Hypofractionated frameless gamma knife radiosurgery for glomus jugulare tumors: A single-center experience

Glomus jugulare tumors (GJTs) are rare, benign neuroendocrine neoplasms arising from the jugular bulb, often causing significant morbidity due to their proximity to critical neurovascular structures. Surgical resection is often associated with high morbidity rates. This study evaluates the efficacy and safety of hypofractionated frameless Gamma Knife radiosurgery (hf-GKRS) for large GJTs. A retrospective analysis was conducted on seven patients with GJTs treated with hf-GKRS between May 2017 and February 2025. Inclusion criteria included age ≥ 18 years, radiologically confirmed GJT and ≥ 6 months follow-up. Treatment involved 3-5 fractions with a median marginal dose of 20 Gy (range: 18-25 Gy). Outcomes assessed included local control (LC), cranial nerve function, adverse radiation effects and overall survival. Seven patients (median age 42 years, 57.1% female) underwent hf-GKRS for glomus jugulare tumors. Four of the seven tumors were right-sided, no prior surgery was performed. Local control was achieved in all cases, with significant tumor regression observed in two patients and stable volumes in the remaining cases. Median follow-up was 28 months (range: 6-78 months). No new cranial nerve deficits or significant radiation-induced complications were observed, except for hearing deterioration in one patient. All patients remained alive at the last follow-up, with preserved functional status (median KPS: 90). hf-GKRS is a safe and effective treatment for GJTs, offering significant local control and minimal morbidity. It represents a viable alternative to surgery, stereotactic radiotherapy and single-fraction radiosurgery, particularly in cases with large tumor volumes.