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Gamma knife surgery for glomus jugulare tumors: an intermediate report on efficacy and safety
Jason Sheehan1, Douglas Kondziolka, John Flickinger
1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia 22908, USA. jps2f@virginia.edu
Object:
Glomus jugulare tumors are rare tumors that commonly involve the middle ear, temporal bone, and lower cranial nerves. Resection, embolization, and radiation therapy have been the mainstays of treatment. Despite these therapies, tumor control can be difficult to achieve particularly without undo risk of patient morbidity or mortality. The authors examine the safety and efficacy of gamma knife surgery (GKS) for glomus jugulare tumors.
Methods:
A retrospective review was undertaken of the results obtained in eight patients who underwent GKS for recurrent, residual, or unresectable glomus jugulare tumors. The median radiosurgical dose to the tumor margin was 15 Gy (range 12-18 Gy). The median clinical follow-up period was 28 months, and the median period for radiological follow up was 32 months. All eight patients demonstrated neurological stability or improvement. No cranial nerve palsies arose or deteriorated after GKS. In the seven patients in whom radiographic follow up was obtained, the tumor size decreased in four and remained stable in three.
Conclusions:
Gamma knife surgery would seem to afford effective local tumor control and preserves neurological function in patients with glomus jugulare tumors. If long-term results with GKS are equally efficacious, the role of stereotactic radiosurgery will expand.
Insights
Gamma Knife Surgery (GKS) offers effective local control for glomus jugulare tumors, preserving neurological function. This radiosurgery approach shows promise for expanding treatment options for these rare tumors.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Glomus jugulare tumors are rare neoplasms affecting the middle ear, temporal bone, and cranial nerves.
- Current treatments like resection, embolization, and radiation therapy present challenges in achieving tumor control without significant patient morbidity.
- The safety and efficacy of Gamma Knife Surgery (GKS) for glomus jugulare tumors require further investigation.
Purpose of the Study:
- To evaluate the safety and efficacy of Gamma Knife Surgery (GKS) for managing glomus jugulare tumors.
- To assess the impact of GKS on tumor control and neurological function in patients with recurrent, residual, or unresectable tumors.
Main Methods:
- A retrospective review of eight patients who underwent GKS for glomus jugulare tumors.
- Radiosurgical doses ranged from 12-18 Gy (median 15 Gy) to the tumor margin.
- Follow-up included clinical assessment (median 28 months) and radiological evaluation (median 32 months).
Main Results:
- All eight patients experienced neurological stability or improvement following GKS.
- No new or worsened cranial nerve palsies were observed post-treatment.
- Radiographic follow-up in seven patients showed tumor size reduction in four and stability in three.
Conclusions:
- Gamma Knife Surgery appears to be an effective treatment for achieving local tumor control in glomus jugulare tumors.
- GKS demonstrates the ability to preserve neurological function in treated patients.
- Long-term efficacy data could expand the role of stereotactic radiosurgery in managing these tumors.