Gamma knife radiosurgery for glomus jugulare tumors: therapeutic advantages of minimalism in the skull base.
BACKGROUND
Glomus jugulare (GJ) tumors are paragangliomas found in the region of the jugular foramen. Surgery with/without embolization and conventional radiotherapy has been the traditional management option.


OBJECTIVE
To analyze the efficacy of gamma knife radiosurgery (GKS) as a primary or an adjunctive form of therapy.


METHODS
A retrospective analysis of patients who received GKS at a tertiary neurosurgical center was performed.


METHODS
Of the 1601 patients who underwent GKS from 1997 to 2006, 24 patients with GJ underwent 25 procedures.


RESULTS
The average age of the cohort was 46.6 years (range, 22-76 years) and the male to female ratio was 1:2. The most common neurological deficit was IX, X, XI cranial nerve paresis (15/24). Fifteen patients received primary GKS. Mean tumor size was 8.7 cc (range 1.1-17.2 cc). The coverage achieved was 93.1% (range 90-97%) using a mean tumor margin dose of 16.4 Gy (range 12-25 Gy) at a mean isodose of 49.5% (range 45-50%). Thirteen patients (six primary and seven secondary) were available for follow-up at a median interval of 24 months (range seven to 48 months). The average tumor size was 7.9 cc (range 1.1-17.2 cc). Using a mean tumor margin dose of 16.3 Gy (range 12-20 Gy) 93.6% coverage (range 91-97%) was achieved. Six patients improved clinically. A single patient developed transient trigeminal neuralgia. Magnetic resonance imaging follow-up was available for 10 patients; seven recorded a decrease in size. There was no tumor progression.


CONCLUSIONS
Gamma knife radiosurgery is a safe and effective primary and secondary modality of treatment for GJ.
Sharma
Manish S
MS
Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi-110 029, India.
Gupta
A
A
Kale
S S
SS
Agrawal
D
D
Mahapatra
A K
AK
Sharma
B S
BS
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005925:Glomus Jugulare Tumor / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D055815:Young Adult