Cranial Nerve Preservation and Outcomes after Stereotactic Radiosurgery for Jugular Foramen Schwannomas

Abstract OBJECTIVE Jugular foramen region schwannomas are rare intracranial tumors that usually present with multiple lower cranial nerve deficits. For some patients, complete surgical resection is possible but may be associated with significant morbidity. Stereotactic radiosurgery is a minimally invasive alternative or adjunct to microsurgery for such tumors. We reviewed our clinical and imaging outcomes after patients underwent gamma knife radiosurgery for management of jugular foramen schwannomas. METHODS Thirty-four patients with 35 tumors (one patient had bilateral tumors) underwent radiosurgery between May 1990 and December 2005. Twenty-two patients had previous microsurgical resection and all patients experienced various cranial neuropathies. A median of six isocenters were used. Median marginal and maximum doses were 14 and 28 Gy, respectively. RESULTS None of the patients were lost to evaluation and the mean duration of follow-up was 83 months. Tumors regressed in 17 patients, remained stable in 16, and progressed in two. Five- and 10-year actuarial control rates were 97 and 94%, respectively. Preexisting cranial neuropathies improved in 20% and remained stable in 77% after radiosurgery. One patient worsened. The function of all previous intact nerves was preserved after radiosurgery. CONCLUSION Stereotactic radiosurgery proved to be a safe and effective management for newly diagnosed or residual jugular foramen schwannomas. Long-term tumor control rates and stability or improvement in cranial nerve function was confirmed.

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Hypofractionated Robotic Stereotactic Radiosurgery for Vagal Paragangliomas: A Novel Treatment Strategy for Cranial Nerve Preservation

Otolaryngology ◽

10.1177/0194599820910150 ◽

2020 ◽

Vol 162 (6) ◽

pp. 897-904

Author(s):

Anne K. Maxwell ◽

Gautam U. Mehta ◽

Thomas Muelleman ◽

Zachary R. Barnard ◽

Thomas Hartwick ◽

...

Keyword(s):

Side Effects ◽

Stereotactic Radiosurgery ◽

Cranial Nerve ◽

Tumor Resection ◽

Tumor Control ◽

Subtotal Resection ◽

Lower Cranial Nerve ◽

Nerve Preservation ◽

Cranial Nerve Preservation ◽

Vagal Function

Objective To provide the first description of hypofractionated stereotactic radiosurgery (SRS) and evaluate tumor control and safety for vagal paragangliomas (VPs), which begin at the skull base but often have significant extracranial extension. Study Design Retrospective chart review. Setting Tertiary-referral neurotology and neurosurgery practice. Subjects and Methods Five VPs in 4 patients (all male, ages 15-56 years) underwent SRS between 2010 and 2018. Outcome measures included tumor dimensions on serial imaging, cranial nerve function, and radiation side effects. Results CyberKnife hypofractionated SRS was performed. The prescription dose was 24 or 27 Gy (maximum dose 33.4 Gy; range, 29.3-35.5 Gy) delivered in 3 equal fractions. The mean isodose line was 79% (range, 76%-82%). Four VPs were treated primarily, and 1 tumor underwent SRS to treat regrowth 2 years after microsurgical subtotal resection via the modified infratemporal fossa approach. The treatment volume ranged from 8.81 to 86.3 cm3 (mean, 35.7 cm3). All demonstrated stable size (n = 3) or regression (n = 2) at last follow-up, 63 to 85 months after SRS (mean, 76 months). One patient had stable premorbid vocal fold paralysis from a prior ipsilateral glomus jugulare tumor resection. All others demonstrated normal vagal function following SRS. Treatment-related side effects, including dysgeusia (n = 1), mucositis (n = 1), and neck soft-tissue edema (n = 2), were self-limited. Conclusions Hypofractionated SRS appears to be both safe and effective for treating VPs, including large-volume and predominantly extracranial tumors, while preserving vagal function. SRS should be considered as a cranial nerve preservation option, especially in settings of contralateral lower cranial nerve deficits or in those with multiple paragangliomas risking both vagal nerves.

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Does Prior Microsurgery Improve or Worsen the Outcomes of Stereotactic Radiosurgery for Cavernous Sinus Meningiomas?

Neurosurgery ◽

10.1227/01.neu.0000431471.64289.3d ◽

2013 ◽

Vol 73 (3) ◽

pp. 401-410 ◽

Cited By ~ 28

Author(s):

Hideyuki Kano ◽

Kyun-Jae Park ◽

Douglas Kondziolka ◽

Aditya Iyer ◽

Xiaomin Liu ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Cavernous Sinus ◽

Cranial Nerve ◽

Progression Free Survival ◽

Tumor Control ◽

Improvement Rate ◽

Cranial Nerve Function ◽

Cranial Neuropathies ◽

Microsurgical Resection

Abstract BACKGROUND: Stereotactic radiosurgery (SRS) is an important option for patients with cavernous sinus meningiomas. OBJECTIVE: To evaluate cranial nerve outcomes in patients who underwent SRS for cavernous sinus meningiomas with or without prior microsurgery. METHODS: During a 23-year interval, 272 patients underwent Gamma Knife SRS for cavernous sinus meningiomas (70 men, 202 women; median age, 54 years). In this series, 99 patients underwent prior microsurgical resection. The median tumor volume was 7.9 cm3 and median marginal dose was 13 Gy. The median follow-up period was 62 months (range, 6-209 months). RESULTS: The progression-free survival after SRS was 96% at 3 years, 94% at 5 years, and 86% at 10 years. After SRS, 13 of 91 patients (14%) who underwent prior microsurgery had improvement of preexisting cranial nerve symptoms or signs. In comparison, 54 of 145 patients (37%) without prior microsurgery had improvement of preexisting cranial nerve symptoms or signs. The improvement rate of cranial nerve deficits after SRS in patients without prior microsurgery was 20% at 1 year, 34% at 2 years, 36% at 3 years, and 39% at 5 years. Patients who had not undergone prior microsurgery had significantly higher improvement rates of preexisting cranial nerve symptoms and signs (P = .001). After SRS, 29 patients (11%) developed new or worsened cranial nerve function. CONCLUSION: SRS provided long-term effective tumor control and a low risk of new cranial nerve deficits. Improvement in preexisting cranial neuropathies was detected in significantly more patients who had not undergone prior microsurgical procedures.

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Microsurgical Management of Jugular Foramen Schwannomas

Neurosurgery ◽

10.1227/neu.0b013e3182770e74 ◽

2012 ◽

Vol 72 (1) ◽

pp. 42-46 ◽

Cited By ~ 20

Author(s):

Cara L. Sedney ◽

Yoichi Nonaka ◽

Ketan R. Bulsara ◽

Takanori Fukushima

Keyword(s):

Cranial Nerve ◽

Tumor Resection ◽

Jugular Foramen ◽

Control Analysis ◽

Lower Cranial Nerve ◽

Nerve Preservation ◽

In Series ◽

Case Control Analysis ◽

Cranial Nerve Preservation ◽

Modern Era

Abstract BACKGROUND: Jugular foramen schwannomas are uncommon and surgically challenging lesions. OBJECTIVE: To determine the importance of surgical technique on morbidity and recurrence of jugular foramen schwannomas. METHODS: A retrospective review and case-control analysis of a single-senior-surgeon series of 81 patients with surgically treated jugular foramen schwannomas was performed, focusing on operative technique. Patients undergoing an aggressive, total tumor resection (series 1) were compared with those undergoing more conservative resection focusing on preserving the pars nervosa (series 2). RESULTS: There was a statistically significant (P = .04) decrease in permanent deficits of the cranial nerve 9/10 complex with a conservative technique. Recurrence was seen in 3 patients (5.7%) in series 1 and in 3 patients (10.7%) in series 2 (P = .36). Recurrence was treated with reoperation in 1 patient, radiation in 1 patient, and observation in the others. CONCLUSION: Although radical gross total resection is desirable, it is not optimal for cranial nerve preservation in patients with jugular foramen schwannomas. A more conservative approach resulted in a statistically significant decrease in lower cranial nerve deficits. There was a nonstatistically significant trend toward increasing recurrence, which may be treated with multiple modality therapy in the modern era.

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Stereotactic radiosurgery for jugular foramen schwannomas: an international multicenter study

Journal of Neurosurgery ◽

10.3171/2017.5.jns162894 ◽

2018 ◽

Vol 129 (4) ◽

pp. 928-936 ◽

Cited By ~ 2

Author(s):

Hideyuki Kano ◽

Antonio Meola ◽

Huai-che Yang ◽

Wan-Yuo Guo ◽

Roberto Martínez-Alvarez ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Radiation Effects ◽

Tumor Volume ◽

Progression Free Survival ◽

Jugular Foramen ◽

Management Approach ◽

Tumor Control ◽

Cranial Neuropathies ◽

Microsurgical Resection ◽

International Multicenter Study

OBJECTIVEFor some jugular foramen schwannomas (JFSs), complete resection is possible but may be associated with significant morbidity. Stereotactic radiosurgery (SRS) is a minimally invasive alternative or adjunct to microsurgery for JFSs. The authors reviewed clinical and imaging outcomes of SRS for patients with these tumors.METHODSNine participating centers of the International Gamma Knife Research Foundation identified 92 patients who underwent SRS between 1990 and 2013. Forty-one patients had prior subtotal microsurgical resection. The median interval between previous surgery and SRS was 15 months (range 0.5–144 months). Eighty-four patients had preexisting cranial nerve (CN) symptoms and signs. The median tumor volume was 4.1 cm3 (range 0.8–22.6 cm3), and the median margin dose was 12.5 Gy (range 10–18 Gy). Patients with neurofibromatosis were excluded from this study.RESULTSThe median follow-up was 51 months (range 6–266 months). Tumors regressed in 47 patients, remained stable in 33, and progressed in 12. The progression-free survival (PFS) was 93% at 3 years, 87% at 5 years, and 82% at 10 years. In the entire series, only a dumbbell shape (extension extracranially via the jugular foramen) was significantly associated with worse PFS. In the group of patients without prior microsurgery (n = 51), factors associated with better PFS included tumor volume < 6 cm3 (p = 0.037) and non–dumbbell-shaped tumors (p = 0.015). Preexisting cranial neuropathies improved in 27 patients, remained stable in 51, and worsened in 14. The CN function improved after SRS in 12% of patients at 1 year, 24% at 2 years, 27% at 3 years, and 32% at 5 years. Symptomatic adverse radiation effects occurred in 7 patients at a median of 7 months after SRS (range 5–38 months). Six patients underwent repeat SRS at a median of 64 months (range 44–134 months). Four patients underwent resection at a median of 14 months after SRS (range 8–30 months).CONCLUSIONSStereotactic radiosurgery proved to be a safe and effective primary or adjuvant management approach for JFSs. Long-term tumor control rates and stability or improvement in CN function were confirmed.

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Neuroendocrine Carcinoma of the Jugular Foramen

Ear Nose & Throat Journal ◽

10.1177/014556130808700209 ◽

2008 ◽

Vol 87 (2) ◽

pp. 86-91 ◽

Cited By ~ 2

Author(s):

John P. Leonetti ◽

Mobeen A. Shirazi ◽

Sam Marzo ◽

Douglas Anderson

Keyword(s):

Neuroendocrine Carcinoma ◽

Vocal Fold ◽

Cranial Nerves ◽

Intensity Modulated Radiation Therapy ◽

Jugular Foramen ◽

Concurrent Chemotherapy ◽

Lower Cranial Nerve ◽

Nerve Preservation ◽

Pathologic Features ◽

Cranial Nerve Preservation

We describe what might have been the first reported case of a neuroendocrine carcinoma of the jugular foramen. A 50-year-old woman presented with progressive left-sided sensorineural hearing loss, vertigo, pulsatile tinnitus, headaches, and ataxia. Magnetic resonance imaging revealed a 4-cm left-sided jugular foramen tumor. The patient underwent near-total resection of the tumor. Despite lower cranial nerve preservation, postoperative paralysis of cranial nerves IX and X occurred, and vocal fold medialization was performed 5 days later. The final pathologic diagnosis was neuroendocrine carcinoma. The patient was treated with concurrent chemotherapy and intensity-modulated radiation therapy. This article will discuss the pathologic features and the management of jugular foramen tumors, along with the differential diagnosis of these rare tumors.

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Stereotactic Radiosurgery of Cranial Nonvestibular Schwannomas: Results of Single- and Multisession Radiosurgery

Neurosurgery ◽

10.1227/neu.0b013e31820c0474 ◽

2011 ◽

Vol 68 (5) ◽

pp. 1200-1208 ◽

Cited By ~ 15

Author(s):

Clara Y. H. Choi ◽

Scott G. Soltys ◽

Iris C. Gibbs ◽

Griffith R. Harsh ◽

Gordon T. Sakamoto ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Cranial Nerve ◽

Medical Center ◽

Cranial Nerves ◽

Jugular Foramen ◽

Tumor Control ◽

Minimal Risk ◽

Invasive Treatment ◽

Non Invasive

Abstract BACKGROUND: Surgical resection of nonvestibular cranial schwannomas carries a considerable risk of postoperative complications. Stereotactic radiosurgery (SRS) offers a non-invasive treatment alternative. The efficacy and safety of multi-session SRS of nonvestibular cranial schwannomas has not been well studied. OBJECTIVE: To analyze the results of single- and multi-session SRS of nonvestibular cranial schwannomas. METHODS: From 2001 to 2007, 42 lesions in 40 patients were treated with SRS at Stanford University Medical Center, targeting schwannomas of cranial nerves IV (n = 1), V (n = 18), VII (n = 6), X (n = 5), XII (n = 2), jugular foramen (n = 8), and cavernous sinus (n = 2). SRS was delivered to a median marginal dose of 18 Gy (range, 15-33 Gy) in 1 to 3 sessions, targeting a median tumor volume of 3.2 cm3 (range, 0.1-23.7 cm3). The median doses for treatments in 1 (n = 18), 2 (n = 9), and 3 (n = 15) sessions were 17.5, 20, and 18 Gy, respectively. RESULTS: With a median follow-up of 29 months (range, 6-84 months), tumor control was achieved in 41 of the 42 lesions. Eighteen of 42 lesions (43%) decreased in size; 23 tumors (55%) remained stable. There were 2 cases of new or worsening cranial nerve deficits in patients treated in single session; no patient treated with multi-session SRS experienced any cranial nerve toxicity (P = 0.18). CONCLUSION: SRS of nonvestibular cranial schwannomas provides excellent tumor control with minimal risk of complications. There was a trend towards decreased complications with multi-session SRS.

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