Hafez Raef F A, Morgan Magad S, Fahmy Osama M
Department of Neurosurgery and Gamma Knife center, International Medical Center (IMC), Cairo, Egypt.
World J Surg Oncol. 2016 Feb 15;14(1):36. doi: 10.1186/s12957-016-0779-7.
Glomus tumors are rare skull base slow-growing, hypervascular neoplasms that frequently involve critical neurovascular structures, and delay in diagnosis is frequent. Surgical removal is rarely radical and is usually associated with morbidity or mortality. Gamma knife surgery (GKS) has gained an increasing dependable role in the management of glomus jugulare tumors, with high rate of tumor growth control, preserving or improving clinical status and with limited complications. This study aims to evaluate intermediate term benefits and complications of gamma knife surgery in management of twenty-two patients bearing growing glomus jugulare tumors at the International Medical Center (IMC), Cairo, Egypt, between 2005 and 2011. The mean follow-up period was 56 months (range 36-108 months); there were 3 males, 19 females; mean age was 43.6 years; 15 patients had GKS as the primary treatment; 2 patients had surgical residuals; 2 had previous radiation therapy; and 3 previously underwent endovascular embolization. The average tumor volume was 7.26 cm3, and the mean marginal dose was 14.7 Gy. Post gamma knife surgery through the follow-up period neurological status was improved in 12 patients, 7 showed stable clinical condition and 3 patients developed new moderate deficits. Tumor volume post GKS was unchanged in 13 patients, decreased in 8, and showed tumor regrowth in 1 patient. Tumor progression-free survival in our studied patients was 95.5% at 5 and 7 years of the follow-up period post GKS. Gamma knife surgery could be used safely and effectively with limited complications as a primary management tool in the treatment of glomus jugulare tumors controlling tumor growth with preserving or improving clinical status especially those who do not have significant cranial or cervical extension, elderly, and surgically unfit patients; moreover, it is safe and highly effective as adjuvant therapy as well.
球瘤是罕见的颅底生长缓慢、血管丰富的肿瘤，常累及关键的神经血管结构，且诊断延迟很常见。手术切除很少能做到根治，且通常伴有发病率或死亡率。伽玛刀手术（GKS）在颈静脉球瘤的治疗中发挥着越来越可靠的作用，肿瘤生长控制率高，能维持或改善临床状况，且并发症有限。本研究旨在评估2005年至2011年期间在埃及开罗国际医疗中心（IMC）对22例生长性颈静脉球瘤患者进行伽玛刀手术的中期疗效和并发症。平均随访期为56个月（范围36 - 108个月）；男性3例，女性19例；平均年龄43.6岁；15例患者以伽玛刀手术作为主要治疗方法；2例患者有手术残留；2例曾接受过放射治疗；3例曾接受过血管内栓塞治疗。平均肿瘤体积为7.26 cm³，平均边缘剂量为14.7 Gy。伽玛刀手术后的随访期间，12例患者神经状态改善，7例临床状况稳定，3例患者出现新的中度功能缺损。伽玛刀手术后，13例患者肿瘤体积未变，8例减小，1例出现肿瘤复发。在我们研究的患者中，伽玛刀手术后5年和随访7年时无肿瘤进展生存率为95.5%。伽玛刀手术可安全有效地用于颈静脉球瘤的治疗，并发症有限，作为主要治疗手段可控制肿瘤生长并维持或改善临床状况，尤其适用于那些没有明显颅或颈部扩展的患者、老年患者以及手术不适合的患者；此外，作为辅助治疗也安全且高效。
