Considerable debate remains in the literature as to whether radiation should be considered first-line therapy for glomus tumors and other tumors of the jugular foramen, rather than surgery.16'60'63 In some large series of patients with glomus tumors, local control and survival have been achieved with radiotherapy in up to 90% of patients.60,81,82 In his literature review of nearly 600 patients treated with either surgery or radiation as the primary modality for glomus tumors, Carrasco81 found no significant differences in rates of tumor recurrence between these groups. In both groups high rates of salvage for recurrent tumors were demonstrated, whether with surgery, radiation, or a combination of both. Of these patients, even those with recurrence, fewer than 10% of patients died as a result of the glomus tumor. The incidence of posttreatment cranial neuropathies is low for radiotherapy.47,83 The advent of

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2. Katsuta T, Rhoton AL, Matsushima T. The jugular foramen: microsurgical anatomy and operative approaches. Neurosurgery 1997;41:149-202

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stereotactic radiosurgery in recent decades provides a more precise technique for administering high-dose focal radiation, and preliminary reports indicate that this modality may have a role in the treatment of jugular foramen tumors.82 One of the main differences between radiotherapy and surgery for glomus tumors is that radiotherapy is used as a means to control tumor growth, whereas surgery is used in an attempt to achieve a cure. Many patients irradiated for lesions of the jugular foramen require subsequent surgery for disease progression, and previously irradiated tissue presents many obvious difficulties for the surgeon.16 In practicality, each of these modalities has clinical utility, and must be chosen separately or in combination as appropriate for individual patients.

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