Comparison of radiosurgery and conventional surgery for the treatment of Glomus Jugulare tumors

Objective: The optimal management of glomus jugulare tumors remains controversial. Available treatments were once associated with poor outcomes and significant complication rates. Advances in skull base surgery and the delivery of radiation therapy by stereotactic radiosurgery have improved the results from these treatment options. We summarize and compare the contemporary outcomes and complications for these therapies. Methods: We reviewed papers regarding treatment of glomus jugulare tumors with radiosurgery or surgery published from 1994 to 2004. Eight radiosurgery (142 patients) and 7 surgical (374 patients) studies were evaluated on neurological outcome, change of tumor size (radiosurgery)/percent of total resections (surgery), recurrences, tumor control, need for further treatment, and complications. Results: The mean age at treatment for surgical and radiosurgical patients was 47.3 and 56.7 years, respectively. Mean follow-up was 49.2 and 39.4 months, respectively. The surgical control rate was 92.1%, with 88.2% of tumors totally resected on the first surgery. CSF leak occurred in 8.3% of surgeries and recurrences in 3.1%; mortality was 1.3%. Among radiosurgical patients, tumors diminished in 36.5%, 61.3% had no change in tumor size, and subjective or objective improvements occurred in 39.0%. Despite residual tumor in 100% of radiosurgical cases, recurrences occurred in only 2.1%, morbidity was 8.5%, and there was 0% mortality. Conclusions: Mortality and recurrences after these treatments are infrequent, and therefore, both treatments are safe and efficacious. Although surgery is associated with higher morbidity, it immediately and totally eliminates the tumor. The radiosurgery results are very promising, although the incidence of late recurrence (10-20 years) is unknown.