Objectives:
Jugular foramen schwannomas (JFS), are rare benign neoplasms, originating from the cranial nerves (CN) IX, X, and XI within the jugular foramen, accounting for less than 5% of all intracranial schwannomas. The primary therapeutic objective of surgical resection (SR) is gross total resection carrying a significant risk of postoperative morbidity such as hearing loss, vocal cord paralysis, and CN VII palsy.
Stereotactic radiosurgery (SRS), a minimally invasive modality, has emerged as an alternative primary or adjunctive treatment for cranial nerve schwannomas, including JFS. SRS offers the potential to reduce morbidity and CN damage while achieving satisfactory local tumor control (LTC). Also, past studies have confirmed CN improvement after the treatment of such tumors with SRS. Nonetheless, SRS may itself cause short and long-term sequela which may impair quality of life and patient compliance.
Comparative studies evaluating postoperative outcomes of SRS in comparison to SR for JFS are lacking. This study aims to address this gap by comparing the postoperative outcomes of SRS and SR in the treatment of JFS at our center. The findings will provide valuable insights into optimizing therapeutic strategies for this rare pathology.
Methods:
We conducted a retrospective analysis of 31 patients with JFS who underwent SRS (13 cases [41.9%]) or SR (18 cases [58.1%]) as their primary management modality over a two-decade period. Outcomes included progression-free survival (PFS), post-management adverse events based on common terminology criteria for adverse events (CTCAE), symptom improvement, overall survival (OS), and the necessity for secondary interventions. Local tumor control (LTC) was also evaluated in all patients with SRS treatment.
Results:
Significant differences were observed in baseline characteristics between the SRS and SR groups, including median age (58 vs. 48 years, p=0.001), largest diameter (32.0 vs. 47.5 mm, p=0.02), and total tumor volume (6.50 vs. 20.5 mm3, p=0.01). There were no significant differences in sex or lesion shape (dumbbell vs. non-dumbbell shaped). After adjusting for baseline characteristics, no significant differences were noted in PFS (87.5 vs. 77.7%), OS (92.3 vs 100%), symptom improvement (61.5 vs 55.5%), or median CTCAE grade (one in both groups) between the SRS and SR groups, respectively. SRS patients had significantly lower odds of requiring secondary treatment procedures after their primary intervention as compared to those who underwent SR (OR = 0.02, 95% CI: 0.001-0.88, p-value = 0.04). Local tumor control for all SRS patients (19 patients) was 86.7% and 62.5% at six-month and five-year time points, respectively.
Symptomatology was evaluated and documented preoperatively and during follow-up visits. Hearing loss (SR=50.0%,SRS=23.1%), hoarseness (SR=33.3%,SRS=38.5%), and dysphagia (SR=33.3%,SRS=38.5%) were the most commonly observed preoperative presenting symptoms. Two patients (15.4%) in the SRS cohort and one patient (5.6%) in the SR group were asymptomatic and JFS was diagnosed incidentally. In the SR subgroup, preoperative symptoms improved in 10 cases (55.6%), persisted in 5 cases (27.8%), and worsened in 3 cases (16.7%) postoperatively. In the SRS group, 8 patients (61.5%) experienced symptom improvement, while symptoms persisted in 4 cases (30.8%) and worsened in 1 case (7.7%). No significant differences in overall symptom change were observed between the treatment groups (χ², p-value = 0.68).
Conclusion(s):
SRS and SR demonstrate comparable effectiveness in treating JFS. However, SRS may be a more favorable option due to a reduced need for secondary interventions. Future controlled prospective studies are necessary to derive more definitive conclusions.
