title: The safety and efficacy of gamma knife surgery in management of glomus jugulare tumor.
abstract: BACKGROUND
  Glomus jugulare is a slowly growing, locally destructive tumor located in the skull base with difficult surgical access. The operative approach is, complicated by the fact that lesions may be both intra and extradural with engulfment of critical neurovascular structures. The tumor is frequently highly vascular, thus tumor resection entails a great deal of morbidity and not infrequent mortality. At timeslarge residual tumors are left behind. To decrease the morbidity associated with surgical resection of glomus jugulare, gamma knife surgery (GKS) was performed as an alternative in 13 patients to evaluate its safety and efficacy.
  
  
  METHODS
  A retrospective review of 13 residual or unresectable glomus jagulare treated with GKS between 2004 and 2008.. Of these, 11 patients underwent GKS as the primary management and one case each was treated for postoperative residual disease and postembolization. The radiosurgical dose to the tumor margin ranged between 12-15 Gy.
  
  
  RESULTS
  Post- gamma knife surgery and during the follow-up period twelve patients demonstrated neurological stability while clinical improvement was achieved in 5 patients. One case developed transient partial 7th nerve palsy that responded to medical treatment. In all patients radiographic MRI follow-up was obtained, the tumor size decreased in two cases and remained stable (local tumor control) in eleven patients.
  
  
  CONCLUSIONS
  Gamma knife surgery provids tumor control with a lowering of risk of developing a new cranial nerve injury in early follow-up period. This procedure can be safely used as a primary management tool in patients with glomus jugulare tumors, or in patients with recurrent tumors in this location. If long-term results with GKS are equally effective it will emerge as a good alternative to surgical resection.
authors.affiliation: Neurosurgery and Gamma knife department, International Medical Center, Cairo, Egypt. raefhafez179@hotmail.com
authors.forename: Raef F A
authors.initials: RF
authors.lastname: Hafez
authors.forename: Magad S
authors.initials: MS
authors.lastname: Morgan
authors.forename: Osama M
authors.initials: OM
authors.lastname: Fahmy
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005925:Glomus Jugulare Tumor / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
references.citation: J Neurosurg. 1994 Jun;80(6):1026-38
references.pmid: 8189258
references.citation: Acta Neurochir (Wien). 2009 May;151(5):423-6
references.pmid: 19296050
references.citation: Acta Neurochir Suppl. 2002;84:91-7
references.pmid: 12379010
references.citation: Neurosurgery. 2006 Sep;59(3):561-9; discussion 561-9
references.pmid: 16955038
references.citation: Neurosurg Focus. 2009 Dec;27(6):E5
references.pmid: 19951058
references.citation: Laryngoscope. 1994 Aug;104(8 Pt 1):917-21
references.pmid: 8052073
references.citation: Laryngoscope. 2000 Jan;110(1):35-8
references.pmid: 10646712
references.citation: Neurosurgery. 2006 Nov;59(5):1030-6; discussion 1036
references.pmid: 17143237
references.citation: Neurol India. 2008 Jan-Mar;56(1):57-61
references.pmid: 18310839
references.citation: Acta Neurochir (Wien). 1994;130(1-4):66-70
references.pmid: 7725944
references.citation: Acta Neurochir (Wien). 1999;141(11):1141-6
references.pmid: 10592113
references.citation: Technol Cancer Res Treat. 2007 Oct;6(5):419-23
references.pmid: 17877430
references.citation: J Neurosurg. 2005 Jan;102 Suppl:241-6
references.pmid: 15662818
references.citation: Mayo Clin Proc. 1992 Jun;67(6):537-40
references.pmid: 1331629
references.citation: Neurosurg Focus. 2004 Aug 15;17(2):E4
references.pmid: 15329019
references.citation: Neurosurg Focus. 2004 Aug 15;17(2):E10
references.pmid: 15329025
references.citation: Skull Base. 2009 Jan;19(1):92-8
references.pmid: 19568346