(642) Primary Versus Salvage Surgery After SRS/RT for Jugulotympanic Paragangliomas: Systematic Review

Introduction: While stereotactic radiosurgery and radiotherapy are widely used for jugulotympanic paragangliomas, surgical outcomes following tumor progression or salvage intervention remain poorly defined. This review examines treatment patterns and outcomes of primary versus post-SRS/RT surgery.

Methods: Study

Design: A systematic review of PubMed and Embase (1996–2025) identified 5,951 records; after duplicate removal and screening, 52 studies met inclusion criteria reporting outcomes for surgically treated jugulotympanic paragangliomas. Of these, 43 evaluated primary surgery only, 6 reported both primary and salvage surgery after RT/SRS, and 3 evaluated RT/SRS as primary therapy. The review protocol was registered in PROSPERO (CRD420251069693).

Results: Among 52 included studies, salvage surgery after RT/SRS was reported in 9 studies (3 RT/SRS-focused and 6 surgical series), representing 19 tumors, whereas 49 studies reported outcomes for 1,999 tumors treated with primary surgery. Extent of resection for salvage surgery was reported in 3 studies, accounting for 7 of 19 tumors (36.8%), with 2 total resections (28.6%) and 5 partial resections (71.4%). In contrast, extent of resection following primary surgery was reported in 44 studies, representing 1,865 of 1,999 tumors, with 1,585 total resections (85.0%) and 280 incomplete resections (15.0%). Complication reporting after salvage surgery was sparse, whereas primary surgery studies consistently reported postoperative complications, most commonly cerebrospinal fluid leak and aspiration.

Conclusions: Salvage surgery following radiation therapy for skull base paragangliomas remains challenging, particularly in patients with complex tumors that fail primary radiation therapy. While outcomes after primary surgery are well established, reports of salvage surgery are sparse and inconsistently reported. Standardized reporting and prospective studies are needed to better understand and predict outcomes of salvage surgery.