1
|
Zohdy YM, Jacob F, Agam M, Alawieh A, Bray D, Barbero JMR, Argaw SA, Maldonado J, Rodas A, Sudhakar V, Porto E, Peragallo JH, Olson JJ, Pradilla G, Garzon-Muvdi T. Volumetric Analysis of Spheno-Orbital Meningiomas: Prognostic Correlation and a Compartmentalized Approach. Neurosurgery 2024; 94:736-744. [PMID: 37931131 DOI: 10.1227/neu.0000000000002724] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/24/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Spheno-orbital meningiomas arise from the arachnoid villi cap cells at the sphenoid ridge and have the ability to spread through soft tissue extension and cranial bone invasion. Owing to their orbital hyperostosis and intraorbital soft tissue extension, they commonly present with ophthalmologic manifestations. This study aims to investigate the correlation between tumor volume with the presenting symptoms and postoperative outcomes. METHODS This retrospective study analyzed patients who underwent surgical resection of spheno-orbital meningiomas. Tumor volumes in different compartments were measured using preoperative and postoperative imaging. Linear and logistic regression analyses were used to identify correlations between tumor volumes and presenting symptoms preoperatively and postoperative outcomes. RESULTS Sixty-six patients were included in this study, of whom 86.4% had proptosis, 80.3% had decreased visual acuity (VA), 30.3% had visual field defects, and 13.6% had periorbital edema. Preoperatively, proptosis linearly correlated with intraosseous tumor volume (coefficient = 0.6, P < .001), while the decrease in baseline VA correlated with the intraorbital tumor volume (coefficient = 0.3, P = .01). The odds of periorbital edema were found to increase with an increase in intraosseous tumor volume with an adjusted odds ratio of 1.4 (95% CI, 1.1-1.7, P = .003), while the odds of visual field defects were found to increase with an increase in intraorbital tumor volume with an adjusted odds ratio of 2.7 (95% CI, 1.3-5.6, P = .01). Postoperatively, the volume of intraosseous tumor resected linearly correlated with the improvement in proptosis (coefficient = 0.7, P < .001), while the volume of intraorbital tumor resected linearly correlated with improvement in VA (coefficient = 0.5, P < .001) and with a larger effect size in patients presenting with moderate-to-severe decrease in VA preoperatively (coefficient = 0.8). CONCLUSION Underscoring the importance of each tumor compartment relative to the patient's symptomatology serves as a valuable guide in implementing a compartmentalized resection approach tailored to the surgical objectives.
Collapse
Affiliation(s)
- Youssef M Zohdy
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - Fadi Jacob
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - Matthew Agam
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - Ali Alawieh
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - David Bray
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | | | - Samson A Argaw
- Rollins School of Public Health, Emory University, Atlanta , Georgia , USA
| | - Justin Maldonado
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - Alejandra Rodas
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - Vivek Sudhakar
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - Edoardo Porto
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan , Italy
| | - Jason H Peragallo
- Department of Ophthalmology, Emory University School of Medicine, Atlanta , Georgia , USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta , Georgia , USA
| | - Jeffrey J Olson
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - Gustavo Pradilla
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| | - Tomas Garzon-Muvdi
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta , Georgia , USA
| |
Collapse
|
2
|
Gill VT, Stålhammar G. Incidence, risk factors and outcomes of cataract surgery after plaque brachytherapy for posterior uveal melanoma. Heliyon 2024; 10:e23447. [PMID: 38173489 PMCID: PMC10761564 DOI: 10.1016/j.heliyon.2023.e23447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose To examine incidence, risk factors, and outcomes of cataract surgery after plaque brachytherapy for posterior uveal melanoma. Design Retrospective interventional cohort study contrasted with general population data. Methods All patients treated with plaque brachytherapy for a posterior uveal melanoma at Sweden's national referral center between 2010 and 2022 were included (n = 933). These patients were cross-referenced with data from the Swedish National Cataract Register. Competing risk incidences and outcomes of cataract surgery were compared with a random sample of 1000 individuals from the general population. Results The 12-year incidence of cataract surgery after plaque brachytherapy was 27 % (95 % CI 23-31 %), which markedly exceeded the incidence of 16 % in the general population (95 % CI 13-18 %, Gray's P < 0.001). Patients treated with Iodine-125 had significantly higher incidence than patients treated with Ruthenium-106, and the latter had greater incidence than the general population (P < 0.001). In univariate competing risk regressions, older patients, female sex, thick tumors, and Iodine-125 were associated with cataract surgery. In multivariate analysis, older patients and Iodine-125 retained their significance. Outcomes of cataract surgery were overall similar in the plaque brachytherapy and general population, but the general population more often received post op. topical NSAID. Conclusions In this study, plaque brachytherapy for posterior uveal melanoma was associated with a significantly increased incidence of cataract surgery. Treatment with the gamma emitting isotope iodine-125 and older patient age at the time of brachytherapy emerged as the major risk factors. Outcomes of cataract surgery were comparable to the general population.
Collapse
Affiliation(s)
- Viktor T. Gill
- Department of Pathology, Västmanland Hospital Västerås, Västerås, Sweden
- Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Stålhammar
- Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden
- Ocular Oncology Service and St. Erik Ophthalmic Pathology Laboratory, St. Erik Eye Hospital, Stockholm, Sweden
| |
Collapse
|
3
|
Stålhammar G. Delays between Uveal Melanoma Diagnosis and Treatment Increase the Risk of Metastatic Death. Ophthalmology 2023:S0161-6420(23)00856-4. [PMID: 37995852 DOI: 10.1016/j.ophtha.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
PURPOSE To investigate if the interval between diagnosis and treatment of posterior uveal melanoma (UM) is associated with metastatic death. DESIGN Retrospective, single-center cohort study. PARTICIPANTS A total of 1145 patients consecutively diagnosed with posterior UM at St. Erik Eye Hospital, Stockholm, Sweden, from 2012 to 2022, with recorded dates of diagnosis and primary treatment. This cohort represents 81% of all diagnosed patients in Sweden during this period. METHODS Data on the interval between diagnosis and treatment were collected for all patients. Its prognostic importance was examined with univariate and multivariate competing risks regressions, and cumulative incidence analyses. MAIN OUTCOME MEASURES Incidence of metastatic death (UM mortality) for patients with prompt (< 1 month from diagnosis) versus delayed treatment (≥ 1 month) and subdistribution hazard ratios (exp(βj)) for every additional 10-day delay in treatment. RESULTS The mean interval between diagnosis and treatment was 34 days (SD, 56, range, 0-932). Patients treated promptly had larger tumors at diagnosis, but there were no differences in patient age, tumor distance to the optic disc, rates of ciliary body involvement (CBI) or extraocular extension (EXE), or symptom duration before diagnosis. Those who were treated more than 1 month after diagnosis had greater UM mortality in American Joint Committee on Cancer (AJCC) stage II and III. In stage I, UM mortality for delayed treatment was lower for the first 10 years, followed by a marked spike in the 11th year. In multivariate competing risks regressions of all 1145 patients with tumor diameter, thickness, CBI, and EXE as covariates, the risk for UM mortality increased with 1% for every additional 10-day delay in treatment (exp(βj) 1.01). Among 355 patients treated with enucleation, this delay was associated with UM mortality, independent of AJCC stage, cytomorphology, and level of immunohistochemical BAP-1 expression. CONCLUSIONS Increasing time between diagnosis and treatment of UM is associated with a higher risk of metastatic death. These results challenge a central concept in the understanding of metastatic progression and may indicate the existence of late metastatic seeding. They also underscore the importance of prompt treatment. Validation in independent cohorts is recommended. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Collapse
Affiliation(s)
- Gustav Stålhammar
- Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden; Ocular Oncology Service and St. Erik Ophthalmic Pathology Laboratory, St. Erik Eye Hospital, Stockholm, Sweden.
| |
Collapse
|