OBJECTIVE: For some jugular foramen schwannomas (JFSs), complete resection is possible but may be associated with significant morbidity. Stereotactic radiosurgery (SRS) is a minimally invasive alternative or adjunct to microsurgery for JFSs. The authors reviewed clinical and imaging outcomes of SRS for patients with these tumors. METHODS: Nine participating centers of the International Gamma Knife Research Foundation identified 92 patients who underwent SRS between 1990 and 2013. Forty-one patients had prior subtotal microsurgical resection. The median interval between previous surgery and SRS was 15 months (range 0.5-144 months). Eighty-four patients had preexisting cranial nerve (CN) symptoms and signs. The median tumor volume was 4.1 cm3 (range 0.8-22.6 cm3), and the median margin dose was 12.5 Gy (range 10-18 Gy). Patients with neurofibromatosis were excluded from this study. RESULTS: The median follow-up was 51 months (range 6-266 months). Tumors regressed in 47 patients, remained stable in 33, and progressed in 12. The progression-free survival (PFS) was 93% at 3 years, 87% at 5 years, and 82% at 10 years. In the entire series, only a dumbbell shape (extension extracranially via the jugular foramen) was significantly associated with worse PFS. In the group of patients without prior microsurgery (n = 51), factors associated with better PFS included tumor volume < 6 cm3 (p = 0.037) and non-dumbbell-shaped tumors (p = 0.015). Preexisting cranial neuropathies improved in 27 patients, remained stable in 51, and worsened in 14. The CN function improved after SRS in 12% of patients at 1 year, 24% at 2 years, 27% at 3 years, and 32% at 5 years. Symptomatic adverse radiation effects occurred in 7 patients at a median of 7 months after SRS (range 5-38 months). Six patients underwent repeat SRS at a median of 64 months (range 44-134 months). Four patients underwent resection at a median of 14 months after SRS (range 8-30 months). CONCLUSIONS: Stereotactic radiosurgery proved to be a safe and effective primary or adjuvant management approach for JFSs. Long-term tumor control rates and stability or improvement in CN function were confirmed.

Department of Neurological Surgery Center for Image guided Neurosurgery University of Pittsburgh Pennsylvania

Department of Neurological Surgery Cleveland Clinic Cleveland Ohio

Department of Neurological Surgery University of Pennsylvania Philadelphia Pennsylvania

Department of Neurological Surgery University of Virginia Charlottesville Virginia

Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czech Republic

Departments of Radiation Oncology and Neurological Surgery Taipei Veterans Hospital Taipei Taiwan

Functional and Radiosurgery Unit Ruber International Hospital Madrid Spain

New York University Langone Medical Center New York New York

Université de Sherbrooke Centre de Recherche Clinique Étienne LeBel Sherbrooke Quebec Canada

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$a Kano, Hideyuki $u 1Department of Neurological Surgery, Center for Image-guided Neurosurgery, University of Pittsburgh, Pennsylvania.

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$a Stereotactic radiosurgery for jugular foramen schwannomas: an international multicenter study / $c H. Kano, A. Meola, HC. Yang, WY. Guo, R. Martínez-Alvarez, N. Martínez-Moreno, D. Urgosik, R. Liscak, O. Cohen-Inbar, J. Sheehan, JYK. Lee, M. Abbassy, GH. Barnett, D. Mathieu, D. Kondziolka, LD. Lunsford,

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$a OBJECTIVE: For some jugular foramen schwannomas (JFSs), complete resection is possible but may be associated with significant morbidity. Stereotactic radiosurgery (SRS) is a minimally invasive alternative or adjunct to microsurgery for JFSs. The authors reviewed clinical and imaging outcomes of SRS for patients with these tumors. METHODS: Nine participating centers of the International Gamma Knife Research Foundation identified 92 patients who underwent SRS between 1990 and 2013. Forty-one patients had prior subtotal microsurgical resection. The median interval between previous surgery and SRS was 15 months (range 0.5-144 months). Eighty-four patients had preexisting cranial nerve (CN) symptoms and signs. The median tumor volume was 4.1 cm3 (range 0.8-22.6 cm3), and the median margin dose was 12.5 Gy (range 10-18 Gy). Patients with neurofibromatosis were excluded from this study. RESULTS: The median follow-up was 51 months (range 6-266 months). Tumors regressed in 47 patients, remained stable in 33, and progressed in 12. The progression-free survival (PFS) was 93% at 3 years, 87% at 5 years, and 82% at 10 years. In the entire series, only a dumbbell shape (extension extracranially via the jugular foramen) was significantly associated with worse PFS. In the group of patients without prior microsurgery (n = 51), factors associated with better PFS included tumor volume < 6 cm3 (p = 0.037) and non-dumbbell-shaped tumors (p = 0.015). Preexisting cranial neuropathies improved in 27 patients, remained stable in 51, and worsened in 14. The CN function improved after SRS in 12% of patients at 1 year, 24% at 2 years, 27% at 3 years, and 32% at 5 years. Symptomatic adverse radiation effects occurred in 7 patients at a median of 7 months after SRS (range 5-38 months). Six patients underwent repeat SRS at a median of 64 months (range 44-134 months). Four patients underwent resection at a median of 14 months after SRS (range 8-30 months). CONCLUSIONS: Stereotactic radiosurgery proved to be a safe and effective primary or adjuvant management approach for JFSs. Long-term tumor control rates and stability or improvement in CN function were confirmed.

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$a Meola, Antonio $u 1Department of Neurological Surgery, Center for Image-guided Neurosurgery, University of Pittsburgh, Pennsylvania.

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$a Yang, Huai-Che $u 2Departments of Radiation Oncology and Neurological Surgery, Taipei Veterans Hospital, Taipei, Taiwan.

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$a Guo, Wan-Yuo $u 2Departments of Radiation Oncology and Neurological Surgery, Taipei Veterans Hospital, Taipei, Taiwan.

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$a Martínez-Alvarez, Roberto $u 3Functional and Radiosurgery Unit, Ruber International Hospital, Madrid, Spain.

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$a Martínez-Moreno, Nuria $u 3Functional and Radiosurgery Unit, Ruber International Hospital, Madrid, Spain.

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$a Urgosik, Dusan $u 4Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic.

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$a Liscak, Roman $u 4Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic.

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$a Cohen-Inbar, Or $u 5Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.

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$a Sheehan, Jason $u 5Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.

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$a Lee, John Y K $u 6Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.

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$a Abbassy, Mahmoud $u 7Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio.

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$a Barnett, Gene H $u 7Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio.

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$a Mathieu, David $u 8Université de Sherbrooke, Centre de Recherche Clinique Étienne-LeBel, Sherbrooke, Quebec, Canada; and.

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$a Kondziolka, Douglas $u 9New York University Langone Medical Center, New York, New York.

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$a Lunsford, L Dade $u 1Department of Neurological Surgery, Center for Image-guided Neurosurgery, University of Pittsburgh, Pennsylvania.

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