Cranial nerve preservation and outcomes after stereotactic radiosurgery for jugular foramen schwannomas.
OBJECTIVE
Jugular foramen region schwannomas are rare intracranial tumors that usually present with multiple lower cranial nerve deficits. For some patients, complete surgical resection is possible but may be associated with significant morbidity. Stereotactic radiosurgery is a minimally invasive alternative or adjunct to microsurgery for such tumors. We reviewed our clinical and imaging outcomes after patients underwent gamma knife radiosurgery for management of jugular foramen schwannomas.


METHODS
Thirty-four patients with 35 tumors (one patient had bilateral tumors) underwent radiosurgery between May 1990 and December 2005. Twenty-two patients had previous microsurgical resection and all patients experienced various cranial neuropathies. A median of six isocenters were used. Median marginal and maximum doses were 14 and 28 Gy, respectively.


RESULTS
None of the patients were lost to evaluation and the mean duration of follow-up was 83 months. Tumors regressed in 17 patients, remained stable in 16, and progressed in two. Five- and 10-year actuarial control rates were 97 and 94%, respectively. Preexisting cranial neuropathies improved in 20% and remained stable in 77% after radiosurgery. One patient worsened. The function of all previous intact nerves was preserved after radiosurgery.


CONCLUSIONS
Stereotactic radiosurgery proved to be a safe and effective management for newly diagnosed or residual jugular foramen schwannomas. Long-term tumor control rates and stability or improvement in cranial nerve function was confirmed.
Martin
Juan J
JJ
Department of Neurological Surgery, University of Pittsburgh School of Medicine, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Kondziolka
Douglas
D
Flickinger
John C
JC
Mathieu
David
D
Niranjan
Ajay
A
Lunsford
L Dade
LD
D001932:Brain Neoplasms / Q000150:complications / Q000601:surgery; D003389:Cranial Nerve Diseases / Q000175:diagnosis / Q000209:etiology; D003390:Cranial Nerve Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D005924:Glomus Jugulare / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009442:Neurilemmoma / Q000150:complications / Q000601:surgery*; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome