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Keywords:

  • Paraganglioma;
  • glomus tumor;
  • lateral skull base;
  • foramen jugulare;
  • Level of Evidence: 2b

Abstract

Objectives/Hypothesis:

Treatment for jugulotympanic paragangliomas (JTPs) is shifting from radical toward function-preserving surgery. Alternative primary treatments are available, such as stereotactic radiotherapy (SRT) and radiosurgery. The aim of this study was to analyze the results after primary function-preserving surgery with or without adjuvant radiotherapy, or primary SRT, in the treatment of JTPs.

Study Design:

Retrospective analysis.

Methods:

From 2000 to 2010, 45 patients (mean age, 62.5 years) received function-preserving treatment for JTPs—four type A paragangliomas (8.9%), 19 type B (42.2%), 13 type C (28.9%), and nine type D (20%) in the Fisch classification. The patients were retrospectively assigned to three groups: primary function-preserving surgery, primary stereotactic radiotherapy, and close follow-up. The end points for analysis were long-term tumor control, cranial nerve function, and hearing.

Results:

A total of 64.4% of the patients (n = 29) received primary surgery, with complete resection in 18. Eleven patients had surgical tumor reduction, with fractionated postoperative radiotherapy (mean 53.5 Gy; range, 50–56 Gy) in five cases and radiosurgery (18 Gy) in one case; five patients received close follow-up. Twelve patients (26.7%) underwent primary radiotherapy (11 with SRT [mean, 50 Gy]; one with radiosurgery [16 Gy]). Four patients (8.9%) received a wait-and-scan strategy. The mean follow-up was 46.8 months. The overall tumor control rate was 97.2%.

Conclusions:

With these high tumor control rates, consistent with the literature, function-preserving therapy for JTPs currently appears to offer the greatest benefit for patients.