title: Less-aggressive surgical management and long-term outcomes of jugular foramen paragangliomas: a neurosurgical perspective.
abstract: OBJECTIVE The aim of this study was to analyze the neurological functional outcome and recurrent risks in surgically treated jugular foramen paragangliomas (JFPs) and to propose an individualized therapeutic strategy. METHODS Clinical charts and radiological information were reviewed retrospectively in 51 consecutive cases of JFPs. Less-aggressive surgical interventions were adopted with the goal of preserving neurovascular structures. Scheduled follow-up was performed. RESULTS The mean age of the patients in the cases reviewed was 41.6 years, and the group included 27 females (52.9%). The mean preoperative Karnofsky Performance Scale (KPS) score was 78.4. The mean lesion size was 3.8 cm. Forty-three cases (84.3%) were Fisch Type D, including 37 cases (72.5%) of Type Di1 and Di2. Thirty-seven cases (72.5%) were Glasscock-Jackson Type III-IV. Gross-total resection and subtotal resection were achieved in 26 (51.0%) and 22 (43.1%) cases, respectively. Surgical morbidities occurred in 23 patients (45.1%), without surgery-related mortality after the first operation. The mean postoperative KPS scores at discharge, 3 months, 1 year, and most recent evaluation were 71.8, 77.2, 83.2, and 79.6, respectively. The mean follow-up duration was 85.7 months. The tumor recurrence/regrowth (R/R) rate was 11.8%. Compared with preoperative status, swallowing function improved or stabilized in 96.1% and facial function improved or stabilized in 94.1% of patients. A House-Brackmann scale Grade I/II was achieved in 43 patients (84.3%). Overall neurological status improved or stabilized in 90.0% of patients. Pathological mitosis (HR 10.640, p = 0.009) was the most significant risk for tumor R/R. A 1-year increase in age (OR 1.115, p = 0.037) and preoperative KPS score < 80 (OR 11.071, p = 0.018) indicated a risk for recent poor neurological function (KPS < 80). Overall R/R-free survival, symptom progression-free survival, and overall survival at 15 years were 78.9%, 86.8%, and 80.6%, respectively. CONCLUSIONS Surgical outcomes for JFPs were acceptable using a less-aggressive surgical strategy. Most patients could adapt to surgical morbidities and carry out normal life activities. Preserving neurological function was a priority, and maximal decompression with or without radiotherapy was desirable to preserve a patient's quality of life when radical resection was not warranted. Early surgery plus preoperative devascularization was proposed, and radiotherapy was mandatory for lesions with pathological mitosis.
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.|China National Clinical Research Center for Neurological Diseases.|Center of Brain Tumor, Beijing Institute for Brain Disorders; and.|Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China.
authors.forename: Da
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.|China National Clinical Research Center for Neurological Diseases.|Center of Brain Tumor, Beijing Institute for Brain Disorders; and.|Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China.
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Zeng
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.|China National Clinical Research Center for Neurological Diseases.|Center of Brain Tumor, Beijing Institute for Brain Disorders; and.|Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China.
authors.forename: Shu-Yu
authors.initials: SY
authors.lastname: Hao
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.|China National Clinical Research Center for Neurological Diseases.|Center of Brain Tumor, Beijing Institute for Brain Disorders; and.|Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China.
authors.forename: Liang
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.
authors.forename: Jie
authors.initials: J
authors.lastname: Tang
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.
authors.forename: Xin-Ru
authors.initials: XR
authors.lastname: Xiao
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.
authors.forename: Guo-Lu
authors.initials: GL
authors.lastname: Meng
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.
authors.forename: Gui-Jun
authors.initials: GJ
authors.lastname: Jia
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.|China National Clinical Research Center for Neurological Diseases.|Center of Brain Tumor, Beijing Institute for Brain Disorders; and.|Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China.
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.|China National Clinical Research Center for Neurological Diseases.|Center of Brain Tumor, Beijing Institute for Brain Disorders; and.|Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.|China National Clinical Research Center for Neurological Diseases.|Center of Brain Tumor, Beijing Institute for Brain Disorders; and.|Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China.
authors.forename: Jun-Ting
authors.initials: JT
authors.lastname: Zhang
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D010235:Paraganglioma / Q000601:surgery*; D012189:Retrospective Studies; D012888:Skull Neoplasms / Q000601:surgery*; D013701:Temporal Bone; D013997:Time Factors; D016896:Treatment Outcome
keywords: CN = cranial nerve; ECA = external carotid artery; GKS = Gamma Knife surgery; GTR = gross-total resection; ICA = internal carotid artery; JFP = jugular foramen paraganglioma; KPS = Karnofsky Performance Scale; LCN = lower CN; PR = partial resection; R/R = recurrence/regrowth; STR = subtotal resection; VA = vertebral artery; glomus jugulare tumor; jugular foramen; oncology; paraganglioma; pathological mitosis