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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.
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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
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Parikh KP, Motiwala M, Beer-Furlan A, Michael LM, Rangarajan SV, Choby GW, Kshettry VR, Saleh S, Mukherjee D, Kirsch C, McKean E, Sorenson JM. Skull Base Registries: A Roadmap. J Neurol Surg B Skull Base 2022; 83:561-578. [PMID: 36393883 PMCID: PMC9653294 DOI: 10.1055/a-1934-9191] [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: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 01/17/2023] Open
Abstract
Hospitals, payors, and patients increasingly expect us to report our outcomes in more detail and to justify our treatment decisions and costs. Although there are many stakeholders in surgical outcomes, physicians must take the lead role in defining how outcomes are assessed. Skull base lesions interact with surrounding anatomy to produce a complex spectrum of presentations and surgical challenges, requiring a wide variety of surgical approaches. Moreover, many skull base lesions are relatively rare. These factors and others often preclude the use of prospective randomized clinical trials, thus necessitating alternate methods of scientific inquiry. In this paper, we propose a roadmap for implementing a skull base registry, along with expected benefits and challenges.
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Affiliation(s)
- Kara P. Parikh
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Mustafa Motiwala
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Andre Beer-Furlan
- Department of Neurosurgery, Moffitt Cancer Center, Tampa, Florida, United States
| | - L. Madison Michael
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Sanjeet V. Rangarajan
- Department of Otolaryngology-Head and Neck Surgery, The University of Tennessee Health Science Center College of Medicine Memphis, Memphis, Tennessee, United States
| | - Garret W. Choby
- Department of Otorhinolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, United States
| | - Varun R. Kshettry
- Brain Tumor and Neuro-Oncology Center Cleveland Clinic, Cleveland, Ohio, United States
| | - Sara Saleh
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, United States
| | - Claudia Kirsch
- Yale University School of Medicine Department of Radiology and Biomedical Imaging, New Haven, Connecticut, United States
- Department of Clinical Dentistry, University of Sheffield, Sheffield, South Yorkshire, England
- Mount Sinai Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Erin McKean
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Jeffrey M. Sorenson
- Department of Neurosurgery, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
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