Clinical and Radiological Response Following Single-Session Gamma Knife Radiosurgery in Glomus Jugulare Tumors

Abstract

Introduction

Glomus tumors are rare, slow-growing, hypervascular skull base tumors and frequently involve critical neurovascular structures. Surgical resection is technically challenging and is associated with high morbidity rates due to lower cranial nerve injury and CSF leak. Gamma knife radiosurgery (GKRS) has revolutionised the management of these lesions with high clinical and tumor control rates and a low side effect profile. In this study, we have attempted to study the tumor and clinical control rate along with the prediction factors.

Methods

This is a retrospective data review of all patients with glomus jugulare tumors from 2010 to 2023 who underwent GKRS in our center. Clinical, neuroimaging, and radiosurgical treatment were re-reviewed, and all patients' prognostic factors for clinical and tumor control were analyzed.

Results

The study included 95 patients. The median age was 45 years, with three-fourths of our patients being female, 69 (72.6%). Hearing loss was the most common symptom. The median marginal dose at the 50% isodose line was 16 Gy. The mean tumor volume was 8.7 cc, and the mean treatment volume was 8.3 cc. The tumor control rate in our study period was 96.9%. Younger age and Glasscock–Jackson type 1 were found to be worse and a good prognostic factor, respectively. The clinical control rate in our study was 93.9%, with no related significant prognostic variable in our study.

Conclusion

Gamma knife is a safe and effective treatment option for these formidable tumors with a very low complication rate.

Keywords

glomus jugulare tumor - radiosurgery - gamma knife radiosurgery - lower cranial nerve

Publikationsverlauf

Eingereicht: 27. November 2024

Angenommen: 19. Juni 2025

Artikel online veröffentlicht:
02. Juli 2025

• References

• 1 Sandow L, Thawani R, Kim MS, Heinrich MC. Paraganglioma of the head and neck: a review. Endocr Pract 2023; 29 (02) 141-147
• 2 Jansen JC, van den Berg R, Kuiper A, van der Mey AG, Zwinderman AH, Cornelisse CJ. Estimation of growth rate in patients with head and neck paragangliomas influences the treatment proposal. Cancer 2000; 88 (12) 2811-2816
• 3 Ramina R, Maniglia JJ, Fernandes YB. et al. Jugular foramen tumors: diagnosis and treatment. Neurosurg Focus 2004; 17 (02) E5
• 4 Wanna GB, Sweeney AD, Haynes DS, Carlson ML. Contemporary management of jugular paragangliomas. Otolaryngol Clin North Am 2015; 48 (02) 331-341
• 5 Lips C, Lentjes E, Höppener J, Luijt Rv, Moll F. Familial paragangliomas. Hered Cancer Clin Pract 2006; 4 (04) 169-176
• 6 Semaan MT, Megerian CA. Current assessment and management of glomus tumors. Curr Opin Otolaryngol Head Neck Surg 2008; 16 (05) 420-426
• 7 Taïeb D, Kaliski A, Boedeker CC. et al. Current approaches and recent developments in the management of head and neck paragangliomas. Endocr Rev 2014; 35 (05) 795-819
• 8 Jackson CG, Glasscock III ME, Harris PF. Glomus tumors. diagnosis, classification, and management of large lesions. Arch Otolaryngol 1982; 108 (07) 401-410
• 9 Oldring D, Fisch U. Glomus tumors of the temporal region: surgical therapy. Am J Otol 1979; 1 (01) 7-18
• 10 Olusanya BO, Davis AC, Hoffman HJ. Hearing loss grades and the international classification of functioning, disability and health. Bull World Health Organ 2019; 97 (10) 725-728
• 11 Ehret F, Kufeld M, Fürweger C. et al. Image-guided robotic radiosurgery for glomus jugulare tumors-multicenter experience and review of the literature. Head Neck 2021; 43 (01) 35-47
• 12 Sheehan JP, Tanaka S, Link MJ. et al. Gamma knife surgery for the management of glomus tumors: a multicenter study. J Neurosurg 2012; 117 (02) 246-254
• 13 Kalhoro A, Hashim ASM. Glomus jugulare tumors treatment by gamma knife radiosurgery: a single center study. Pak J Med Sci 2023; 39 (01) 46-49
• 14 Hellinger RL, Wolf A, Blach L, Kleinberg LR, Coy S. Long-term results of gamma knife radiosurgery for glomus tumors: an analysis of 32 patients. Cureus 2021; 13 (09) e18095
• 15 Sallabanda K, Barrientos H, Isernia Romero DA. et al. Long-term outcomes after radiosurgery for glomus jugulare tumors. Tumori 2018; 104 (04) 300-306
• 16 Hafez RFA, Morgan MS, Fahmy OM, Hassan HT. Long-term effectiveness and safety of stereotactic gamma knife surgery as a primary sole treatment in the management of glomus jagulare tumor. Clin Neurol Neurosurg 2018; 168: 34-37
• 17 Sharma M, Meola A, Bellamkonda S. et al. Long-term outcome following stereotactic radiosurgery for glomus jugulare tumors: a single institution experience of 20 years. Neurosurgery 2018; 83 (05) 1007-1014
• 18 Patel NS, Carlson ML, Pollock BE. et al. Long-term tumor control following stereotactic radiosurgery for jugular paraganglioma using 3D volumetric segmentation. J Neurosurg 2018; 130 (02) 379-387
• 19 Ibrahim R, Ammori MB, Yianni J, Grainger A, Rowe J, Radatz M. Gamma knife radiosurgery for glomus jugulare tumors: a single-center series of 75 cases. J Neurosurg 2017; 126 (05) 1488-1497
• 20 Winford TW, Dorton LH, Browne JD, Chan MD, Tatter SB, Oliver ER. Stereotactic radiosurgical treatment of glomus jugulare tumors. Otol Neurotol 2017; 38 (04) 555-562
• 21 El Majdoub F, Hunsche S, Igressa A, Kocher M, Sturm V, Maarouf M. Stereotactic LINAC-radiosurgery for glomus jugulare tumors: a long-term follow-up of 27 patients. PLoS One 2015; 10 (06) e0129057
• 22 Gandía-González ML, Kusak ME, Moreno NM, Sárraga JG, Rey G, Álvarez RM. Jugulotympanic paragangliomas treated with gamma knife radiosurgery: a single-center review of 58 cases. J Neurosurg 2014; 121 (05) 1158-1165
• 23 Sager O, Beyzadeoglu M, Dincoglan F. et al. Evaluation of linear accelerator-based stereotactic radiosurgery in the management of glomus jugulare tumors. Tumori 2014; 100 (02) 184-188
• 24 Gerosa M, Visca A, Rizzo P, Foroni R, Nicolato A, Bricolo A. Glomus jugulare tumors: the option of gamma knife radiosurgery. Neurosurgery 2006; 59 (03) 561-569 , discussion 561–569
• 25 Al-Mefty O, Teixeira A. Complex tumors of the glomus jugulare: criteria, treatment, and outcome. J Neurosurg 2002; 97 (06) 1356-1366
• 26 Borba LAB, Araújo JC, de Oliveira JG. et al. Surgical management of glomus jugulare tumors: a proposal for approach selection based on tumor relationships with the facial nerve. J Neurosurg 2010; 112 (01) 88-98
• 27 Fayad JN, Keles B, Brackmann DE. Jugular foramen tumors: clinical characteristics and treatment outcomes. Otol Neurotol 2010; 31 (02) 299-305
• 28 Jackson CG, McGrew BM, Forest JA, Netterville JL, Hampf CF, Glasscock III ME. Lateral skull base surgery for glomus tumors: long-term control. Otol Neurotol 2001; 22 (03) 377-382
• 29 Pareschi R, Righini S, Destito D, Raucci AF, Colombo S. Surgery of glomus jugulare tumors. Skull Base 2003; 13 (03) 149-157
• 30 Sanna M, Jain Y, De Donato G, Rohit, Lauda L, Taibah A. Management of jugular paragangliomas: the Gruppo Otologico experience. Otol Neurotol 2004; 25 (05) 797-804
• 31 Wakefield DV, Venable GT, VanderWalde NA. et al. Comparative neurologic outcomes of salvage and definitive gamma knife radiosurgery for glomus jugulare: a 20-year experience. J Neurol Surg B Skull Base 2017; 78 (03) 251-255