Stereotactic Radiosurgery for an Unresectable Jugulotympanic Paraganglioma: Clinical Response and Acute Toxicity in a 70-Year-Old Patient

Jugulotympanic paragangliomas (JTPs) are rare, highly vascular neuroendocrine tumors characterized by slow but locally aggressive growth at the skull base.Their management in elderly patients is particularly challenging because of their close proximity to critical neurovascular structures.We report the case of a 70year-old woman with a 20-year history of pulsatile tinnitus and a 13-year history of chronic vertigo.Her symptoms progressively worsened, with the recent onset of otic bleeding, occipital headache, and dysphonia, prompting referral to the Radiation Oncology Department.Physical examination revealed a pulsatile reddish mass in the left middle ear, along with ipsilateral lower cranial nerve deficits.Given the unresectable nature of the lesion and the patient's comorbidities, definitive stereotactic radiosurgery (SRS) was recommended.Treatment was delivered in a single fraction of 14 Gy with the aim of achieving local tumor control and symptom stabilization.Following treatment, the patient experienced significant improvement in pulsatile tinnitus and complete resolution of occipital pain.At the three-month follow-up evaluation, she developed local complications including tympanic membrane ulceration and middle ear mucosal necrosis, which were managed conservatively with antibiotic therapy and close clinical surveillance.At eight months after treatment, the patient maintained clinical improvement and neurological stability, with persistent local tumor control on follow-up MRI and no evidence of locoregional progression.SRS represents an effective treatment option for unresectable JTPs, offering symptom control and functional preservation with acceptable toxicity.Nevertheless, careful post-treatment monitoring is essential for the early identification and management of radiation-related complications, particularly in tumors with extensive local invasion.