Gamma knife radiosurgery for patients with jugular foramen schwannomas: systematic review and meta-analysis.

in Neurosurgical review by Filipe Virgilio Ribeiro, Marcelo Porto Sousa, Lucca B Palavani, Filipi Fim Andreão, Helvécio Neves Feitosa Filho, Leonardo Januário Campos Cardoso, Christian Ken Fukunaga, Murilo Mancilha, Davi Neves Coelho, Yasmin Picanço Silva, Ocílio Ribeiro Gonçalves, José Victor Dantas Dos Santos, Marcio Yuri Ferreira, Raphael Bertani, Allan Dias Polverini, Herika Negri Brito

TLDR

  • Stereotactic radiosurgery (SRS) is a promising treatment option for jugular foramen schwannomas (JFSs) with a high tumor control rate, but complications remain significant.
  • New cranial nerve deficits occur in 34% of patients, and neurological deficits affect 19% of patients post-SRS.
  • Future studies are necessary to compare SRS with surgical resection and optimize treatment strategies for JFSs.

Abstract

Resection has traditionally been the gold standard for treating jugular foramen schwannomas (JFSs). However, given the high risk of neurological deficits associated with surgical intervention, stereotactic radiosurgery (SRS) has emerged as a promising alternative. Despite its growing popularity for other brain tumors, there remains a paucity of data on the outcomes of SRS for JFSs. This study aims to assess the safety and efficacy of SRS as a treatment option for patients with JFSs. We searched Medline, Embase, and Web of Science databases following PRISMA guidelines. Eligible studies included randomized controlled trials and observational studies reporting ≥ 4 JFS patients treated with gamma knife radiosurgery. Comparative analysis with 95% confidence intervals (CI) under a random-effects model was utilized to pool the data. A single-arm meta-analysis evaluated tumor control, neurological deficits, and complications. The analysis included 16 studies with 348 patients and a median follow-up of 33 months. Results demonstrated a 98% (CI: 95 - 100%) rate of tumor control, a 39% (CI: 23-54%) rate of tumor shrinking, and a 19% (CI: 13-26%) rate of neurological deficits. New cranial nerve deficits occurred in 34% of patients (CI: 27-41%). SRS demonstrated a high tumor control rate for jugular foramen schwannomas. However, complications remain significant, with neurological deficits and new cranial nerve deficits post Gamma Knife radiosurgery (GKRS). These findings underscore the need for further studies, including comparative analyses between SRS and surgical resection, to better delineate the risk-benefit profile of these treatment modalities.

Overview

  • The study aims to assess the safety and efficacy of stereotactic radiosurgery (SRS) as a treatment option for patients with jugular foramen schwannomas (JFSs).
  • The study searched for 16 eligible studies with a total of 348 patients, with a median follow-up of 33 months.
  • The primary objective of the study is to evaluate tumor control, neurological deficits, and complications in patients with JFSs treated with SRS.

Comparative Analysis & Findings

  • The analysis demonstrated a 98% rate of tumor control, 39% rate of tumor shrinking, and 19% rate of neurological deficits post-SRS.
  • New cranial nerve deficits occurred in 34% of patients.
  • The study did not include comparative analyses between SRS and surgical resection to better delineate the risk-benefit profile of these treatment modalities.

Implications and Future Directions

  • These findings suggest that SRS is a viable treatment option for JFSs, but complications remain significant.
  • Future studies should prioritize comparative analyses between SRS and surgical resection to better understand the risk-benefit profile of each treatment modality.
  • Further research is needed to identify the optimal treatment strategy for patients with JFSs.
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