Stereotactic radiosurgery for jugular foramen schwannomas

BACKGROUND Jugular foramen schwannomas pose difficult management problems because of t he surgical risk of lower cranial neuropathy. The indications and results o f stereotactic radiosurgery are not well documented. METHODS We reviewed our 10-year experience in the management of 17 patients who had jugular foramen schwannomas managed with the gamma knife. Thirteen patient s previously had undergone surgery (range, 1-6 resections). Four patients h ad multiple cranial nerve deficits before microsurgical resection; 12 devel oped multiple lower cranial nerve palsies after resection. Four patients un derwent radiosurgery based on imaging criteria alone. Conformal dose planni ng (tumor margin dose of 12-18 Gy) successfully encompassed the irregular t umor volumes in all patients. RESULTS Follow-up varied from 6 to 74 months. Tumor size decreased in eight patient s, remained stable in eight, and increased in one patient during the averag e follow-up interval of 3.5 years. Six patients improved and 10 others reta ined their preradiosurgery clinical status. One patient had an increase in tumor size and clinical deterioration 6 months after radiosurgery and under went microsurgical resection. No patient developed new cranial nerve or oth er neurological deficits after radiosurgery. CONCLUSIONS We believe that gamma knife radiosurgery is an effective alternative to mic rosurgical resection for patients who have small tumors and intact lower cr anial nerve function. It is also effective for patients who have residual o r recurrent tumors after microsurgical resection. (C) 1999 by Elsevier Scie nce Inc.