Skip to main content

Advertisement

SpringerLink
Log in

Paragangliomas of head and neck: a treatment option with CyberKnife radiosurgery

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Paragangliomas are highly vascular and predominantly benign neoplasms that have traditionally been treated by surgery, embolization and/or external beam radiotherapy (EBRT). The aim of this study is to evaluate the short-term local tumor control and safety of CyberKnife radiosurgery for these lesions. Nine patients, eight with jugular glomus paragangliomas and one with a carotid body paraganglioma, were treated. The target contouring was performed on merged CT and MR images. Eight patients were treated with doses ranging from 11 to 13 Gy (mean 12.5 Gy) in a single fraction and one with 24 Gy in three fractions prescribed to 72–83% isodose line. The mean follow-up was 20 months. One patient died from unrelated causes. There were no local recurrences. All eight patients also demonstrated neurological stability or improvement. Neither cranial nerve palsies have arisen, nor has deterioration beyond baseline been observed. In conclusion, CyberKnife radiosurgery appears to be both safe and effective in the treatment of skull base paragangliomas. Determining whether long-term complications will arise will require further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Baysal BE (2002) Hereditary paraganglioma targets diverse paraganglia. J Med Genet 39:617–622

    Article  CAS  PubMed  Google Scholar 

  2. Al-Mefty O, Teixeira A (2002) Complex tumors of the glomus jugulare: criteria, treatment, and outcome. J Neurosurg 97:1356–1366

    Article  PubMed  Google Scholar 

  3. Lee JH, Barich F, Karnell LH, Robinson RA, Zhen WK, Gantz BJ, Hoffman HT, American College of Surgeons Commission on Cancer, American Cancer Society (2002) National Cancer Data Base report on malignant paragangliomas of the head and neck. Cancer 94:730–737

    Article  PubMed  Google Scholar 

  4. Bojrab DI, Bhansali SA, Zarbo RJ (1992) Management of metastatic glomus jugulare tumors. Skull Base Surg 2:1–5

    Article  CAS  PubMed  Google Scholar 

  5. Pfeiffer J (1984) Neuropathologie, vol 4. Springer, Heidelberg

    Google Scholar 

  6. Neumann HP, Bausch B, McWhinney SR, Bender BU, Gimm O, Franke G, Schipper J, Klisch J, Altehoefer C, Zerres K, Januszewicz A, Eng C, Smith WM, Munk R, Manz T, Glaesker S, Apel TW, Treier M, Reineke M, Walz MK, Hoang-Vu C, Brauckhoff M, Klein-Franke A, Klose P, Schmidt H, Maier-Woelfle M, Peçzkowska M, Szmigielski C, Eng C, Freiburg-Warsaw-Columbus Pheochromocytoma Study Group (2002) Germ-line mutations in nonsyndromic pheochromocytoma. N Engl J Med 346:1459–1566

    Article  CAS  PubMed  Google Scholar 

  7. Thabet MH, Kotob H (2001) Cervical paragangliomas: diagnosis, management and complications. J Laryngol Otol 115:467–474

    CAS  PubMed  Google Scholar 

  8. Foote RL, Pollock BE, Gorman DA, Schomberg PJ, Stafford SL, Link MJ, Kline RW, Strome SE, Kasperbauer JL, Olsen KD (2002) Glomus jugulare tumor: tumor control and complications after stereotactic radiosurgery. Head Neck 24:332–338 (discussion 338–339)

    Article  PubMed  Google Scholar 

  9. Springate SC, Weichselbaum RR (1990) Radiation or surgery for chemodectoma of the temporal bone: a review of local control and complications. Head Neck 12(4):303–307

    Article  CAS  PubMed  Google Scholar 

  10. Gottfried ON, Liu JK, Couldwell WT (2004) Comparison of radiosurgery and conventional surgery for the treatment of glomus jugulare tumors. Neurosurg Focus 15;17(2):E4

    Google Scholar 

  11. Chretien PB, Engelman K, Hoye RC, Geelhoed GW (1971) Surgical management of intravascular glomus jugulare tumor. Am J Surg 122:740–743

    Article  CAS  PubMed  Google Scholar 

  12. Cece JA, Lawson W, Biller HF, Eden AR, Parisier SC (1987) Complications in the management of large glomus jugulare tumors. Laryngoscope 97(2):152–157

    Article  CAS  PubMed  Google Scholar 

  13. Gjuric M, Rüdiger Wolf S, Wigand ME, Weidenbecher M (1996) Cranial nerve and hearing function after combined-approach surgery for glomus jugulare tumors. Ann Otol Rhinol Laryngol 105(12):949–954

    CAS  PubMed  Google Scholar 

  14. Jackson CG, McGrew BM, Forest JA, Netterville JL, Hampf CF, Glasscock ME 3rd (2001) Lateral skull base surgery for glomus tumors: long-term control. Otol Neurotol 22:377–382

    Article  CAS  PubMed  Google Scholar 

  15. Watkins LD, Mendoza N, Cheesman AD, Symon L (1994) Glomus jugulare tumours: a review of 61 cases. Acta Neurochir (Wien) 130:66–70

    Article  CAS  Google Scholar 

  16. Cole JM, Beiler D (1994) Long-term results of treatment for glomus jugulare and glomus vagale tumors with radiotherapy. Laryngoscope 104:1461–1465

    CAS  PubMed  Google Scholar 

  17. de Jong AL, Coker NJ, Jenkins HA, Goepfert H, Alford BR et al (1995) Radiation therapy in the management of paragangliomas of the temporal bone. Am J Otol 16:283–289

    Article  PubMed  Google Scholar 

  18. Springate SC, Haraf D, Weichselbaum RR (1991) Temporal bone chemodectomas—comparing surgery and radiation therapy. Oncology (Williston Park) 5:131–137 (discussion 140–143)

    CAS  Google Scholar 

  19. Cummings BJ, Beale FA, Garrett PG, Harwood AR, Keane TJ, Payne DG, Rider WD (1984) The treatment of glomus tumors in the temporal bone by megavoltage radiation. Cancer 53:2635–2640

    Article  CAS  PubMed  Google Scholar 

  20. Lalwani AK, Jackler RK, Gutin PH (1993) Lethal fibrosarcoma complicating radiation therapy for benign glomus jugulare tumor. Am J Otol 14:398–402

    CAS  PubMed  Google Scholar 

  21. Jordan JA, Roland PS, McManus C, Weiner RL, Giller CA (2000) Stereotastic radiosurgery for glomus jugulare tumors. Laryngoscope 110:35–38

    Article  CAS  PubMed  Google Scholar 

  22. Murphy TP, Brackmann DE (1989) Effects of preoperative embolization on glomus jugulare tumors. Laryngoscope 99:1244–1247

    Article  CAS  PubMed  Google Scholar 

  23. Liscak R, Vladyka V, Wowra B, Kemeny A, Forster D, Burzaco JA, Martinez R, Eustacchio S, Pendl G, Regis J, Pellet W (1999) Gamma Knife radiosurgery of the glomus jugulare tumour—early multicentre experience. Acta Neurochir (Wien) 141:1141–1146

    Article  CAS  Google Scholar 

  24. Saringer W, Khayal H, Ertl A, Schoeggl A, Kitz K (2001) Efficiency of gamma knife radiosurgery in the treatment of glomus jugulare tumors. Minim Invasive Neurosurg 44:141–146

    Article  CAS  PubMed  Google Scholar 

  25. Eustacchio S, Trummer M, Unger F, Schröttner O, Sutter B, Pendl G et al (2002) The role of Gamma Knife radiosurgery in the management of glomus jugular tumours. Acta Neurochir Suppl 84:91–97

    CAS  PubMed  Google Scholar 

  26. Adler JR Jr, Murphy MJ, Chang SD et al (1999) Image-guided robotic radiosurgery. Neurosurgery 44:1299–1307

    Article  PubMed  Google Scholar 

  27. Chang SD, Adler JR (2001) Robotics and radiosurgery: the CyberKnife. Stereotact Funct Neurosurg 76:204–208

    Article  CAS  PubMed  Google Scholar 

  28. Chang SD, Main W, Martin DP, Gibbs IC, Heilbrun MP (2003) An analysis of the accuracy of the CyberKnife: a robotic frameless stereotactic radiosurgical system. Neurosurgery 52:140–147

    Article  PubMed  Google Scholar 

  29. Flickinger JC, Lunsford LD, Kondziolka D (1992) Dose prescription and dose-volume effects in radiosurgery. Neurosurg Clin N Am 3:51–59

    CAS  PubMed  Google Scholar 

  30. Young NM, Wiet RJ, Russell EJ, Monsell EM (1988) Superselective embolization of glomus jugulare tumors. Ann Otol Rhinol Laryngol 97:613–620

    CAS  PubMed  Google Scholar 

  31. Gjuric M, Seidinger L, Wigand ME (1996) Long-term results of surgery for temporal bone paraganglioma. Skull Base Surg 6:147–152

    Article  CAS  PubMed  Google Scholar 

  32. Green JD Jr, Brackmann DE, Nguyen CD, Arriaga MA, Telischi FF, De la Cruz A et al (1994) Surgical management of previously untreated glomus jugulare tumors. Laryngoscope 104:917–921

    PubMed  Google Scholar 

  33. Kaylie DM, Horgan MA, Delashaw JB, McMenomey SO (2004) Hearing preservation with the transcrusal approach to the petroclival region. Otol Neurotol 25:594–598 (discussion 598)

    Article  PubMed  Google Scholar 

  34. Netterville JL, Reilly KM, Robertson D, Reiber ME, Armstrong WB, Childs P (1995) Carotid body tumors: a review of 30 patients with 46 tumors. Laryngoscope 105:115–126

    Article  CAS  PubMed  Google Scholar 

  35. Oghalai JS, Leung MK, Jackler RK, McDermott MW (2004) Transjugular craniotomy for the management of jugular foramen tumors with intracranial extension. Otol Neurotol 25:570–579 (discussion 579)

    Article  PubMed  Google Scholar 

  36. Patel SJ, Sekhar LN, Cass SP, Hirsch BE (1994) Combined approaches for resection of extensive glomus jugulare tumors. A review of 12 cases. J Neurosurg 80:1026–1038

    Article  CAS  PubMed  Google Scholar 

  37. Sanna M, Bacciu A, Falcioni M, Taibah A (2006) Surgical management of jugular foramen schwannomas with hearing and facial nerve function preservation: a series of 23 cases and review of the literature. Laryngoscope 116:2191–2204

    Article  PubMed  Google Scholar 

  38. Sanna M, Bacciu A, Falcioni M, Taibah A, Piazza P et al (2007) Surgical management of jugular foramen meningiomas: a series of 13 cases and review of the literature. Laryngoscope 117:1710–1719

    Article  PubMed  Google Scholar 

  39. Raquet F, Mann W, Maurer J, Gislbach J (1991) Functional deficits of caudal cranial nerves after surgery of tumors in the foramen jugulare. A long-term follow-up study. Laryngorhinootologie 70:284–288

    Article  CAS  PubMed  Google Scholar 

  40. Hawthorne MR, Makek MS, Harris JP, Fisch U (1988) The histopathological and clinical features of irradiated and nonirradiated temporal paragangliomas. Laryngoscope 98:325–331

    Article  CAS  PubMed  Google Scholar 

  41. Larner JM, Hahn SS, Spaulding CA, Constable WC (1992) Glomus jugulare tumors. Long-term control by radiation therapy. Cancer 69:1813–1817

    Article  CAS  PubMed  Google Scholar 

  42. Carrasco V, Rosenman J (1993) Radiation therapy of glomus jugulare tumors. Laryngoscope 103:23–27

    CAS  PubMed  Google Scholar 

  43. Hinerman RW, Amdur RJ, Morris CG, Kirwan J, Mendenhall WM (2008) Definitive radiotherapy in the management of paragangliomas arising in the head and neck: a 35-year experience. Head Neck 30(11):1431–1438

    Article  PubMed  Google Scholar 

  44. Gerosa M, Visca A, Rizzo P, Foroni R, Nicolato A, Bricolo A (2006) Glomus jugulare tumors: the option of gamma knife radiosurgery. Neurosurgery 59:561–569 (discussion 561–569)

    Article  PubMed  Google Scholar 

  45. Sheehan J, Kondziolka D, Flickinger J, Lunsford LD (2005) Gamma knife surgery for glomus jugulare tumors: an intermediate report on efficacy and safety. J Neurosurg 102(Suppl):241–246

    Article  PubMed  Google Scholar 

  46. Lim M, Bower R, Nangiana JS, Adler JR, Chang SD (2007) Radiosurgery for glomus jugulare tumors. Technol Cancer Res Treat 6(5):419–423

    PubMed  Google Scholar 

  47. Lim M, Gibbs IC, Adler JR Jr, Chang SD (2004) Efficacy and safety of stereotactic radiosurgery for glomus jugulare tumors. Neurosurg Focus 17(2):E11

    Article  PubMed  Google Scholar 

  48. Fu D, Kuduvalli G (2008) A fast, accurate, and automatic 2D–3D image registration for image-guided cranial radiosurgery. Med Phys 35(5):2180–2194

    Article  PubMed  Google Scholar 

  49. Nicolato A, Lupidi F, Sandri MF, Foroni R, Zampieri P, Mazza C, Pasqualin A, Beltramello A, Gerosa M (2006) Gamma knife radiosurgery for cerebral arteriovenous malformations in children/adolescents and adults. Part II: differences in obliteration rates, treatment-obliteration intervals, and prognostic factors. Int J Radiat Oncol Biol Phys 64(3):914–921

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors have no financial interest in the instruments presented in this manuscript.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Division of Radiotherapy, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy

    Marcello Marchetti, Ida Milanesi & Laura Fariselli

  2. Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy

    Marcello Marchetti & Giovanni Broggi

  3. CyberKnife Center CDI, Milan, Italy

    Livia C. Bianchi, Lorenzo Brait, Achille Bergantin, Giovanni Broggi & Laura Fariselli

Authors
  1. Livia C. Bianchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcello Marchetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lorenzo Brait
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Achille Bergantin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ida Milanesi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giovanni Broggi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Laura Fariselli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcello Marchetti.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bianchi, L.C., Marchetti, M., Brait, L. et al. Paragangliomas of head and neck: a treatment option with CyberKnife radiosurgery. Neurol Sci 30, 479–485 (2009). https://doi.org/10.1007/s10072-009-0138-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-009-0138-3

Keywords

Search

Navigation