Balancing Surgery and Radiosurgery in Jugulotympanic Paragangliomas

Jugulotympanic paragangliomas (JTPs) are rare, benign, but locally aggressive neuroendocrine tumors of the temporal bone and jugular foramen. Due to their proximity to critical neurovascular structures, they can cause considerable morbidity. This study retrospectively assesses treatment outcomes in JTP patients, examining the effectiveness of surgical resection and stereotactic radiosurgery (RS) in tumor control and recurrence prevention. A retrospective analysis was performed on 11 adult patients diagnosed with JTP from January 2022 to December 2024. Data collected included demographics, tumor characteristics, surgical approach, histopathology, and follow-up imaging. Tumors were classified using the Fisch system, and the Ki-67 index was used to assess proliferative activity. Eleven patients (seven females and four males; median age = 64.5 years) were included. Tumor sizes ranged from 1.0 × 0.5 cm to 2.7 × 2.2 cm. Based on the Fisch classification, six tumors were class B, two were class A, one was class C1, and one was class D1. All patients underwent surgical excision via an endoaural-transcanal approach with potassium titanyl phosphate (KTP) laser hemostasis. Complete resection was achieved in five cases; six required additional stereotactic RS. Follow-up imaging showed no recurrence in fully resected cases, and tumor control in those treated with RS. Most tumors had a Ki-67 proliferation index < 5%. Surgical resection remains the preferred treatment for small, accessible JTPs. For most glomus jugulare cases, as well as residual or surgically complex tumors, a combination of surgery and RS plays a crucial role in effective management. The Ki-67 proliferation index does not independently predict recurrence.