{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T23:31:44Z","timestamp":1773703904420,"version":"3.50.1"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Jugular foramen schwannomas (JFSs) are rarely seen, benign tumors with slow growth. Today, management options for JFSs include observation, surgery, and radiation. However, the optimal treatment strategy remains controversial. Stereotactic radiosurgery serves as a minimally invasive alternative or adjuvant therapeutic regimen of microsurgery. Gamma Knife radiosurgery is suitable for patients with JFS who have small- and medium-sized tumors and normal cranial nerve (CN) function. Hypofractionated stereotactic radiotherapy (HSRT) offers a potential radiobiological advantage and may result in better preservation of normal structures compared to single-fraction stereotactic radiosurgery. The aim of the article was to review the clinical and radiographic outcomes of patients with JFS who were treated using HSRT.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors retrospectively analyzed 74 patients with JFS who received HSRT between January 2009 and January 2020 in the authors\u2019 center. Among them, 53 patients were newly diagnosed with JFS, 19 patients had a previous history of microsurgical resection, and the other 2 patients underwent CyberKnife because of tumor recurrence after Gamma Knife radiosurgery. A total of 73 patients had preexisting CN symptoms and signs. The median tumor volume was 14.8 cm<jats:sup>3<\/jats:sup> (range 0.5\u201341.2 cm<jats:sup>3<\/jats:sup>), and most of them (70.3%) were \u2265 10 cm<jats:sup>3<\/jats:sup>. The radiation dose regimen was prescribed depending on the tumor size, and more fractions were used in larger tumors. The median margin doses prescribed were 18.2 Gy\/2 fractions, 21.0 Gy\/3 fractions, and 21.6 Gy\/4 fractions.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The median follow-up was 103 months (range 18\u2013158 months). After treatment, 42 (56.8%) patients had tumor regression, 27 (36.5%) patients had stable tumors, and 5 (6.8%) experienced tumor progression. Among them, MRI revealed that 1 patient had a complete response. Three patients received surgery at a median of 25 months because of tumor progression. One patient underwent ventriculoperitoneal shunt insertion for hydrocephalus that developed after HSRT independent of tumor progression. The 5-year progression-free survival rate was 93.2%. Preexisting cranial neuropathies improved in 46 patients, remained stable in 14, and worsened in 14.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>HSRT proved to be a safe and effective primary or adjuvant treatment strategy for JFSs, although 14 patients (18.9%) experienced some degree of delayed symptomatic deterioration posttreatment. This therapeutic option was demonstrated to provide both excellent tumor control and improvement in CN function.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.8.jns231026","type":"journal-article","created":{"date-parts":[[2023,11,18]],"date-time":"2023-11-18T01:27:19Z","timestamp":1700270839000},"page":"1254-1261","source":"Crossref","is-referenced-by-count":6,"title":["Long-term clinical outcomes of hypofractionated stereotactic radiotherapy using the CyberKnife robotic radiosurgery system for jugular foramen schwannomas"],"prefix":"10.3171","volume":"140","author":[{"given":"Wei","family":"Zou","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, CyberKnife Center, Huashan Hospital, Fudan University, Shanghai, China"},{"name":"Neurosurgical Institute, Fudan University, Shanghai, China"},{"name":"National Center for Neurological Disorders, Shanghai, China"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yun","family":"Guan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, CyberKnife Center, Huashan Hospital, Fudan University, Shanghai, China"},{"name":"Neurosurgical Institute, Fudan University, Shanghai, China"},{"name":"National Center for Neurological Disorders, Shanghai, China"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huaguang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, CyberKnife Center, Huashan Hospital, Fudan University, Shanghai, China"},{"name":"Neurosurgical Institute, Fudan University, Shanghai, China"},{"name":"National Center for Neurological Disorders, Shanghai, China"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiu","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, CyberKnife Center, Huashan Hospital, Fudan University, Shanghai, China"},{"name":"Neurosurgical Institute, Fudan University, Shanghai, China"},{"name":"National Center for Neurological Disorders, Shanghai, China"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enmin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, CyberKnife Center, Huashan Hospital, Fudan University, Shanghai, China"},{"name":"Neurosurgical Institute, Fudan University, Shanghai, China"},{"name":"National Center for Neurological Disorders, Shanghai, China"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chengjun","family":"Yao","sequence":"additional","affiliation":[{"name":"Neurosurgical Institute, Fudan University, Shanghai, China"},{"name":"National Center for Neurological Disorders, Shanghai, China"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; and"},{"name":"Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, CyberKnife Center, Huashan Hospital, Fudan University, Shanghai, China"},{"name":"Neurosurgical Institute, Fudan University, Shanghai, China"},{"name":"National Center for Neurological Disorders, Shanghai, China"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"J Ayub Med Coll Abbottabad","first-page":"174","article-title":"Jugular foramen schwannoma\u2014a very rare entity","volume":"21","author":"Ahmad M","year":"2009","unstructured":"Ahmad M, Butt RM, Ahmad N. Jugular foramen schwannoma\u2014a very rare entity. J Ayub Med Coll Abbottabad. 2009;21(2):174\u2013175."},{"issue":"3","key":"b2","series-title":"Otol Neurotol","first-page":"387","article-title":"Jugular foramen schwannoma: analysis on its origin and location","volume":"29","author":"Song MH","year":"2008","unstructured":"Song MH, Lee HY, Jeon JS, Lee JD, Lee HK, Lee WS. Jugular foramen schwannoma: analysis on its origin and location. Otol Neurotol. 2008;29(3):387\u2013391."},{"issue":"3","key":"b3","series-title":"Neurosurgery","first-page":"424","article-title":"Surgical treatment of jugular foramen schwannoma: surgical treatment based on a new classification","volume":"77","author":"Samii M","year":"2015","unstructured":"Samii M, Alimohamadi M, Gerganov V. Surgical treatment of jugular foramen schwannoma: surgical treatment based on a new classification. Neurosurgery. 2015;77(3):424\u2013432."},{"issue":"1","key":"b4","series-title":"Neurosurgery","first-page":"42","article-title":"Microsurgical management of jugular foramen schwannomas","volume":"72","author":"Sedney CL","year":"2013","unstructured":"Sedney CL, Nonaka Y, Bulsara KR, Fukushima T. Microsurgical management of jugular foramen schwannomas. Neurosurgery. 2013;72(1):42\u201346."},{"issue":"1 suppl","key":"b5","series-title":"Neurosurgery","first-page":"59","article-title":"Tumors of the jugular foramen: diagnosis and management","volume":"57","author":"Ramina R","year":"2005","unstructured":"Ramina R, Maniglia JJ, Fernandes YB, Paschoal JR, Pfeilsticker LN, Coelho Neto M. Tumors of the jugular foramen: diagnosis and management. Neurosurgery. 2005;57(1 suppl):59\u201368."},{"issue":"8","key":"b6","series-title":"Acta Neurochir (Wien)","first-page":"1517","article-title":"Optimal treatment of jugular foramen schwannomas: long-term outcome of a multidisciplinary approach for a series of 29 cases in a single institute","volume":"159","author":"Ryu SM","year":"2017","unstructured":"Ryu SM, Lee JI, Park K,  Optimal treatment of jugular foramen schwannomas: long-term outcome of a multidisciplinary approach for a series of 29 cases in a single institute. Acta Neurochir (Wien). 2017;159(8):1517\u20131527."},{"key":"b7","series-title":"World Neurosurg","first-page":"134","article-title":"Long-term functional and recurrence outcomes of surgically treated jugular foramen schwannomas: a 20-year experience","volume":"86","author":"Zeng XJ","year":"2016","unstructured":"Zeng XJ, Li D, Hao SY,  Long-term functional and recurrence outcomes of surgically treated jugular foramen schwannomas: a 20-year experience. World Neurosurg. 2016;86:134\u2013146."},{"issue":"5","key":"b8","series-title":"J Neurosurg","first-page":"794","article-title":"Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system","volume":"109","author":"Bulsara KR","year":"2008","unstructured":"Bulsara KR, Sameshima T, Friedman AH, Fukushima T. Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system. J Neurosurg. 2008;109(5):794\u2013803."},{"issue":"5","key":"b9","series-title":"J Neurosurg","first-page":"1143","article-title":"Less-aggressive surgical management and long-term outcomes of jugular foramen paragangliomas: a neurosurgical perspective","volume":"125","author":"Li D","year":"2016","unstructured":"Li D, Zeng XJ, Hao SY,  Less-aggressive surgical management and long-term outcomes of jugular foramen paragangliomas: a neurosurgical perspective. J Neurosurg. 2016;125(5):1143\u20131154."},{"issue":"5","key":"b10","series-title":"Neurosurg Rev","first-page":"1339","article-title":"Optimal surgical approaches and treatment outcomes in patients with jugular foramen schwannomas: a single institution series of 31 cases and a literature review","volume":"43","author":"Wang X","year":"2020","unstructured":"Wang X, Long W, Liu D, Yuan J, Xiao Q, Liu Q. Optimal surgical approaches and treatment outcomes in patients with jugular foramen schwannomas: a single institution series of 31 cases and a literature review. Neurosurg Rev. 2020;43(5):1339\u20131350."},{"key":"b11","series-title":"World Neurosurg","first-page":"552","article-title":"A single-institution retrospective study of jugular foramen schwannoma management: radical resection versus subtotal intracranial resection through a retrosigmoid suboccipital approach followed by radiosurgery","volume":"88","author":"Park ES","year":"2016","unstructured":"Park ES, Lee EJ, Park JB,  A single-institution retrospective study of jugular foramen schwannoma management: radical resection versus subtotal intracranial resection through a retrosigmoid suboccipital approach followed by radiosurgery. World Neurosurg. 2016;88:552\u2013562."},{"issue":"2","key":"b12","series-title":"Otol Neurotol","first-page":"299","article-title":"Jugular foramen tumors: clinical characteristics and treatment outcomes","volume":"31","author":"Fayad JN","year":"2010","unstructured":"Fayad JN, Keles B, Brackmann DE. Jugular foramen tumors: clinical characteristics and treatment outcomes. Otol Neurotol. 2010;31(2):299\u2013305."},{"issue":"2","key":"b13","series-title":"Surg Neurol","first-page":"172","article-title":"Stereotactic radiosurgery for jugular foramen schwannomas","volume":"52","author":"Muthukumar N","year":"1999","unstructured":"Muthukumar N, Kondziolka D, Lunsford LD, Flickinger JC. Stereotactic radiosurgery for jugular foramen schwannomas. Surg Neurol. 1999;52(2):172\u2013179."},{"issue":"4","key":"b14","series-title":"J Neurosurg","first-page":"822","article-title":"Gamma Knife surgery for patients with jugular foramen schwannomas: a multiinstitutional retrospective study in Japan","volume":"125","author":"Hasegawa T","year":"2016","unstructured":"Hasegawa T, Kato T, Kida Y,  Gamma Knife surgery for patients with jugular foramen schwannomas: a multiinstitutional retrospective study in Japan. 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Neurosurg Rev. 2012;35(4):549\u2013553."},{"issue":"6","key":"b17","series-title":"J Neurol Surg B Skull Base","first-page":"580","article-title":"Toxicity of Gamma Knife radiosurgery may be greater in patients with lower cranial nerve schwannomas","volume":"79","author":"Ruangkanchanasetr R","year":"2018","unstructured":"Ruangkanchanasetr R, Lee JYK, Nagda SN,  Toxicity of Gamma Knife radiosurgery may be greater in patients with lower cranial nerve schwannomas. J Neurol Surg B Skull Base. 2018;79(6):580\u2013585."},{"issue":"7","key":"b18","series-title":"Asian Pac J Cancer Prev","first-page":"3271","article-title":"Clinical outcomes of intracranial nonvestibular schwannomas treated with Linac-based stereotactic radiosurgery and radiotherapy","volume":"17","author":"Puataweepong P","year":"2016","unstructured":"Puataweepong P, Dhanachai M, Hansasuta A,  Clinical outcomes of intracranial nonvestibular schwannomas treated with Linac-based stereotactic radiosurgery and radiotherapy. Asian Pac J Cancer Prev. 2016;17(7):3271\u20133276."},{"issue":"1","key":"b19","series-title":"J Neurooncol","first-page":"187","article-title":"Single institution experience treating 104 vestibular schwannomas with fractionated stereotactic radiation therapy or stereotactic radiosurgery","volume":"116","author":"Anderson BM","year":"2014","unstructured":"Anderson BM, Khuntia D, Bentzen SM,  Single institution experience treating 104 vestibular schwannomas with fractionated stereotactic radiation therapy or stereotactic radiosurgery. J Neurooncol. 2014;116(1):187\u2013193."},{"issue":"4","key":"b20","series-title":"J Neurosurg","first-page":"928","article-title":"Stereotactic radiosurgery for jugular foramen schwannomas: an international multicenter study","volume":"129","author":"Kano H","year":"2018","unstructured":"Kano H, Meola A, Yang HC,  Stereotactic radiosurgery for jugular foramen schwannomas: an international multicenter study. J Neurosurg. 2018;129(4):928\u2013936."},{"issue":"6","key":"b21","series-title":"Neurosurgery","first-page":"1200","article-title":"Multisession stereotactic radiosurgery for vestibular schwannomas: single-institution experience with 383 cases","volume":"69","author":"Hansasuta A","year":"2011","unstructured":"Hansasuta A, Choi CY, Gibbs IC,  Multisession stereotactic radiosurgery for vestibular schwannomas: single-institution experience with 383 cases. Neurosurgery. 2011;69(6):1200\u20131209."},{"issue":"1","key":"b22","series-title":"Am J Clin Oncol","first-page":"13","article-title":"Fractionated radiation therapy for benign nonacoustic schwannomas","volume":"41","author":"Kharod SM","year":"2018","unstructured":"Kharod SM, Herman MP, Amdur RJ, Mendenhall WM. Fractionated radiation therapy for benign nonacoustic schwannomas. Am J Clin Oncol. 2018;41(1):13\u201317."},{"key":"b23","series-title":"World Neurosurg","first-page":"398","article-title":"The outcome of hypofractionated stereotactic radiosurgery for large vestibular schwannomas","volume":"93","author":"Teo M","year":"2016","unstructured":"Teo M, Zhang M, Li A,  The outcome of hypofractionated stereotactic radiosurgery for large vestibular schwannomas. World Neurosurg. 2016;93:398\u2013409."},{"issue":"5","key":"b24","series-title":"J Neurosurg","first-page":"1045","article-title":"Jugular foramen schwannomas","volume":"60","author":"Kaye AH","year":"1984","unstructured":"Kaye AH, Hahn JF, Kinney SE, Hardy RW Jr, Bay JW. Jugular foramen schwannomas. J Neurosurg. 1984;60(5):1045\u20131053."},{"issue":"3","key":"b25","series-title":"Auris Nasus Larynx","first-page":"398","article-title":"Severe progressive sensorineural hearing loss improved after removal of large jugular foramen schwannoma","volume":"38","author":"Oishi N","year":"2011","unstructured":"Oishi N, Kohno N, Shiokawa Y. Severe progressive sensorineural hearing loss improved after removal of large jugular foramen schwannoma. Auris Nasus Larynx. 2011;38(3):398\u2013401."},{"issue":"1","key":"b26","series-title":"Acta Neurochir (Wien)","first-page":"35","article-title":"Nonvestibular schwannomas: an evaluation of functional outcome after radiosurgical and microsurgical management","volume":"152","author":"Safavi-Abbasi S","year":"2010","unstructured":"Safavi-Abbasi S, Bambakidis NC, Zabramski JM,  Nonvestibular schwannomas: an evaluation of functional outcome after radiosurgical and microsurgical management. Acta Neurochir (Wien). 2010;152(1):35\u201346."},{"issue":"2","key":"b27","series-title":"Neurosurg Rev","first-page":"151","article-title":"Dumbbell-shaped jugular foramen schwannomas: surgical management, outcome and complications on a series of 16 patients","volume":"32","author":"Chibbaro S","year":"2009","unstructured":"Chibbaro S, Mirone G, Makiese O, Bresson D, George B. Dumbbell-shaped jugular foramen schwannomas: surgical management, outcome and complications on a series of 16 patients. Neurosurg Rev. 2009;32(2):151\u2013159."},{"issue":"suppl 1","key":"b28","series-title":"J Clin Neurosci","first-page":"32","article-title":"Surgical tactics and outcome of treatment in jugular foramen schwannomas","volume":"8","author":"Lee SK","year":"2001","unstructured":"Lee SK, Park K, Kong DS,  Surgical tactics and outcome of treatment in jugular foramen schwannomas. J Clin Neurosci. 2001;8(suppl 1):32\u201339."},{"issue":"5 suppl","key":"b29","series-title":"J Neurosurg","first-page":"456","article-title":"Gamma knife radiosurgery for jugular foramen schwannomas","volume":"97","author":"Zhang N","year":"2002","unstructured":"Zhang N, Pan L, Dai JZ, Wang BJ, Wang EM, Cai PW. Gamma knife radiosurgery for jugular foramen schwannomas. J Neurosurg. 2002;97(5 suppl):456\u2013458."},{"issue":"4","key":"b30","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1002","article-title":"Stereotactic radiosurgery: the preferred management for patients with nonvestibular schwannomas?","volume":"52","author":"Pollock BE","year":"2002","unstructured":"Pollock BE, Foote RL, Stafford SL. Stereotactic radiosurgery: the preferred management for patients with nonvestibular schwannomas? Int J Radiat Oncol Biol Phys. 2002;52(4):1002\u20131007."},{"issue":"5","key":"b31","series-title":"Neurosurgery","first-page":"1200","article-title":"Stereotactic radiosurgery of cranial nonvestibular schwannomas: results of single- and multisession radiosurgery","volume":"68","author":"Choi CY","year":"2011","unstructured":"Choi CY, Soltys SG, Gibbs IC,  Stereotactic radiosurgery of cranial nonvestibular schwannomas: results of single- and multisession radiosurgery. Neurosurgery. 2011;68(5):1200\u20131208."},{"issue":"14","key":"b32","series-title":"Future Oncol","first-page":"1777","article-title":"Is the CyberKnife\u00a9 radiosurgery system effective and safe for patients? An umbrella review of the evidence","volume":"18","author":"Cheng Y","year":"2022","unstructured":"Cheng Y, Lin Y, Long Y,  Is the CyberKnife\u00a9 radiosurgery system effective and safe for patients? An umbrella review of the evidence. Future Oncol. 2022;18(14):1777\u20131791."},{"issue":"2 suppl","key":"b33","series-title":"Neurosurgery","first-page":"A1","article-title":"Cyberknife image-guided radiosurgery","volume":"64","author":"Adler JR Jr","year":"2009","unstructured":"Adler JR Jr, Chang SD. Cyberknife image-guided radiosurgery. Neurosurgery. 2009;64(2 suppl):A1."},{"issue":"6","key":"b34","series-title":"J Neurosurg","first-page":"887","article-title":"The widened transcochlear approach to jugular foramen tumors","volume":"69","author":"Pellet W","year":"1988","unstructured":"Pellet W, Cannoni M, Pech A. The widened transcochlear approach to jugular foramen tumors. 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