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Ehret F, Kufeld M, Fürweger C, Haidenberger A, Schichor C, Tonn JC, Muacevic A, Hempel JM. Single-session image-guided robotic radiosurgery and quality of life for glomus jugulare tumors. Head Neck 2020; 42:2421-2430. [PMID: 32394483 DOI: 10.1002/hed.26231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/03/2020] [Accepted: 04/22/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Limited data are available on the efficacy and impact on the quality of life (Qol) of single-session image-guided robotic radiosurgery (RRS) for glomus jugulare tumors (GJTs). This study investigates the role of RRS in the management of GJTs and reviews the RRS literature. METHODS We analyzed 53 GJT patients treated with RRS to evaluate the safety, local control, clinical outcome, and Qol assessed by the SF12v2. RESULTS The local control was 98% at a median follow-up of 38 months. The median tumor volume was 4.3 cc and tumors were treated with a median dose of 16.5 Gy. At the last follow-up, 35 patients had recovered from their symptoms or experienced symptom improvement. Qol analyses showed no significant decline while bodily pain significantly decreased. CONCLUSIONS RRS is a safe and efficient tool for the treatment of GJTs. Qol of patients after treatment is stable and tends to improve over time.
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Affiliation(s)
| | | | - Christoph Fürweger
- European Cyberknife Center, Munich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | | | - Christian Schichor
- Department of Neurosurgery, Campus Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Campus Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - John-Martin Hempel
- Department of Otorhinolaryngology and Head and Neck Surgery, Campus Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
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Kocur D, Ślusarczyk W, Przybyłko N, Hofman M, Jamróz T, Suszyński K, Baron J, Kwiek S. Endovascular Approach to Glomus Jugulare Tumors. Pol J Radiol 2017; 82:322-326. [PMID: 28685005 PMCID: PMC5487373 DOI: 10.12659/pjr.901141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/06/2016] [Indexed: 11/17/2022] Open
Abstract
Background Paragangliomas are benign neuroendocrine tumors derived from the glomus cells of the vegetative nervous system. Typically, they are located in the region of the jugular bulb and middle ear. The optimal management is controversial and can include surgical excision, stereotactic radiosurgery and embolization. Case Report We report the endovascular approach to three patients harboring glomus jugulare paragangliomas. In all cases incomplete occlusion of the lesions was achieved and recanalization in the follow-up period was revealed. Two patients presented no clinical improvement and the remaining one experienced a transient withdrawal of tinnitus. Conclusions It is technically difficult to achieve complete obliteration of glomus jugulare tumors with the use of embolization and the subtotal occlusion poses a high risk of revascularization and is not beneficial in terms of alleviating clinical symptoms.
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Affiliation(s)
- Damian Kocur
- Department of Neurosurgery, prof. Gibiński Central Clinical Hospital, Katowice, Poland
| | - Wojciech Ślusarczyk
- Department of Physiology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Nikodem Przybyłko
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Mariusz Hofman
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Tomasz Jamróz
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Krzysztof Suszyński
- Department of Sports Medicine and Physiology of Physical Effort, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Jan Baron
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Stanisław Kwiek
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
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Li D, Zeng XJ, Hao SY, Wang L, Tang J, Xiao XR, Meng GL, Jia GJ, Zhang LW, Wu Z, Zhang JT. Less-aggressive surgical management and long-term outcomes of jugular foramen paragangliomas: a neurosurgical perspective. J Neurosurg 2016; 125:1143-1154. [PMID: 26918473 DOI: 10.3171/2015.10.jns151875] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the neurological functional outcome and recurrent risks in surgically treated jugular foramen paragangliomas (JFPs) and to propose an individualized therapeutic strategy. METHODS Clinical charts and radiological information were reviewed retrospectively in 51 consecutive cases of JFPs. Less-aggressive surgical interventions were adopted with the goal of preserving neurovascular structures. Scheduled follow-up was performed. RESULTS The mean age of the patients in the cases reviewed was 41.6 years, and the group included 27 females (52.9%). The mean preoperative Karnofsky Performance Scale (KPS) score was 78.4. The mean lesion size was 3.8 cm. Forty-three cases (84.3%) were Fisch Type D, including 37 cases (72.5%) of Type Di1 and Di2. Thirty-seven cases (72.5%) were Glasscock-Jackson Type III-IV. Gross-total resection and subtotal resection were achieved in 26 (51.0%) and 22 (43.1%) cases, respectively. Surgical morbidities occurred in 23 patients (45.1%), without surgery-related mortality after the first operation. The mean postoperative KPS scores at discharge, 3 months, 1 year, and most recent evaluation were 71.8, 77.2, 83.2, and 79.6, respectively. The mean follow-up duration was 85.7 months. The tumor recurrence/regrowth (R/R) rate was 11.8%. Compared with preoperative status, swallowing function improved or stabilized in 96.1% and facial function improved or stabilized in 94.1% of patients. A House-Brackmann scale Grade I/II was achieved in 43 patients (84.3%). Overall neurological status improved or stabilized in 90.0% of patients. Pathological mitosis (HR 10.640, p = 0.009) was the most significant risk for tumor R/R. A 1-year increase in age (OR 1.115, p = 0.037) and preoperative KPS score < 80 (OR 11.071, p = 0.018) indicated a risk for recent poor neurological function (KPS < 80). Overall R/R-free survival, symptom progression-free survival, and overall survival at 15 years were 78.9%, 86.8%, and 80.6%, respectively. CONCLUSIONS Surgical outcomes for JFPs were acceptable using a less-aggressive surgical strategy. Most patients could adapt to surgical morbidities and carry out normal life activities. Preserving neurological function was a priority, and maximal decompression with or without radiotherapy was desirable to preserve a patient's quality of life when radical resection was not warranted. Early surgery plus preoperative devascularization was proposed, and radiotherapy was mandatory for lesions with pathological mitosis.
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Affiliation(s)
- Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.,China National Clinical Research Center for Neurological Diseases.,Center of Brain Tumor, Beijing Institute for Brain Disorders; and.,Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Xiao-Jun Zeng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.,China National Clinical Research Center for Neurological Diseases.,Center of Brain Tumor, Beijing Institute for Brain Disorders; and.,Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Shu-Yu Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.,China National Clinical Research Center for Neurological Diseases.,Center of Brain Tumor, Beijing Institute for Brain Disorders; and.,Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Liang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.,China National Clinical Research Center for Neurological Diseases.,Center of Brain Tumor, Beijing Institute for Brain Disorders; and.,Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Jie Tang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Xin-Ru Xiao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Guo-Lu Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Gui-Jun Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Li-Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.,China National Clinical Research Center for Neurological Diseases.,Center of Brain Tumor, Beijing Institute for Brain Disorders; and.,Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.,China National Clinical Research Center for Neurological Diseases.,Center of Brain Tumor, Beijing Institute for Brain Disorders; and.,Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Jun-Ting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.,China National Clinical Research Center for Neurological Diseases.,Center of Brain Tumor, Beijing Institute for Brain Disorders; and.,Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
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Michelozzi C, Januel AC, Cuvinciuc V, Tall P, Bonneville F, Fraysse B, Deguine O, Serrano E, Cognard C. Arterial embolization with Onyx of head and neck paragangliomas. J Neurointerv Surg 2015; 8:626-35. [PMID: 25935924 DOI: 10.1136/neurintsurg-2014-011582] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 03/27/2015] [Indexed: 11/04/2022]
Abstract
OBJECT To report the morbidity and long term results in the treatment of paragangliomas by transarterial embolization with ethylene vinyl alcohol (Onyx), either as preoperative or palliative treatment. METHODS Between September 2005 and 2012, 18 jugulotympanic, 7 vagal, and 4 carotid body paragangliomas (CBPs) underwent Onyx embolization, accordingly to our head and neck multidisciplinary team's decision. CBPs were embolized preoperatively. Jugulotympanic and vagal paragangliomas underwent surgery when feasible, otherwise palliative embolization was carried out alone, or in combination with radiotherapy or tympanic surgery in the case of skull base or tympanic extension. Treatment results, and clinical and MRI follow-up data were recorded. RESULTS In all cases, devascularization of at least 60% of the initial tumor blush was obtained; 6 patients underwent two embolizations. Post-embolization, 8 patients presented with cranial nerve palsy, with partial or complete regression at follow-up (mean 31 months, range 3-86 months), except for 2 vagal and 1 hypoglossal palsy. 10 patients were embolized preoperatively; 70% were cured after surgery and 30% showed residual tumor. 19 patients received palliative embolization, of whom 5 underwent radiotherapy and 3 received tympanic surgery post-embolization. Long term follow-up of palliative embolization resulted in tumor volume stability (75%) or extension in intracranial or tympanic compartments. Onyx embolization of CBPs resulted in more difficult surgical dissection in 2 of 4 cases. CONCLUSIONS Onyx embolization is a valuable alternative to surgery in the treatment of jugulotympanic and vagal paragangliomas; tympanic surgery or radiosurgery of the skull base should be considered in selected cases. Preoperative Onyx embolization of CBPs is not recommended.
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Affiliation(s)
- Caterina Michelozzi
- Dipartimento di Radiologia diagnostica e Interventistica, Scuola di Specialità di Radiodiagnostica, Università degli Studi di Milano, Ospedale Sanpaolo, Milano, Italy Neuroradiology Department, University Hospital of Purpan, Toulouse, France
| | | | - Victor Cuvinciuc
- DISIM, Neuroradiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Philippe Tall
- Neuroradiology Department, University Hospital of Purpan, Toulouse, France
| | - Fabrice Bonneville
- Neuroradiology Department, University Hospital of Purpan, Toulouse, France
| | - Bernard Fraysse
- Department of Otology-Neuro-otology and Skull Base Surgery, University Hospital of Purpan, Toulouse, France
| | - Olivier Deguine
- Department of Otology-Neuro-otology and Skull Base Surgery, University Hospital of Purpan, Toulouse, France
| | - Elie Serrano
- Department of ENT, University Hospital of Rangueil-Larrey, Toulouse, France
| | - Christophe Cognard
- Neuroradiology Department, University Hospital of Purpan, Toulouse, France
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