title: Treatment of glomus jugulare tumors in patients with advanced age: planned limited surgical resection followed by staged gamma knife radiosurgery: a preliminary report.
abstract: OBJECTIVE
  To minimize treatment comorbidities in glomus jugulare tumor patients with advanced age while reducing pulsatile tinnitus and preserving or improving residual hearing using a limited middle ear/mastoid tumor resection and postoperative gamma knife radiosurgery to tumor remnants in the jugular foramen region.
  
  
  METHODS
  Retrospective consecutive case review of five patients.
  
  
  METHODS
  Tertiary referral, academic medical center.
  
  
  METHODS
  Patients with advanced age (mean, 69.6 yr; range, 61-78 yr) harboring symptomatic glomus jugulare tumors.
  
  
  METHODS
  All patients were treated with resection of middle ear and mastoid portions of tumor and subsequent gamma knife radiosurgery to jugular foramen portion of tumor.
  
  
  METHODS
  Length of hospitalization; hearing, pulsatile tinnitus, cranial nerve, and tumor control status.
  
  
  RESULTS
  All patients were treated on an outpatient surgical basis without the need for blood transfusion. There were no incidents of a change in cranial nerve status (Cranial Nerves VII, IX, X, XI, and XII) in the immediate postoperative period. All patients had improvement or resolution of pulsatile tinnitus with preservation or improvement of preoperative hearing levels. Tumor volume was stable or reduced in all patients at mean follow-up of 19 months (range, 11-24 mo). Gamma knife radiosurgery (mean peripheral dose of 15 Gy) was not associated with any significant immediate or delayed complications.
  
  
  CONCLUSIONS
  Short-term data reveals that staged microsurgical and radiosurgical therapy for glomus jugulare tumors in the symptomatic patient with advanced age is safe and yields favorable results regarding tinnitus, hearing, and cranial nerve status. Long-term data are needed to further evaluate the effectiveness of this treatment algorithm before extrapolating this treatment option to younger patients.
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
authors.forename: Seth N
authors.initials: SN
authors.lastname: Willen
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Einstein
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Maciunas
authors.forename: Cliff A
authors.initials: CA
authors.lastname: Megerian
mesh_terms: D000368:Aged; D000556:Ambulatory Surgical Procedures; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005925:Glomus Jugulare Tumor / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000601:surgery*; D011878:Radiotherapy; D012086:Reoperation; D012189:Retrospective Studies; D014012:Tinnitus / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome