Abstract
BackgroundGlomus jugulare tumors are rare slow-growing hypervascular tumors that arise from the paraganglia of the chemoreceptor system within the jugulare foramen of the temporal lobe. The historical standard treatment has been surgical resection, but because of their high vascularity and involvement with cranial nerves (CNs), Gamma Knife radiosurgery (GKRS) has been advocated as an alternative. The goal of this study is to update and report long-term results of GKRS to achieve local control and symptomatic improvement and to reduce morbidity and mortality when treating glomus jugulare tumors.Materials and MethodsThis study retrospectively collected and reviewed clinical and radiographic data of 32 patients with glomus jugulare tumors treated with GKRS at the Miami Neuroscience Center, South Miami, FL, from 1995 to 2019. For the 32 patients, the mean volume treated was 13.9 cc (0.23 to 40.0 cc), with an average of 8.6 isocenters. The median prescription dose was 12.84 Gy ± 2.07 Gy (range: 10-20 Gy). Follow-up data were available for 29 out of 32 patients, with a median clinical follow-up time of 37.3 months (range: 4.3-169.1 months). At follow-up, patients were evaluated for neurological signs and symptoms and radiographic evidence of progression of disease.ResultsThe median age of the cohort treated with GKRS was 60 years (range: 14-83 years). There were three males and 27 females. Presenting symptomatology was available for 30 out of 32 patients. The most common presenting symptom was hearing loss (21/30) and the most common CN deficit was in CN VIII (19/30). Out of 29 of the patients followed up, 28 patients had improvement (20/29) or resolution (8/29) of symptoms. At the most recent evaluation or contact, patients were without symptomatic progression of CN deficits.Radiographic tumor control was achieved in 28 out of 29 patients. One patient had a recurrence seven years after GKRS, which was treated with surgery. There were no complications, radionecrosis, or mortality reported from GKRS.ConclusionThese data confirm that GKRS is a reasonable upfront treatment option for glomus jugulare tumors. GKRS should be considered more frequently given its excellent long-term local control with low morbidity and risk of complications.
Highlights
Glomus jugulare tumors (GJTs) are rare slow-growing hypervascular benign tumors that arise from the paraganglia of the chemoreceptor system within the jugulare foramen of the temporal lobe [1]
The median age of the cohort treated with Gamma Knife radiosurgery (GKRS) was 60 years
The most common presenting symptom was hearing loss (21/30) and the most common cranial nerves (CNs) deficit was in CN VIII (19/30)
Summary
Glomus jugulare tumors (GJTs) are rare slow-growing hypervascular benign tumors that arise from the paraganglia of the chemoreceptor system within the jugulare foramen of the temporal lobe [1]. These are the most common tumors of the middle ear and occur predominantly in women, with three to six women for every man diagnosed [2,3]. Common symptoms include hearing loss, pulsatile tinnitus, and lower cranial nerve (CN) deficits [1] They are multicentric in 3-10% of sporadic cases and 25-50% of familial cases [4]. The goal of this study is to update and report long-term results of GKRS to achieve local control and symptomatic improvement and to reduce morbidity and mortality when treating glomus jugulare tumors
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