Outcomes of Gamma Knife Radiosurgery for Glomus Jugulare Tumors: A 35-Year Single-Center Experience

Background: Glomus jugulare tumors (GJTs) pose a management challenge because of their vascularity and complex location. Stereotactic radiosurgery offers a minimally invasive strategy for patients with GJTs. We described our experience with Gamma knife radiosurgery (GKRS) for GJTs over the past 35 years.

Methods: We reviewed the GKRS prospectively maintained 35-year 17,800-patient database. Forty patients (24 females, median age of 56 years) with 40 GJTs were identified. Pulsatile tinnitus (N = 13) was the most common presenting symptom, and the left jugular foramen was the most common location (N = 22). Single-session GKRS was employed in 36 patients. The median tumor volume was 7.5 cc (range, 1.1–45.9). The median margin dose was 13.5 Gy (range, 12–18) delivered at a 50% isodose line.

Results: At a median follow-up of 55.5 months (range, 6.0–339.3) symptom control and preserved quality of life were achieved in 39 (97.5%) patients. Low House-Brackmann grade (p = 0.008) and Gardner-Robertson score (p ≤ 0.001) before GKRS correlated with better facial and cochlear nerve function after treatment, respectively. Tumor control was achieved in 38 (95%) patients. The actuarial 5-, 10-, and 15-year progression-free survival (PFS) rates were all 100% after primary GKRS, and 91.7%, 83.3%, and 83.3% for salvage GKRS (p = 0.101). Univariate analysis showed that patients with larger (≥ 10 cc) tumor volumes (HR: 1.35 [95% CI: 1.11–1.70], p = 0.013) and higher modified Fisch class Di2 (HR: 1.40 [95% CI: 1.18–1.64], p = 0.016) were associated with worse PFS. Two patients developed asymptomatic intratumoral cysts after GKRS. One patient died 8 months after salvage GKRS related to cystic tumor progression.

Conclusion: As a minimally invasive single management, GKRS proved to be a safe and effective strategy for GJTs. GKRS should be considered both as an optimal primary management and as an early salvage strategy for tumors that remain after initial attempted resection

Publication History

Article published online:
01 February 2023