HSC Section 8_April 2017

or younger patients with large tumors and intact CN who are troubled by aural symp-

toms such as pulsatile tinnitus, conductive hearing loss, and fullness. In a previous

report, Cosetti and colleagues

reviewed the role of conservative management of

JP and glomus tympanicum in patients over the age of 60 years. In a small sample,

they found that 1 of 3 patients experienced tumor growth following subtotal resection

nearly 6 years after treatment. In a study of patients over the age of 60 with advanced

tumors, Willen and colleagues

identified no significant treatment failures at

19 months of mean follow-up with planned subtotal resection and adjuvant radio-

therapy. Unfortunately, the published follow-up for these reports is generally short

and limited by a relatively small number of cases. However, at this time, the authors’

treatment algorithm has evolved to include subtotal resection. Akin to other benign

skull base tumors, the authors believe that tumor recurrence is likely related to extent

of resection. That is, the more tumor that is removed, the less likely the residual tumor

is to grow.

Radiation

Because of the complexity of JP surgery, particularly regarding the close proximity of a

vascular tumor to the facial nerve, the lower CN, and the carotid artery, nonsurgical

management options such have radiation have emerged. Initially, fractionated

external beam radiation was introduced for primary and salvage therapy. Control rates

between 86% and 100% were described in early studies, which helped to establish

the legitimacy of radiotherapy in the management algorithm for JP.

25–27

Over time,

the use of therapeutic radiation evolved to employ stereotactic techniques that offer

comparable tumor doses with less radiation injury to surrounding tissue.

Radiosurgery is now a well-accepted treatment modality for GJT. The treatment-

specific tumor control and adverse effect profile has been shown to be least

Fig. 7.

Pre- and postembolization angiography of a GJT. (

) Pre-embolization image in

which an arrow designates the highly vascularized tumor. (

) Postembolization image in

which the major vascular pedicles for the tumor have been obliterated.

Jugular Paragangliomas

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