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Curry SD, Kocharyan A, Lekovic GP. Multi-Disciplinary Approach to Skull Base Paragangliomas. Brain Sci 2023; 13:1533. [PMID: 38002493 PMCID: PMC10669609 DOI: 10.3390/brainsci13111533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
The treatment of skull base paragangliomas has moved towards the use of cranial nerve preservation strategies, using radiation therapy and subtotal resection in instances when aiming for gross total resection would be expected to cause increased morbidity compared to the natural history of the tumor itself. The goal of this study was to analyze the role of surgery in patients with skull base paragangliomas treated with CyberKnife stereotactic radiosurgery (SRS) for definitive tumor control. A retrospective review identified 22 patients (median age 65.5 years, 50% female) treated with SRS from 2010-2022. Fourteen patients (63.6%) underwent microsurgical resection. Gross total resection was performed in four patients for tympanic paraganglioma (n = 2), contralateral paraganglioma (n = 1), and intracranial tumor with multiple cranial neuropathies (n = 1). Partial/subtotal resection was performed for the treatment of pulsatile tinnitus and conductive hearing loss (n = 6), chronic otitis and otorrhea (n = 2), intracranial extension (n = 1), or episodic vertigo due to perilymphatic fistula (n = 1). Eighteen patients had clinical and imaging follow-up for a mean (SD) of 4.5 (3.4) years after SRS, with all patients having clinical and radiological tumor control and no mortalities. Surgery remains an important component in the multidisciplinary treatment of skull base paraganglioma when considering other outcomes besides local tumor control.
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Affiliation(s)
- Steven D. Curry
- House Clinic, Los Angeles, CA 90017, USA
- Department of Head and Neck Surgery, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA
| | - Armine Kocharyan
- House Clinic, Los Angeles, CA 90017, USA
- Department of Head and Neck Surgery, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA
| | - Gregory P. Lekovic
- House Clinic, Los Angeles, CA 90017, USA
- Department of Neurosurgery, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA
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Treatment decision and estimation of growth of head and neck paragangliomas. Am J Otolaryngol 2022; 43:103357. [PMID: 34972002 DOI: 10.1016/j.amjoto.2021.103357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Head and neck paragangliomas are slow growing tumors where observation has become more widely accepted. Tumor growth rate as well as predictors of increased tumor growth were analyzed with the goal to identify factors to better predict disease progression and counsel patients. MATERIALS AND METHODS Multi-institutional retrospective cohort study from 2011 to 2020. RESULTS 130 head and neck paragangliomas in 125 patients were analyzed. 38 were observed (30.4%), 16 radiated (12.8%), and 71 underwent surgery (56.8%). Surgical patients were significantly younger (p = 0.038) and with more genetically mediated paragangliomas (p = 0.026). Significantly more patients were asymptomatic in the observation group (p = 0.005). Of the 39 observed tumors, 43.6% (n = 17) grew with a tumor doubling time of 5.67 years. More than half of the observed paragangliomas had no growth. When examining symptoms postoperatively and at follow-up, the surgical cohort had significantly more worsening symptoms (p = 0.007) and new cranial neuropathies (p = 0.031). CONCLUSIONS Head and neck paragangliomas have slow growth rates if they grow at all. Patients in the surgical cohort had more clinical symptoms at presentation and worsening postoperative symptoms.
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Ong V, Bourcier AJ, Florence T, Mozaffari K, Mekonnen M, Sheppard JP, Duong C, Ding K, Yang I. Stereotactic Radiosurgery for Glomus Jugulare Tumors: Systematic Review and Meta-Analysis. World Neurosurg 2022; 162:e49-e57. [DOI: 10.1016/j.wneu.2022.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/30/2022]
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Long-term Outcomes for the Treatment of Paragangliomas in the Upfront, Adjuvant, and Salvage Settings With Stereotactic Radiosurgery and Intensity-modulated Radiotherapy. Otol Neurotol 2020; 41:133-140. [DOI: 10.1097/mao.0000000000002461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Safety and Efficacy of Primary Multisession Dose Fractionated Gamma Knife Radiosurgery for Jugular Paragangliomas. World Neurosurg 2019; 131:e136-e148. [DOI: 10.1016/j.wneu.2019.07.090] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/17/2022]
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The Application of Sigmoid Sinus Tunnel-packing or Push-packing of the Inferior Petrous Sinus in the Microsurgical Management of Jugular Paragangliomas. Otol Neurotol 2019; 39:e166-e172. [PMID: 29315193 DOI: 10.1097/mao.0000000000001683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze the outcomes of microsurgically treated jugular paragangliomas with control of bleeding from the inferior petrous sinus. STUDY DESIGN Retrospective patient review. SETTING A single university hospital. PATIENTS Forty-three patients with jugular paragangliomas were diagnosed in the past 7 years in our clinic. MAIN OUTCOME MEASURES Surgical tumor control, intraoperative blood loss, intraoperative management of the facial nerve, and the preoperative and postoperative function of the lower central nerves. RESULTS Twenty-six patients underwent microsurgical treatment. Eighteen tumors were class C2 (69.2%), six were class C3 (23.1%), and two were class CDe1 (7.7%). Gross total tumor resection was achieved in 92.3% of the patients. The mean blood loss during surgery was 438.5 ml. The recurrence rate was 3.8% over a mean follow-up of 29.2 months. New facial palsy and lower cranial nerve deficit occurred in 42.3 and 11.5% of the patients, respectively. CONCLUSION The infratemporal fossa approach type A with sigmoid sinus tunnel-packing or push-packing technique facilitated the control of bleeding from the inferior petrous sinus and improved the outcomes of microsurgical treatment for jugular paragangliomas.
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Lassen‐Ramshad Y, Ozyar E, Alanyali S, Poortmans P, Van Houtte P, Sohawon S, Esassolak M, Krengli M, Villa S, Miller RC, Demiroz C, Akyurek S, Aggerholm‐Pedersen N, Thariat J. Reply to “Proper tumor classification and growth rate are key elements when considering indications and results of radiotherapy for head and neck paragangliomas”. Head Neck 2019; 41:2837-2838. [DOI: 10.1002/hed.25800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/23/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Yasmin Lassen‐Ramshad
- Danish Centre for Particle TherapyAarhus University Hospital Aarhus Denmark
- Department of OncologyAarhus University Hospital Aarhus Denmark
| | - Enis Ozyar
- Acibadem M.A. Aydinlar UniversitySchool of Medicine, Department of Radiation Oncology Turkey
| | - Senem Alanyali
- Department of Radiation OncologyFaculty of Medicine, Ege University Turkey
| | | | - Paul Van Houtte
- Department of Radiation OncologyJules Bordet Institute Brussels Belgium
| | - Schoeb Sohawon
- Department of Radiation OncologyJules Bordet Institute Brussels Belgium
| | - Mustafa Esassolak
- Department of Radiation OncologyFaculty of Medicine, Ege University Turkey
| | - Marco Krengli
- Department of RadiotherapyUniversity of Piemonte Orientale Novara Italy
| | - Salvador Villa
- Department of Radiation OncologyCatalan Institute of Oncology Badalona Spain
| | - Robert C. Miller
- Department of Radiation OncologyMayo Clinic Jacksonville Florida
| | - Candan Demiroz
- Uludag University Faculty of MedicineRadiation Oncology Clinical Division Turkey
| | - Serap Akyurek
- Department of RadiotherapyAnkara University School of Medicine Ankara Turkey
| | | | - Juliette Thariat
- Radiation Oncology DepartmentCentre Francois Baclesse Caen France
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Spina A, Boari N, Gagliardi F, Bailo M, Del Vecchio A, Bolognesi A, Mortini P. Gamma Knife radiosurgery for glomus tumors: Long-term results in a series of 30 patients. Head Neck 2018; 40:2677-2684. [PMID: 30456888 DOI: 10.1002/hed.25517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/10/2018] [Accepted: 09/28/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Glomus tumors are rare and benign hypervascular tumors. Surgery represented the mainstay of their treatment, even if it has been associated with high morbidity and mortality rates. Recently, the treatment shifted to a multimodal approach and Gamma Knife radiosurgery represents one of the treatment options. METHODS Authors retrospectively analyzed the clinical and radiological outcome of a series of patients who underwent Gamma Knife radiosurgery for glomus tumors. RESULTS Thirty patients underwent Gamma Knife radiosurgery. Mean tumor volume was 7.69 cc (range 0.36-24.6). Mean tumor margin dose was 16 Gy (range 13-18). Median follow-up was of 91 months (mean 90; range 11-172). Overall clinical control rate was 100%; overall volumetric tumor control rate was 96.6%. Patients' and tumors' characteristics, treatment data, and outcome have been analyzed. CONCLUSION Gamma Knife radiosurgery represents a safe and effective treatment for glomus tumors. Longer follow-up and larger cohort studies are needed to definitively outline the role of Gamma Knife radiosurgery for glomus tumors.
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Affiliation(s)
- Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Nicola Boari
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Antonella Del Vecchio
- Service of Medical Physics, I.R.C.C.S. San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Bolognesi
- Service of Radiation Oncology, I.R.C.C.S. San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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Wakefield DV, Venable GT, VanderWalde NA, Michael LM, Sorenson JM, Robertson JH, Cunninghan D, Ballo MT. Comparative Neurologic Outcomes of Salvage and Definitive Gamma Knife Radiosurgery for Glomus Jugulare: A 20-Year Experience. J Neurol Surg B Skull Base 2017; 78:251-255. [PMID: 28593112 DOI: 10.1055/s-0036-1597986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/04/2016] [Indexed: 10/20/2022] Open
Abstract
Objective This case series investigates management of glomus jugulare (GJ) tumors utilizing definitive and salvage Gamma Knife stereotactic radiosurgery (GKSRS). Methods A retrospective chart review was performed to collect data. Statistical analysis included patient, tumor, and treatment information. Results From 1996 to 2013, 17 patients with GJ received GKSRS. Median age was 64 years (range, 27-76). GKSRS was delivered for definitive treatment in eight (47%) and salvage in nine (53%) patients. Median tumor volume was 9.8 cm 3 (range, 2.8-42 cm 3 ). Median dose was 15 Gy (range, 13-18 Gy). Median follow-up was 123 months (range, 38-238 months). Tumor size decreased in 10 (59%), stabilized in 6 (35%), and increased in 1 patient (6%). Overall neurological deficit improved in 53%, stabilized in 41%, and worsened in 6% of patients. Overall cause-specific survival was 100%, and actuarial local control was 94%. Eighty-eight percent of patients without prior resection experienced neurologic deficit improvement, while 25% of patients with prior resection experienced neurologic improvement ( p = 0.02). Conclusion Gamma Knife radiosurgery provides effective long-term control of GJ and overall improvement or stabilization of neurological deficit in most patients. Patients with prior resection are less likely to experience improvement of neurologic deficit.
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Affiliation(s)
- Daniel V Wakefield
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Garrett T Venable
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Noam A VanderWalde
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,West Cancer Center, Memphis, Tennessee, United States
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States.,Memphis Regional Gamma Knife Center, Memphis, Tennessee, United States
| | - Jeffery M Sorenson
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States.,Memphis Regional Gamma Knife Center, Memphis, Tennessee, United States
| | - Jon H Robertson
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States.,Memphis Regional Gamma Knife Center, Memphis, Tennessee, United States
| | - David Cunninghan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States.,Memphis Regional Gamma Knife Center, Memphis, Tennessee, United States
| | - Matthew T Ballo
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,West Cancer Center, Memphis, Tennessee, United States
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Moore MG, Netterville JL, Mendenhall WM, Isaacson B, Nussenbaum B. Head and Neck Paragangliomas. Otolaryngol Head Neck Surg 2016; 154:597-605. [DOI: 10.1177/0194599815627667] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/29/2015] [Indexed: 11/16/2022]
Abstract
Objective Head and neck paragangliomas are a group of slow-growing hypervascular tumors associated with the paraganglion system. The approach to evaluate and treat these lesions has evolved over the last 2 decades. While radical surgery had been the traditional approach, improvements in diagnostic imaging as well as radiation therapy techniques have led to an emphasis on observation and nonsurgical therapy in many patients. This article reviews the contemporary approach to the workup and management of head and neck paragangliomas. Data Source Articles were identified from PubMed. Review Methods PubMed searches with the following keywords were performed: carotid body paraganglioma management, vagal paraganglioma management, jugulotympanic paraganglioma management, imaging of head and neck paragangliomas, head and neck paraganglioma embolization, paraganglioma radiation, head and neck paraganglioma management, observation of head and neck paragangliomas, bilateral carotid body paragangliomas, and genetics of paragangliomas. Review and original research articles available in the English language and published during or after 2009 were selected on the basis of their clinical relevance and scientific strength. Certain articles published prior to 2009 were also included if they provided background information that was relevant. Conclusions/Implications for Practice Workup and treatment of head and neck paragangliomas are changing. With more now known regarding the longitudinal behavior of these tumors, observation and nonsurgical therapy are indicated in many instances. For patients where surgery is the most appropriate option, improved diagnostic and perioperative techniques are allowing patients to tolerate resection, often with reduced morbidity.
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Affiliation(s)
- Michael G. Moore
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James L. Netterville
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William M. Mendenhall
- Department of Radiation Oncology, University of Florida School of Medicine, Gainesville, Florida, USA
| | - Brandon Isaacson
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brian Nussenbaum
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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