Treatment Of Glomus Jugulare Tumors Research Articles

Feasibility Study of Stereotactic Radiosurgery Treatment of Glomus Jugulare Tumors via HyperArc VMAT.

This study aims to report on the clinical validation and feasibility of utilizing a novel fully automated treatment planning and delivery system, HyperArc VMAT stereotactic radiosurgery (SRS) for glomus jugulare tumors (GJT). Independent dose verification of the HyperArc module via the MD Anderson's SRS head phantom irradiation and credentialing results showed compliance with the SRS treatment requirements per IROC MD Anderson's standard. Following the Alliance clinical trial, AAPM, RTOG protocols, and QUANTEC requirements, utilizing selected three-partial arc geometry of HyperArc module on TrueBeam Linac with 6MV-FFF beam, GJT SRS plans were generated for nine previously treated Gamma Knife (GK) radiosurgery patients using advanced Acuros-based algorithm to account for tissue inhomogeneity corrections and frameless immobilization with Q-fix mask and Encompass device insert. HyperArc VMAT produced highly conformal SRS dose distributions to GJT, a steep dose gradient around the GJT, and spared adjacent critical organs including the spinal cord (< 3.0 Gy). Due to faster patient setup and less MLC modulation through the target (average beam-on time, 6.2 minutes), the HyperArc VMAT plan can deliver a single high-dose of 18 Gy to the GJT in less than 15 minutes overall treatment time, significantly improving patient comfort and clinic workflow. Pretreatment portal dosimetry quality assurance results and independent dose verification via Monte Carlo-based physics second check met our clinical SRS protocol's requirements for treatment. Due to the highly conformal dose distribution, rapid dose fall-off, excellent sparing of adjacent critical organs, and highly precise and accurate treatment, clinical implementation of frameless HyperArc VMAT for GJT patients who may not have access to nor tolerate frame-based GK SRS treatment are underway.

Infratemporal approach with anterior transposition of facial nerve in paraganglioma surgery

Abstract Introduction The treatment of glomus jugulare tumors can be extremely challenging. In certain patients, residual tumor is left at surgery to prevent devastating lower cranial nerve deficits or to reduce potential morbidity associated with carotid artery injury. The interest of this article is to demonstrate the importance of anterior transposition of the facial nerve in the approach of the jugular paraganglioma and to analyze the surgical technique, complications, and outcomes. Methods We retrospectively studied 07 patients with jugular paragangliomas treated between January 2010 and December 2016 at Ali Ait Idir University Hospital in Algiers, Algeria. All patients were operated by the infratemporal fossa approaches type A (Fisch) [13]. We have developed for better exposed jugular golf the anterior transposition of the facial nerve. Preoperative embolization was performed for all patients. Results Total removal was possible in 04 patients. The most frequent and also the most dangerous surgical complication was lower cranial nerve deficit. This deficit occurred in 02 patients, but it was transient in one cases. Cerebrospinal fluid leakage remains a potentially fatal complication. In our study two patients developed CSF leaks and were treated conservatively with iterative lumbar punctures. Transposition of a normal facial nerve usually causes moderate postoperative paresis that may improve partially within 3 to 6 months. Conclusion Radical resection of jugular paragangliomas is difficult, and infratemporale approach (Fisch type A) with anterior transposition of facial nerve offer the best chance of total removal with preservation of facial and lower cranial nerves.

Outcomes of Primary Radiosurgery Treatment of Glomus Jugulare Tumors: Systematic Review With Meta-analysis.

1) Determine tumor control, symptomatic control, and complication rates of primary radiosurgery (PRS) for treatment of glomus jugulare tumors (GJTs) via systematic review and meta-analysis. 2) Identify risk factors for these outcomes. 1) Search of English articles in PubMed, Web of Science, Cochrane, and EBSCOhost databases from January 1950 to August 2017. Inclusion criteria: 1) treated GJT patients who had no previous treatment with radiosurgery, 2) follow-up with magnetic resonance imaging for at least 12 months, 3) reported pre and posttreatment symptoms, tumor control, or complications for individual PRS patients or for PRS patients as a cohort. The following were extracted: number of patients, level of evidence, mean age, mean pretreatment tumor volume, tumor control rate, criteria for change in tumor size, symptom control rate, and complications. At the individual patient level the following were extracted: age, number of treatment fractions, total radiation dose to tumor margin, pretreatment tumor volume, Fisch or Glasscock-Jackson stage, pre- and posttreatment symptoms, tumor control, symptom control/improvement, length of follow-up, and complications. Fifteen studies encompassing 91 patients met criteria. Tumor control was achieved in 92% of patients, symptom control in 93%, and complications occurred in 8%. There was one major complication. Smaller tumor volume predicted improvement in symptoms with PRS. In the short term, PRS is safe and effective at controlling growth and clinical symptoms for patients with GJTs, though there exists significant selection bias, inconsistent reporting, and clinical heterogeneity among existing studies.

Long-term outcomes after radiosurgery for glomus jugulare tumors.

The treatment of glomus jugulare tumors (GJT) remains controversial due to high morbidity. Historically, these tumors have primarily been managed surgically. The purpose of this retrospective review was to assess the tumor and clinical control rates as well as long-term toxicity of GJT treated with radiosurgery. Between 1993 and 2014, 30 patients with GJT (31 tumors) were managed with radiosurgery. Twenty-one patients were female and the median age was 59 years. Twenty-eight patients (93%) were treated with radiosurgery, typically at 14 Gy ( n = 26), and 2 patients (7%) with stereotactic radiosurgery. Sixteen cases (52%) had undergone prior surgery. The mean follow-up was 4.6 years (range 1.5-12). Crude overall survival, tumor control, clinical control, and long-term grade 1 toxicity rates were 97%, 97%, 97%, and 13% (4/30), respectively. No statistically significant risk factor was associated with lower tumor control in our series. Univariate analysis showed a statistically significant association between patients having 1 cranial nerve (CN) involvement before radiosurgery and a higher risk of lack of improvement of symptoms (odds ratio 5.24, 95% confidence interval 1.06-25.97, p = .043). Radiosurgery is an effective and safe treatment modality for GJT. Patients having 1 CN involvement before radiosurgery show a higher risk of lack of improvement of symptoms.

Stereotactic radiosurgery for the treatment of glomus tumors

Introduction: Despite of being a slow growing hypervascular benign tumor, Glomus Jugulare is a challenge for the neurosurgeon, due to its complex localization and relation to the cranial nerves. Microsurgery alone or associated with radiation therapy have been used for decades, and is frequently associated with severe neurological sequelae. In the last decade, radiosurgery has been employed for tumor growth control, but long term follow up is still missing. Objective: The objective is to analyze the late results of radiosurgery alone in the treatment of glomus jugulare tumors. Material and Methods: From a series of 596 patients submitted to radiosurgery at our institution, seven patients with eight complex glomus jugulare tumors were selected. All patients were submitted to radiosurgery, 4 men and 3 women, age 20 to 78. The median volume of the lesions was 12.56 cc (range from 3.06 to 19.6 cc). The primary symptoms were pain and tinnitus, one patient had facial palsy before the initial treatment. Two patients were submitted to surgery before radiosurgery, and both developed lower cranial dysfunction, one of them underwent to conventional radiotherapy before radiosurgery. The patients received a single dose of 18 Gy to 20 Gy, using a LINAC with a conformal shaped beam collimator. Results: All patients had important pain relief (no more medication necessary) and a follow up of 30 to 96 months showed slight reduction in all of eight lesions. No patient suffered a new lower cranial nerve deficit after conformal shaped beam radiosurgery. Conclusion: Despite of the small number of cases, long term follow-up showed that radiosurgery is safe and effective to provide tumor growth control and to reduce pain associated with glomus jugulare tumors.

Stereotactic Radiosurgical Treatment of Glomus Jugulare Tumors.

Determine treatment outcomes of stereotactic radiosurgery (SRS) for glomus jugulare tumors (GJT), focusing on three-dimensional volume change and symptoms before and after SRS, as well as complications related to SRS. Retrospective case review. Tertiary referral center. Thirty-eight patients treated with SRS between 2000 and 2015. SRS treatment of GJT. The tumor volumes on pre- and posttreatment imaging were compared utilizing the Leskell GammaPlan treatment plan software to assess tumor progression. Pre- and posttreatment symptoms, Fisch classification, and complications were recorded. The mean radiographic follow-up was 39.1 months. The mean dose-to-tumor margin was 13.2 Gy. The mean tumor size at treatment was 5.8 and 5.2 cm at last follow-up. Thirty-three patients had follow-up imaging suitable for analysis. When defining both 10 and 15% tumor size increases as significant, 27 (82%) and 29 (88%) tumors decreased in size or remained stable, respectively. For the seven tumors with documented pre-SRS growth, treatment success was 86%. The mean marginal dose for treatment success and failure were 13.2 and 13.7 Gy, respectively. Patients receiving a higher margin dose had a greater risk of tumor progression (p = 0.0277). Fisch classification did not impact tumor progression rate. Initial tumor volume had no significance on tumor response to SRS. SRS is an effective treatment option for GJT. Both initial tumor volume and Fisch classification did not impact tumor progression. There were no significant patient or lesion characteristics that distinguished treatment success and/or failure.

Treatment Outcomes for Single Modality Management of Glomus Jugulare Tumors With Stereotactic Radiosurgery.

The objectives were to evaluate the audiological outcomes, response of symptoms, and response of tumor volume in patients with glomus jugulare tumors treated solely with single fraction gamma knife radiosurgery. Single institution retrospective review. Academic, tertiary referral center. The diagnosis code for glomus jugulare was used to identify patients. Only those who underwent gamma knife radiosurgery were included. Those previously treated with any modality were excluded. A total of 12 patients were included for the tumor response and symptom response data and 7 of those were included in the audiometric analysis. Audiometric data at most recent follow-up compared with presentation, subjective improvement in pulsatile tinnitus, and change in tumor volume at most recent follow-up compared with pretreatment. The average time to most recent follow-up was 27.6 months. There was no significant change in pure-tone average or word recognition. Pulsatile tinnitus completely resolved or improved in 80% of patients. Cranial neuropathies were stable or improved. A single patient experienced facial nerve paresis 2 years after treatment, which resolved with steroid treatment. Tumor control was 100% and the average change in tumor volume was a decrease of 37%. Single modality gamma knife radiosurgery treatment of glomus jugulare tumors seems to be safe. Treatment results in decreased tumor volume and improved pulsatile tinnitus in most patients. There was no significant progression of hearing loss after treatment. Lower cranial nerve function remains stable in all patients.

An intermediate term benefits and complications of gamma knife surgery in management of glomus jugulare tumor.

Glomus tumors are rare skull base slow-growing, hypervascular neoplasms that frequently involve critical neurovascular structures, and delay in diagnosis is frequent. Surgical removal is rarely radical and is usually associated with morbidity or mortality. Gamma knife surgery (GKS) has gained an increasing dependable role in the management of glomus jugulare tumors, with high rate of tumor growth control, preserving or improving clinical status and with limited complications. This study aims to evaluate intermediate term benefits and complications of gamma knife surgery in management of twenty-two patients bearing growing glomus jugulare tumors at the International Medical Center (IMC), Cairo, Egypt, between 2005 and 2011. The mean follow-up period was 56 months (range 36–108 months); there were 3 males, 19 females; mean age was 43.6 years; 15 patients had GKS as the primary treatment; 2 patients had surgical residuals; 2 had previous radiation therapy; and 3 previously underwent endovascular embolization. The average tumor volume was 7.26 cm3, and the mean marginal dose was 14.7 Gy. Post gamma knife surgery through the follow-up period neurological status was improved in 12 patients, 7 showed stable clinical condition and 3 patients developed new moderate deficits. Tumor volume post GKS was unchanged in 13 patients, decreased in 8, and showed tumor regrowth in 1 patient. Tumor progression-free survival in our studied patients was 95.5 % at 5 and 7 years of the follow-up period post GKS. Gamma knife surgery could be used safely and effectively with limited complications as a primary management tool in the treatment of glomus jugulare tumors controlling tumor growth with preserving or improving clinical status especially those who do not have significant cranial or cervical extension, elderly, and surgically unfit patients; moreover, it is safe and highly effective as adjuvant therapy as well.

EP-1080: Treatment of glomus jugulare tumors invading skull base by Gamma Knife radiosurgery

EP-1080: Treatment of glomus jugulare tumors invading skull base by Gamma Knife radiosurgery

Successful Management of a Catecholamine-Secreting Glomus Jugulare Tumor with Radiosurgery Alone

Secretory glomus jugulare tumors are often resected surgically to control the systemic effects of the catecholamines they produce. This involves complex skull base surgery, which carries significant risks and frequent morbidity. Stereotactic radiosurgery (SRS) is a recently recognized treatment for glomus jugulare tumors, though little is known about its use in secretory tumors. Case Report A young fit patient with a catecholamine-secreting glomus jugulare tumor was treated with SRS alone and over the following 37 months her urinary catecholamine excretion fell to near normal levels, and serial magnetic resonance imaging (MRI) confirmed a reduction in tumor volume. Discussion Radiosurgery is an accepted treatment for glomus jugulare tumors and is now readily available to skull base surgeons. In this case a catecholamine-secreting tumor was successfully controlled with radiosurgery alone. Further research and long-term follow-up will determine the role of this treatment in the nonsurgical management of secreting glomus jugulare tumors.

Stereotactic radiosurgery for the treatment of Glomus Jugulare Tumors

Background:The glomus jugulare tumor is a slowly growing benign neoplasm originating from neural crest. There is a high morbidity associated with surgical resection of glomus jugulare. Radiosurgery play a relevant role as a therapeutic option in these tumors and its use has grown in popularity. The authors describe a retrospective series of 15 patients and reviewed the literature about the glomus jugulare tumors.Methods:We reviewed retrospectively the data of 15 patients treated with stereotactic linear accelerator stereotactic radiosurgery (LINAC) radiosurgery between 2006 and 2011.Results:The average tumor volume was 18.5 cm3. The radiation dose to the tumor margin ranged between 12 and 20 Gy. The neurological status improved in three patients and remained unchanged in 12 patients. One patient developed a transient 7th nerve palsy that improved after clinical treatment. All tumors remained stable in size on follow-up with resonance magnetic images.Conclusions:The radiosurgery is a safe and effective therapy for patients with glomus jugulare tumor. Despite the short follow-up period and the limited number of patients analyzed, we can infer that radiosurgery produce a tumor growth control with low morbidity, and may be used as a good option to surgical resection in selected cases.

Glomus Jugulare Tumors: A Series of 24 Cases

Objective: Describe the surgical technique and experience of a neurotology surgical team working in Lisbon, Portugal, in the surgical treatment of glomus jugulare tumors. Method: The retrospective study included 24 patients operated between 1988 and 2007. Data were obtained from the medical records and after a recent evaluation of the patients. The outcome measures were: clinical manifestations, preoperative embolization and surgical technique, tumor removal, morbidity, mortality, and evolution of residual lesions. Results: Symptoms included hearing loss (33%); pulsatile tinnitus (21%); and cranial nerves X (29%), VII (25%), and XII (21%) paralysis. Preoperative embolization was performed in 92% of the cases, and the surgical technique was the infratemporal fossa aproach type A in all the cases. Total removal of the tumor was obtained in 11 (45%) cases. Only 21% of the patients had a grade III-IV House-Brackmann or worse after 12 months. Two patients died from pneumonia. Five (21%) of the patients required a second surgery, but only one patient required radiotherapy after incomplete removal of the tumor. Conclusion: Glomus jugulare tumors and their treatment have significant morbidity and mortality. Neurotology surgical teams should be created to develop surgical expertise and competence in the treatment of the disease in order to offer the best options to these patients.

Should Gamma Knife be Offered as a Primary Treatment for a Resectable Glomus Jugulare Tumor?

ABSTRACTAttempted total resections is the preferred treatment option in the management of glomus jugulare tumors in most subjects. In the elderly patients, it may be advisable to leave a tiny residue over the involved cranial nerve to preserve function. In a medically unfit and anesthetically high-risk subject observation with serial MRI scans is the preferred line of management. If in such a patient there occurs brainstem compression, it is prudent to only operate the intracranial part to relieve the compression explaining the very high-risk in this group. Radiotherapy is not to be offered as a primary treatment for glomus jugulare tumors.

Linac-based stereotactic body radiation therapy for treatment of glomus jugulare tumors

Background: Glomus jugulare tumors are rare, typically benign, tumors that arise from the neural crest cells that are associated with the autonomic ganglia in and around the jugular bulb. Treatment options for glomus jugulare tumors include embolization followed by resection, fractionated external beam radiation therapy (EBRT), stereotactic radiosurgery (SRS), and/or stereotactic body radiation therapy (SBRT). Materials and methods: 18 patients were treated with linear-accelerator based stereotactic body radiation therapy (SBRT) between May 2002 and November 2008. Fifteen patients (83%) had single glomus jugulare tumors and 3 patients had bilateral glomus jugulare tumors (although each of these patients had a single tumor targeted). The median tumor volume was 5.83 cm 3 (range, 0.32–35.47 cm 3). Ten tumors (56%) were previously untreated, and 8 (44%) tumors were persistent after previous surgical resection. One patient had undergone previous EBRT and 2 patients were previously treated with Gamma Knife radiosurgery to the intracranial portion of their tumor, with planned SBRT to the extracranial portion 2–4 months later at our institution. The median prescribed dose was 20 Gy in 3 fractions (range: 16–25 Gy in 1–5 fx) to the 80% isodose line. The median prescription coverage of the tumor was 93.6% (range: 83–98.72%). Results: Median follow-up for the entire cohort was 22 months. All the patients were alive at the time of the last follow-up with imaging available for review. The tumor was stable in 17 patients and decreased in size in one patient – yielding a local control rate of 100%. No patients experienced any new or worsening treatment-related neurologic deficits. Conclusions: SBRT is a safe and efficacious treatment modality for glomus jugulare tumors.

Treatment of Glomus Jugulare Tumors with Gamma Knife Radiosurgery

The LaryngoscopeVolume 120, Issue S3 p. S70-S70 Poster Presentations from the 2010 Triological Society Combined Section Meetings Treatment of Glomus Jugulare Tumors with Gamma Knife Radiosurgery Philip Chen M.D., Philip Chen M.D. Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, VirginiaSearch for more papers by this authorJames Nguyen B.A., James Nguyen B.A. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VirginiaSearch for more papers by this authorJason Sheehan M.D. PhD, Jason Sheehan M.D. PhD Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VirginiaSearch for more papers by this authorSpencer Payne M.D., Spencer Payne M.D. Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, VirginiaSearch for more papers by this authorGeorge Hashisaki M.D., George Hashisaki M.D. Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, VirginiaSearch for more papers by this author Philip Chen M.D., Philip Chen M.D. Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, VirginiaSearch for more papers by this authorJames Nguyen B.A., James Nguyen B.A. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VirginiaSearch for more papers by this authorJason Sheehan M.D. PhD, Jason Sheehan M.D. PhD Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VirginiaSearch for more papers by this authorSpencer Payne M.D., Spencer Payne M.D. Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, VirginiaSearch for more papers by this authorGeorge Hashisaki M.D., George Hashisaki M.D. Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, VirginiaSearch for more papers by this author First published: 14 December 2010 https://doi.org/10.1002/lary.21259AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume120, IssueS3Supplement: Poster Presentations from the Triological Society's 2010 Annual MeetingOctober 2010Pages S70-S70 RelatedInformation

Radiosurgery of Glomus Jugulare Tumors: A Meta-analysis

Radiosurgery of Glomus Jugulare Tumors: A Meta-analysis

Treatment of glomus jugulare tumors with gamma knife radiosurgery

Surgical resection, preoperative embolization, radiation therapy, and stereotactic radiosurgery have been used to treat glomus jugulare tumors (GJT). However, the optimal treatment of these tumors remains unclear. The authors report their data on treatment of GJTs with gamma knife radiosurgery (GKS). Retrospective review and pooled analysis. Fifteen patients (nine female, six male) were treated with GKS at a single tertiary care institution for GJTs over a 14-year period. Criteria for selection included GKS followed by at least one posttreatment radiographic image, and volumetric analysis was performed. A required 15% change in tumor volume was considered real. Pooled analysis was performed to compare outcomes with other series. The mean total radiologic follow-up was 43.2 months. The mean dose-to-the tumor margin was 14.6 Gy. The mean tumor size at treatment was 7.3 cc and 6.3 cc at last follow-up. After treatment, seven tumors decreased (46.7%), five remained unchanged (33.3%), and three (20%) grew on imaging. Treatment failures received a mean marginal dose of 13.2 Gy compared with 15.1 Gy for treatment successes (P =.08). Overall tumor control rate after GKS in the existing literature with inclusion of the present study is 90.5%. GKS is an effective treatment option for patients with GJTs, including those with prior surgical resection. Marginal radiation doses greater than 13 Gy may be optimal for tumor control. Longer follow-up will better define the benefits and risks of stereotactic radiosurgery in treating patients with GJT.

Stereotactic Radiation in the Treatment of Glomus Jugulare Tumors

Introduction: Glomus jugulare tumors are a challenge to treat due to their proximity to the facial nerve and lower cranial nerves. Postoperative deficits may include severe dysphagia, hoarseness, and facial paralysis. To decrease the morbidity from the treatment of glomus jugulare tumors, we have incorporated radiosurgery as either primary treatment or as an adjunct to surgery.

Gamma knife radiosurgery for the treatment of glomus jugulare tumors

The treatment of glomus jugulare tumors represents a challenge for the neurosurgeon, since they invade major vessels and compress critical cranial nerves, resulting in significant morbidity from tumor resection. Among alternative and complementary treatment options, gamma knife radiosurgery is a less invasive procedure and may provide better protection of vital structures. This study aimed to evaluate the efficacy and long-term outcomes of gamma knife surgery in the treatment of these tumors in a large series with the longest follow-up period compared with previous reports. A total of 18 patients with glomus jugulare tumors that underwent gamma knife radiosurgery (GKS) were included. Eleven patients had a history of previous microsurgical treatment. The mean marginal radiation dose was 15.6 Gy (median 15 Gy, range 13-20 Gy). Patients were followed for a mean period of 52.7 months (median 41.5 months); the effect of gamma knife radiosurgery was evaluated using magnetic resonance (MR) images. Based on the last MR images, tumor control could be achieved in 17 out of 18 patients (94.4%). No complications such as radiation-induced peritumoral edema or radiation necrosis occurred. Neurological follow-up examinations revealed improved clinical status in ten patients (55.6%), stable neurological status in seven (38.9%), and deterioration in one patient (5.5%). At the last visit, 17 out of 18 patients were alive. Our results indicate that stereotactic radiosurgery is an effective and safe treatment modality in the management of glomus jugulare tumors, particularly for residual or previously untreated small tumors.

Radiosurgery for Glomus Jugulare Tumors

Results for treating glomus jugulare tumors with radiosurgery have been limited by short follow-up and small number of patients. We report our experience using LINAC or CyberKnife in 21 tumors with a median follow-up of 66 months (Mean follow-up of 60 months). In addition, we have a subset of eight patients that were followed out for more than 10 years. Patients were treated with doses ranging from 1400 cGy to 2700 cGy. We retrospectively assessed patients for efficacy and post treatment side effects. All patients had stable neurological symptoms, and two patients experienced transient ipsilateral tongue weakness and hearing loss, both of which subsequently resolved. One patient experienced transient ipsilateral vocal cord paresis; however, this patient received previous external beam radiotherapy. All tumors remained stable or decreased in size by MRI exam. Our results support radiosurgery as an effective and safe method of treatment for glomus jugulare tumors with low morbidity as evidenced by a larger number of patients and long term follow-up.