Gamma knife radiosurgery for patients with jugular foramen schwannomas: systematic review and meta-analysis

Resection has traditionally been the gold standard for treating jugular foramen schwannomas (JFSs). However, given the high risk of neurological deficits associated with surgical intervention, stereotactic radiosurgery (SRS) has emerged as a promising alternative. Despite its growing popularity for other brain tumors, there remains a paucity of data on the outcomes of SRS for JFSs. This study aims to assess the safety and efficacy of SRS as a treatment option for patients with JFSs. We searched Medline, Embase, and Web of Science databases following PRISMA guidelines. Eligible studies included randomized controlled trials and observational studies reporting ≥ 4 JFS patients treated with gamma knife radiosurgery. Comparative analysis with 95% confidence intervals (CI) under a random-effects model was utilized to pool the data. A single-arm meta-analysis evaluated tumor control, neurological deficits, and complications. The analysis included 16 studies with 348 patients and a median follow-up of 33 months. Results demonstrated a 98% (CI: 95 - 100%) rate of tumor control, a 39% (CI: 23-54%) rate of tumor shrinking, and a 19% (CI: 13-26%) rate of neurological deficits. New cranial nerve deficits occurred in 34% of patients (CI: 27-41%). SRS demonstrated a high tumor control rate for jugular foramen schwannomas. However, complications remain significant, with neurological deficits and new cranial nerve deficits post Gamma Knife radiosurgery (GKRS). These findings underscore the need for further studies, including comparative analyses between SRS and surgical resection, to better delineate the risk-benefit profile of these treatment modalities.