors. Local control, toxicity, symptomatology, and quality of life. Strahlenther Onkol 183:5575622007

  • 13

    Heth J: The basic science of glomus jugulare tumors. Neurosurg Focus 17:2E22004

  • 14

    Hinerman RWAmdur RJMorris CGKirwan JMendenhall WM: Definitive radiotherapy in the management of paragangliomas arising in the head and neck: a 35-year experience. Head Neck 30:143114382008

  • 15

    Ivan MESughrue MEClark AJKane AJAranda DBarani IJ: A meta-analysis of tumor control rates and treatment-related morbidity for patients with glomus jugulare tumors. Clinical article. J Neurosurg 114:129913052011

  • 16

    Jackson CGGlasscock ME IIIHarris PF: Glomus tumors. Diagnosis, classification, and management of large lesions. Arch Otolaryngol 108:4014101982

  • 17

    Jackson CGMcGrew BMForest JANetterville JLHampf CFGlasscock ME III: Lateral skull base surgery for glomus tumors: long-term control. Otol Neurotol 22:3773822001

  • 18

    Jordan JARoland PSMcManus CWeiner RLGiller CA: Stereotactic radiosurgery for glomus jugulare tumors. Laryngoscope 110:35382000

  • 19

    Lack EECubilla ALWoodruff JMFarr HW: Paragangliomas of the head and neck region: a clinical study of 69 patients. Cancer 39:3974091977

  • 20

    Lalwani AKJackler RKGutin PH: Lethal fibrosarcoma complicating radiation therapy for benign glomus jugulare tumor. Am J Otol 14:3984021993

  • 21

    Larner JMHahn SSSpaulding CAConstable WC: Glomus jugulare tumors. Long-term control by radiation therapy. Cancer 69:181318171992

  • 22

    Liscák RVladyka VWowra BKemeny AForster DBurzaco JA: Gamma Knife radiosurgery of the glomus jugulare tumour—early multicentre experience. Acta Neurochir (Wien) 141:114111461999

  • 23

    Mingione VYen CPVance MLSteiner MSheehan JLaws ER: Gamma surgery in the treatment of nonsecretory pituitary macroadenoma. J Neurosurg 104:8768832006

  • 24

    Minniti GTraish DAshley SGonsalves ABrada M: Risk of second brain tumor after conservative surgery and radiotherapy for pituitary adenoma: update after an additional 10 years. J Clin Endocrinol Metab 90:8008042005

  • 25

    Niranjan AFlickinger JC: Radiobiology, principle and technique of radiosurgery. Prog Neurol Surg 21:32422008

  • 26

    Ojemann RG: Skull-base surgery: a perspective. J Neurosurg 76:5695701992

  • 27

    Oldring DFisch U: Glomus tumors of the temporal region: surgical therapy. Am J Otol 1:7181979

  • 28

    Pareschi RRighini SDestito DRaucci AFColombo S: Surgery of glomus jugulare tumors. Skull Base 13:1491572003

  • 29

    Patel SJSekhar LNCass SPHirsch BE: Combined approaches for resection of extensive glomus jugulare tumors. A review of 12 cases. J Neurosurg 80:102610381994

  • 30

    Reddy EKMansfield CMHartman GV: Chemodectoma of glomus jugulare. Cancer 52:3373401983

  • 31

    Rowe JGrainger AWalton LSilcocks PRadatz MKemeny A: Risk of malignancy after gamma knife stereotactic radiosurgery. Neurosurgery 60:60652007

  • 32

    Saringer WKhayal HErtl ASchoeggl AKitz K: Efficiency of gamma knife radiosurgery in the treatment of glomus jugulare tumors. Minim Invasive Neurosurg 44:1411462001

  • 33

    Sheehan JKondziolka DFlickinger JLunsford LD: Gamma knife surgery for glomus jugulare tumors: an intermediate report on efficacy and safety. J Neurosurg 102:Suppl2412462005

  • 34

    Sheehan JYen CPSteiner L: Gamma Knife surgery–induced meningioma. Report of two cases and review of the literature. J Neurosurg 105:3253292006

  • 35

    Spector GJGado MCiralsky ROgura JHMaisel RH: Neurologic implications of glomus tumors in the head and neck. Laryngoscope 85:138713951975

  • 36

    Thomsen KElbrond OAndersen AP: Glomus jugulare tumours. (A series of 21 cases). J Laryngol Otol 89:111311211975

  • 37

    Tuniz FSoltys SGChoi CYChang SDGibbs ICFischbein NJ: Multisession cyberknife stereotactic radiosurgery of large, benign cranial base tumors: preliminary study. Neurosurgery 65:8989072009

  • 38

    van der Mey AGMaaswinkel-Mooy PDCornelisse CJSchmidt PHvan de Kamp JJ: Genomic imprinting in hereditary glomus tumours: evidence for new genetic theory. Lancet 2:129112941989

  • 39

    Varma ANathoo NNeyman GSuh JHRoss JPark J: Gamma knife radiosurgery for glomus jugulare tumors: volumetric analysis in 17 patients. Neurosurgery 59:103010362006

  • 40

    Watkins LDMendoza NCheesman ADSymon L: Glomus jugulare tumours: a review of 61 cases. Acta Neurochir (Wien) 130:66701994

  • 41

    Whitfield PCGrey PHardy DGMoffat DA: The surgical management of patients with glomus tumours of the skull base. Br J Neurosurg 10:3433501996




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