NCOG-25. STEREOTACTIC RADIOSURGERY VERSUS SURGICAL MICRODISSECTION FOR JUGULAR FORAMEN SCHWANNOMAS: A RETROSPECTIVE COMPARATIVE STUDY

Abstract INTRODUCTION Jugular foramen schwannomas (JFS) are rare, benign tumors arising from lower cranial nerves. Given their delicate location, surgical microdissection carries a substantial risk of neurological morbidity. Stereotactic radiosurgery (SRS) presents an alternative, particularly for smaller or residual tumors. OBJECTIVE This study aims to compare the outcomes and symptomatic improvements between these two treatment modalities. METHODS We conducted a retrospective analysis of 32 patients with JFS who underwent SRS (13 cases [40.6%]) or surgical dissection (19 cases [59.4%]) as their primary management at Stanford Medical Center between 1998 and 2024. 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. RESULTS Significant differences were observed in baseline characteristics between the SRS and surgery groups, including mean age (62.52 vs. 46.87 years, p<0.001), mean largest diameter (34.38 vs. 53.66 mm, p=0.02), and median total tumor volume (6.50 vs. 19.70 mm3, p=0.009). 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 (85.71 vs. 77.77%), OS (92.3 vs 100%), symptom improvement (61.53 vs. 52.63%) or mean CTCAE grade (1.31 vs. 1.58) between the SRS and surgery groups. SRS patients had significantly lower odds of requiring secondary treatment procedures after their primary intervention as compared to those in the surgery group (OR=0.01, 95% CI: 0.0001-0.59, p=0.02). CONCLUSION Both SRS and surgery provide exceptional outcomes for JFS with no significant differences in PFS, OS, CTCAE grades, or symptom improvement between the two groups. However, SRS patients had lower odds of requiring secondary interventions for JFS. This is among the first studies comparing surgical microdissection and SRS for JFS. Future controlled prospective studies are necessary to derive more definitive conclusions.