1Department of Neurosurgery, CyberKnife Center, Huashan Hospital, Fudan University, Shanghai, China.
2Neurosurgical Institute, Fudan University, Shanghai, China.
J Neurosurg. 2023 Nov 17;140(5):1254-1261. doi: 10.3171/2023.8.JNS231026. Print 2024 May 1.
Jugular foramen schwannomas (JFSs) are rarely seen, benign tumors with slow growth. Today, management options for JFSs include observation, surgery, and radiation. However, the optimal treatment strategy remains controversial. Stereotactic radiosurgery serves as a minimally invasive alternative or adjuvant therapeutic regimen of microsurgery. Gamma Knife radiosurgery is suitable for patients with JFS who have small- and medium-sized tumors and normal cranial nerve (CN) function. Hypofractionated stereotactic radiotherapy (HSRT) offers a potential radiobiological advantage and may result in better preservation of normal structures compared to single-fraction stereotactic radiosurgery. The aim of the article was to review the clinical and radiographic outcomes of patients with JFS who were treated using HSRT.
The authors retrospectively analyzed 74 patients with JFS who received HSRT between January 2009 and January 2020 in the authors' center. Among them, 53 patients were newly diagnosed with JFS, 19 patients had a previous history of microsurgical resection, and the other 2 patients underwent CyberKnife because of tumor recurrence after Gamma Knife radiosurgery. A total of 73 patients had preexisting CN symptoms and signs. The median tumor volume was 14.8 cm3 (range 0.5-41.2 cm3), and most of them (70.3%) were ≥ 10 cm3. The radiation dose regimen was prescribed depending on the tumor size, and more fractions were used in larger tumors. The median margin doses prescribed were 18.2 Gy/2 fractions, 21.0 Gy/3 fractions, and 21.6 Gy/4 fractions.
The median follow-up was 103 months (range 18-158 months). After treatment, 42 (56.8%) patients had tumor regression, 27 (36.5%) patients had stable tumors, and 5 (6.8%) experienced tumor progression. Among them, MRI revealed that 1 patient had a complete response. Three patients received surgery at a median of 25 months because of tumor progression. One patient underwent ventriculoperitoneal shunt insertion for hydrocephalus that developed after HSRT independent of tumor progression. The 5-year progression-free survival rate was 93.2%. Preexisting cranial neuropathies improved in 46 patients, remained stable in 14, and worsened in 14.
HSRT proved to be a safe and effective primary or adjuvant treatment strategy for JFSs, although 14 patients (18.9%) experienced some degree of delayed symptomatic deterioration posttreatment. This therapeutic option was demonstrated to provide both excellent tumor control and improvement in CN function.
颈静脉孔神经鞘瘤（JFS）是一种罕见的良性肿瘤，生长缓慢。目前，JFS 的治疗方案包括观察、手术和放疗。然而，最佳的治疗策略仍存在争议。立体定向放射外科是一种微创替代或辅助显微手术的治疗方案。伽玛刀放射外科适用于肿瘤体积较小、中、颅神经（CN）功能正常的 JFS 患者。分割立体定向放疗（HSRT）提供了潜在的放射生物学优势，与单次分割立体定向放射外科相比，可能导致正常结构更好的保留。本文旨在回顾作者中心接受 HSRT 治疗的 JFS 患者的临床和影像学结果。
作者回顾性分析了 2009 年 1 月至 2020 年 1 月期间在作者中心接受 HSRT 治疗的 74 例 JFS 患者。其中，53 例为初诊 JFS 患者，19 例为经显微手术切除后复发患者，2 例因伽玛刀放射外科后肿瘤复发而行 CyberKnife 治疗。73 例患者均存在术前 CN 症状和体征。肿瘤体积中位数为 14.8cm3（范围 0.5-41.2cm3），其中 70.3%的患者肿瘤体积≥10cm3。放射剂量方案根据肿瘤大小而定，较大的肿瘤采用更多的分割。中位处方边缘剂量分别为 18.2Gy/2 个分割、21.0Gy/3 个分割和 21.6Gy/4 个分割。
中位随访时间为 103 个月（范围 18-158 个月）。治疗后，42 例（56.8%）患者肿瘤退缩，27 例（36.5%）患者肿瘤稳定，5 例（6.8%）患者肿瘤进展。其中，MRI 显示 1 例患者完全缓解。3 例患者因肿瘤进展，在中位时间 25 个月时行手术治疗。1 例患者因 HSRT 后出现与肿瘤进展无关的脑积水行脑室-腹腔分流术。5 年无进展生存率为 93.2%。46 例患者术前颅神经功能障碍得到改善，14 例患者保持稳定，14 例患者恶化。
HSRT 是 JFS 的一种安全有效的初始或辅助治疗策略，尽管 14 例（18.9%）患者在治疗后出现不同程度的症状延迟恶化。该治疗选择证明既能提供良好的肿瘤控制，又能改善颅神经功能。
