Radiosurgery For Jugular Foramen Schwannoma

Jin Young Lim1, Won Seop Seo1, Seok Keun Choi1

1University of Kyung Hee, Seoul, Korea

Keywords: jugular foramen, gamma knife, schwannoma, skull base, radiosurgery

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     With increase of clinical experience of Gamma Knife radiosurgery (GKS) for the intracranial benign lesions, it has been proved that radiosurgery is an effective treatment tool. Moreover in cases the tumor located in deep portion which are difficult to access with microsurgery like as jugular foramen, the role of radiosurgery has been increased.
     The author reviewed the radiosurgical effect and perspectives of GKS for jugular foramen schwannoma with several literatures.
     During last 17 years, twelve cases of jugular foramen schwannoma (5.2% of 233 intracranial schwannomas), mainly glossopharyngeal, were treated with GKS in our clinic. We evaluated 10 patients who were followed-up more than 2 years. Two patients had undergone prior mass removal and the others were managed with GKS as a primary treatment. In one patient repeated GKS was performed at 5 years after first GKS for extracranial remnant portion.
     The mean tumor volume was 4.9 cc (0.5-10.0l). The mean marginal dose was 13.6 Gy (12-19). Every patient was followed-up with MR annually after GKS. The median follow-up after radiosurgery was 62.1 months (24-182).
     All patients had symptoms such as headache, dizziness, vomiting, hearing disturbance and paraparesis and 4 patients had low cranial nerve-associated neurologic deficits, which were tongue paresthesia, swallowing difficulty and hoarseness. Initial symptoms are improved or disappeared in 6 of 10 patients after GKS, which includes 3 patients who had undergone temporary aggravation of their initial symptom or transient newly developed symptoms. Tumor volume was decreased in five of 10 patients (50%) and unchanged in five of 10 patients (50%) after GKS. Adverse radiation effect was occurred in one case, suffered with newly developed dizziness resulted from cerebral edema at cerebellar hemisphere at 8 months after GKS, but has been improving.
     This is a retrospective study.
     In the treatment of jugular foramen schwannoma, GKS showed high tumor control rate and low morbidity.
     As the proved effect for intracranial schwannomas, so the radiosurgery can be applied for the jugular foramen schwannoma safely and effectively.


Project Roles:

J. Lim (), W. Seo (), S. Choi ()