Gamma Knife surgery for the management of glomus tumors: A multicenter study - Clinical article

Jason P. Sheehan, Shota Tanaka, Michael J. Link, Bruce E. Pollock, Douglas Kondziolka, David Mathieu, Christopher Duma, A. Byron Young, Anthony M. Kaufmann, Heyoung McBride, Peter A. Weisskopf, Zhiyuan Xu, Hideyuki Kano, Huai Che Yang, L. Dade Lunsford

Research output: Contribution to journalArticle

50 Scopus citations

Abstract

Object. Glomus tumors are rare skull base neoplasms that frequently involve critical cerebrovascular structures and lower cranial nerves. Complete resection is often difficult and may increase cranial nerve deficits. Stereotactic radiosurgery has gained an increasing role in the management of glomus tumors. The authors of this study examine the outcomes after radiosurgery in a large, multicenter patient population. Methods. Under the auspices of the North American Gamma Knife Consortium, 8 Gamma Knife surgery centers that treat glomus tumors combined their outcome data retrospectively. One hundred thirty-four patient procedures were included in the study (134 procedures in 132 patients, with each procedure being analyzed separately). Prior resection was performed in 51 patients, and prior fractionated external beam radiotherapy was performed in 6 patients. The patients' median age at the time of radiosurgery was 59 years. Forty percent had pulsatile tinnitus at the time of radiosurgery. The median dose to the tumor margin was 15 Gy. The median duration of follow-up was 50.5 months (range 5-220 months). Results. Overall tumor control was achieved in 93% of patients at last follow-up; actuarial tumor control was 88% at 5 years postradiosurgery. Absence of trigeminal nerve dysfunction at the time of radiosurgery (p = 0.001) and higher number of isocenters (p = 0.005) were statistically associated with tumor progression-free tumor survival. Patients demonstrating new or progressive cranial nerve deficits were also likely to demonstrate tumor progression (p = 0.002). Pulsatile tinnitus improved in 49% of patients who reported it at presentation. New or progressive cranial nerve deficits were noted in 15% of patients; improvement in preexisting cranial nerve deficits was observed in 11% of patients. No patient died as a result of tumor progression. Conclusions. Gamma Knife surgery was a well-tolerated management strategy that provided a high rate of longterm glomus tumor control. Symptomatic tinnitus improved in almost one-half of the patients. Overall neurological status and cranial nerve function were preserved or improved in the vast majority of patients after radiosurgery.

Original languageEnglish (US)
Pages (from-to)246-254
Number of pages9
JournalJournal of neurosurgery
Volume117
Issue number2
DOIs
StatePublished - Aug 1 2012

Keywords

  • Gamma knife
  • Glomus tumor
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Sheehan, J. P., Tanaka, S., Link, M. J., Pollock, B. E., Kondziolka, D., Mathieu, D., Duma, C., Young, A. B., Kaufmann, A. M., McBride, H., Weisskopf, P. A., Xu, Z., Kano, H., Yang, H. C., & Lunsford, L. D. (2012). Gamma Knife surgery for the management of glomus tumors: A multicenter study - Clinical article. Journal of neurosurgery, 117(2), 246-254. https://doi.org/10.3171/2012.4.JNS11214