title: Gamma Knife surgery for patients with jugular foramen schwannomas: a multiinstitutional retrospective study in Japan.
abstract: OBJECTIVE This study aimed to explore the efficacy and safety of stereotactic radiosurgery in patients with jugular foramen schwannomas (JFSs). METHODS This study was a multiinstitutional retrospective analysis of 117 patients with JFSs who were treated with Gamma Knife surgery (GKS) at 18 medical centers of the Japan Leksell Gamma Knife Society. The median age of the patients was 53 years. Fifty-six patients underwent GKS as their initial treatment, while 61 patients had previously undergone resection. At the time of GKS, 46 patients (39%) had hoarseness, 45 (38%) had hearing disturbances, and 43 (36%) had swallowing disturbances. Eighty-five tumors (73%) were solid, and 32 (27%) had cystic components. The median tumor volume was 4.9 cm3, and the median prescription dose administered to the tumor margin was 12 Gy. Five patients were treated with fractionated GKS and maximum and marginal doses of 42 and 21 Gy, respectively, using a 3-fraction schedule. RESULTS The median follow-up period was 52 months. The last follow-up images showed partial remission in 62 patients (53%), stable tumors in 42 patients (36%), and tumor progression in 13 patients (11%). The actuarial 3- and 5-year progression-free survival (PFS) rates were 91% and 89%, respectively. The multivariate analysis showed that pre-GKS brainstem edema and dumbbell-shaped tumors significantly affected PFS. During the follow-up period, 20 patients (17%) developed some degree of symptomatic deterioration. This condition was transient in 12 (10%) of these patients and persistent in 8 patients (7%). The cause of the persistent deterioration was tumor progression in 4 patients (3%) and adverse radiation effects in 4 patients (3%), including 2 patients with hearing deterioration, 1 patient with swallowing disturbance, and 1 patient with hearing deterioration and hypoglossal nerve palsy. However, the preexisting hoarseness and swallowing disturbances improved in 66% and 63% of the patients, respectively. CONCLUSIONS GKS resulted in good tumor control in patients with either primary or residual JFSs. Although some patients experienced some degree of symptomatic deterioration after treatment, persistent adverse radiation effects were seen in only 3% of the entire series at the last follow-up. Lower cranial nerve deficits were extremely rare adverse radiation effects, and preexisting hoarseness and swallowing disturbances improved in two-thirds of patients. These results indicated that GKS was a safe and reasonable alternative to surgical resection in selected patients with JFSs.
authors.affiliation: Department of Neurosurgery, Komaki City Hospital, Komaki.
authors.forename: Toshinori
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Department of Neurosurgery, Komaki City Hospital, Komaki.
authors.forename: Takenori
authors.initials: T
authors.lastname: Kato
authors.affiliation: Department of Neurosurgery, Kamiiida Daiichi General Hospital, Nagoya.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kida
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University, Tokyo.
authors.forename: Ayaka
authors.initials: A
authors.lastname: Sasaki
authors.affiliation: Department of Neurosurgery, Osaka City General Hospital, Osaka.
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Iwai
authors.affiliation: Department of Neurosurgery, Shinsuma Hospital, Kobe.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kondoh
authors.affiliation: Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Tsugawa
authors.affiliation: Department of Neurosurgery, Rakusai Shimizu Hospital, Kyoto.
authors.forename: Manabu
authors.initials: M
authors.lastname: Sato
authors.affiliation: Department of Neurosurgery, Kitanihon Neurosurgical Hospital, Gosen.
authors.forename: Mitsuya
authors.initials: M
authors.lastname: Sato
authors.affiliation: Department of Neurosurgery, Chiba Cerebral and Cardiovascular Center, Ichihara.
authors.forename: Osamu
authors.initials: O
authors.lastname: Nagano
authors.affiliation: Department of Neurosurgery, Atami Tokoro Memorial Hospital, Atami.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Nakaya
authors.affiliation: Department of Neurosurgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Nakazaki
authors.affiliation: Department of Neurosurgery, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki.
authors.forename: Tadashige
authors.initials: T
authors.lastname: Kano
authors.affiliation: Department of Neurosurgery, Okamura Isshindow Hospital, Okayama.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hasui
authors.affiliation: Department of Neurosurgery, Kouseikai Takai Hospital, Tenri.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nagatomo
authors.affiliation: Department of Neurosurgery, Shiroyama Hospital, Habikino.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Yasuda
authors.affiliation: Department of Neurosurgery, Mominoki Hospital, Kochi.
authors.forename: Akihito
authors.initials: A
authors.lastname: Moriki
authors.affiliation: Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo.
authors.forename: Toru
authors.initials: T
authors.lastname: Serizawa
authors.affiliation: Department of Neurosurgery, Shonan Fujisawa Tokushukai Hospital, Fujisawa; and.
authors.forename: Seiki
authors.initials: S
authors.lastname: Osano
authors.affiliation: Department of Neurosurgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Inoue
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000532:radiotherapy*; D005260:Female; D005720:Gamma Rays; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009442:Neurilemmoma / Q000532:radiotherapy*; D016634:Radiosurgery / Q000009:adverse effects; D012189:Retrospective Studies; D019291:Skull Base; D055815:Young Adult
keywords: GKS = Gamma Knife surgery; Gamma Knife; JFS = jugular foramen schwannoma; PFS = progression-free survival; SRS = stereotactic radiosurgery; functional outcome; jugular foramen schwannoma; stereotactic radiosurgery; tumor control