- Email: [email protected]
The surgical resectability of meningiomas of the cavernous sinus.
• Outcomes of patients with no laboratory assess ment before anesthesia and a surgical procedure. Narr BJ*, Warner ME, Schroeder DR, Warner MA. Mayo Clin Proc 1997;71:505-509.
T
HE AUTHORS ESTIMATED THE FREQUENCY OF PERI-
operative morbidity in patients who underwent anesthesia and a surgical procedure with no preoperative laboratory testing. Medical records of 56,119 patients who underwent surgical or diagnostic pro cedures and anesthesia at Mayo Clinic Rochester in 1994 were reviewed and 5,120 were found who had no laboratory tests done within 90 days before the procedure. The authors randomly selected 1,044 patients (87 from each month). The 1,044 patients ranged in age from 0 to 95 years (median age, 21 years). Ninety-four percent were relatively healthy. No deaths or major perioperative morbidities occurred, and no blood transfusions were necessary. Intraoperatively, 17 laboratory tests and one electrocardiogram were obtained, and three results were abnormal. Postoperatively, 42 blood tests and two electrocardiographic procedures were performed. Five of the blood tests showed abnormal results. No laboratory test done intraoperatively or postoperatively was found to change surgical or medical management substantially. One patient who had unanticipated blood loss during an outpatient procedure was admitted to the hospital for observation. The authors conclude that patients who have been assessed by history and physical examination and determined to have no preoperative indication for laboratory tests can safely undergo anesthesia and operation with tests obtained only as indicated intraoperatively and postoperatively; cur rent anesthetic and medical practices rapidly identify perioperative indications for laboratory evaluation as they arise. — Thomas J. Liesegang *Department of Anesthesiology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905.
• Detection of human papillomavirus infection in squamous tumors of the conjunctiva and lacrimal sac by immunohistochemistry, in situ hybridiza tion, and polymerase chain reaction. Nakamura Y*, Mashima Y, Kameyama K, Mukai M, Oguchi Y. Br J Ophthalmol 1997;81:308-311. 428
S
QUAMOUS CELL TUMORS OF THE OCULAR SURFACE,
including the lacrimal pathway, range from be nign lesions to invasive carcinomas. Some of these tumors are associated with human papillomavirus (HPV) infection, with the types of HPV differing among papillomas and dysplastic or malignant le sions. The authors evaluated 17 tumors from patients by immunohistochemistry, in situ hybridization, and polymerase chain reaction techniques. Nine of the 17 tumors were benign, four were dysplastic, and four were carcinomas. Eight specimens showed positive immunochemical staining with antibodies to HPV; four of the eight were papillomas, three were dysplas tic lesions, and one was a carcinoma. Koilocytosis was detected in seven of these eight tumors. Five of the eight specimens positive for immunohistochemical staining were also positive for HPV DNA by in situ hybridization, and all eight were positive for HPV DNA by the polymerase chain reaction method. The authors conclude that approxi mately 50% of squamous tumors of the ocular surface and lacrimal sac are associated with HPV infection as confirmed by a combination of immunohistochemis try, in situ hybridization, and polymerase chain reaction. — Thomas J. Liesegang *Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160, Japan.
• The surgical resectability of meningiomas of the cavernous sinus. O'Sullivan MG, van Loveren HR*, Tew JM. Neurosurgery 1997;40:238-247.
I
N THIS RETROSPECTIVE REVIEW, 39 PATIENTS, INCLUD-
ing 27 women and 12 men ranging in age from 24 to 73 years (median, 48 years), underwent surgical treatment for cavernous sinus meningioma. The cav ernous internal carotid artery was partially encased in 15 patients, totally encased in 11 patients, and narrowed by tumor in 13 patients. Of eight patients who underwent complete tumor resection, seven had partial encasement of the internal carotid artery. Of 31 patients who underwent subtotal resection, 11 underwent postoperative radiotherapy. There were no deaths in the series. Morbidity was 17.9% for cranial nerves controlling extraocular motor function. Trigeminal nerve function did not improve after surgical
AMERICAN JOURNAL OF OPHTHALMOLOGY
SEPTEMBER 1997
treatment. The median follow-up period was 2 years (range, 6 months to 5.3 years). Symptomatic and radiographic recurrence occurred in two patients who underwent complete tumor resection and in two patients who underwent subtotal resection. The au thors conclude that the resectability of meningiomas of the cavernous sinus depends on the degree of internal carotid artery involvement, that total exci sion of these tumors is possible but rarely achieved in holocavernous meningiomas, that cranial nerve mor bidity is significant, and that subtotal excision with or without postoperative radiotherapy is an effective short-term oncological strategy. Invited comments from other neurosurgeons that follow this article highlight the degree of controversy surrounding the management of these tumors. — Nancy J. Newman 'Editorial Office, Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Bethesda Ave, PO Box 670515, Cincinnati, OH, 45267-0515.
• Asymptomatic optic disc edema. Gordon RN, Burde RM*, Slamovits T. J Neuro-Ophthalmol 1997;17:29-32.
N
ONARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROP-
athy (AION) classically presents with visual loss, altitudinal visual field defects, and optic nerve swell ing. Anterior ischemic optic neuropathy presumably occurs secondary to an ischemic event to the anterior optic nerve. So-called premonitory AION refers to a syndrome in which patients at risk for nonarteritic AION are noted to have asymptomatic disk edema followed days to months later by loss of vision and visual field more classic for AION. The authors describe two patients who were at risk for developing nonarteritic AION who presented with optic disk edema but who did not have visual loss or visual field defects during 1 and 2 years of follow-up. The optic disk edema resolved spontaneously in both affected eyes. The authors conclude that the clinical spectrum of nonarteritic AION can range from a "full-blown" classic attack to a minimal attack characterized by disk swelling without visual loss. The amount and distribution of disk ischemia determines the individu al clinical picture. The failure of the affected eye to develop symptoms may represent a graded axonal V0L.124,
No. 3
atrophy with mechanical decompression of the optic nerve. — Nancy J. Newman 'Department of Ophthalmology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210 St, Bronx, NY 10467.
• Bilateral superior ophthalmic vein enlargement associated with diffuse cerebral swelling. Khanna RK, Pham CJ, Malik GM*, Spickler EM, Mehta B, Rosenblum ML. J Neurosurg 1997;86:893-897.
U
NILATERAL SUPERIOR OPHTHALMIC VEIN (SOV) EN-
largement is most commonly caused by local orbital pathology or carotid-cavernous fistulas. Bi lateral SOV enlargement can occur with carotidcavernous fistulas, septic or aseptic cavernous sinus thrombosis, or thyroid ophthalmopathy. The authors describe 11 patients with bilateral SOV enlargement in whom the only association was cerebral swelling as detected by computed tomography and increased intracranial pressure as documented by intracranial pressure monitoring. The bilaterally enlarged SOVs returned to a normal size following resolution of cerebral swelling and increased intracranial pressure. The authors believe that the bilateral SOV enlarge ment was caused by mechanical cavernous sinus venous stagnation from cerebral swelling, a syndrome that may occur more commonly than is currently appreciated. — Nancy J. Newman 'Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202.
• Local inhibition of natural killer cell activity promotes the progressive growth of intraocular tumors. Apte RS, Mayhew E, Niederkorn JY*. Invest Ophthalmol Vis Sci 1997;38:1277-1282.
T
HE AUTHORS TESTED THE EFFECT OF AQUEOUS HU-
mor (AH) on inhibiting natural killer (NK) cell antitumor activity in vitro and in vivo. Two NKsensitive tumor cell lines were tested, RMA-S lymphoma and OCM-3 uveal melanoma, for NK cellmediated lysis in vitro with a 51Cr release assay and in vivo by intraocular anterior chamber and subcutane ous implantation in C57BL/6 immunodeficient mice
ABSTRACTS
429
T
HE AUTHORS ESTIMATED THE FREQUENCY OF PERI-
operative morbidity in patients who underwent anesthesia and a surgical procedure with no preoperative laboratory testing. Medical records of 56,119 patients who underwent surgical or diagnostic pro cedures and anesthesia at Mayo Clinic Rochester in 1994 were reviewed and 5,120 were found who had no laboratory tests done within 90 days before the procedure. The authors randomly selected 1,044 patients (87 from each month). The 1,044 patients ranged in age from 0 to 95 years (median age, 21 years). Ninety-four percent were relatively healthy. No deaths or major perioperative morbidities occurred, and no blood transfusions were necessary. Intraoperatively, 17 laboratory tests and one electrocardiogram were obtained, and three results were abnormal. Postoperatively, 42 blood tests and two electrocardiographic procedures were performed. Five of the blood tests showed abnormal results. No laboratory test done intraoperatively or postoperatively was found to change surgical or medical management substantially. One patient who had unanticipated blood loss during an outpatient procedure was admitted to the hospital for observation. The authors conclude that patients who have been assessed by history and physical examination and determined to have no preoperative indication for laboratory tests can safely undergo anesthesia and operation with tests obtained only as indicated intraoperatively and postoperatively; cur rent anesthetic and medical practices rapidly identify perioperative indications for laboratory evaluation as they arise. — Thomas J. Liesegang *Department of Anesthesiology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905.
• Detection of human papillomavirus infection in squamous tumors of the conjunctiva and lacrimal sac by immunohistochemistry, in situ hybridiza tion, and polymerase chain reaction. Nakamura Y*, Mashima Y, Kameyama K, Mukai M, Oguchi Y. Br J Ophthalmol 1997;81:308-311. 428
S
QUAMOUS CELL TUMORS OF THE OCULAR SURFACE,
including the lacrimal pathway, range from be nign lesions to invasive carcinomas. Some of these tumors are associated with human papillomavirus (HPV) infection, with the types of HPV differing among papillomas and dysplastic or malignant le sions. The authors evaluated 17 tumors from patients by immunohistochemistry, in situ hybridization, and polymerase chain reaction techniques. Nine of the 17 tumors were benign, four were dysplastic, and four were carcinomas. Eight specimens showed positive immunochemical staining with antibodies to HPV; four of the eight were papillomas, three were dysplas tic lesions, and one was a carcinoma. Koilocytosis was detected in seven of these eight tumors. Five of the eight specimens positive for immunohistochemical staining were also positive for HPV DNA by in situ hybridization, and all eight were positive for HPV DNA by the polymerase chain reaction method. The authors conclude that approxi mately 50% of squamous tumors of the ocular surface and lacrimal sac are associated with HPV infection as confirmed by a combination of immunohistochemis try, in situ hybridization, and polymerase chain reaction. — Thomas J. Liesegang *Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160, Japan.
• The surgical resectability of meningiomas of the cavernous sinus. O'Sullivan MG, van Loveren HR*, Tew JM. Neurosurgery 1997;40:238-247.
I
N THIS RETROSPECTIVE REVIEW, 39 PATIENTS, INCLUD-
ing 27 women and 12 men ranging in age from 24 to 73 years (median, 48 years), underwent surgical treatment for cavernous sinus meningioma. The cav ernous internal carotid artery was partially encased in 15 patients, totally encased in 11 patients, and narrowed by tumor in 13 patients. Of eight patients who underwent complete tumor resection, seven had partial encasement of the internal carotid artery. Of 31 patients who underwent subtotal resection, 11 underwent postoperative radiotherapy. There were no deaths in the series. Morbidity was 17.9% for cranial nerves controlling extraocular motor function. Trigeminal nerve function did not improve after surgical
AMERICAN JOURNAL OF OPHTHALMOLOGY
SEPTEMBER 1997
treatment. The median follow-up period was 2 years (range, 6 months to 5.3 years). Symptomatic and radiographic recurrence occurred in two patients who underwent complete tumor resection and in two patients who underwent subtotal resection. The au thors conclude that the resectability of meningiomas of the cavernous sinus depends on the degree of internal carotid artery involvement, that total exci sion of these tumors is possible but rarely achieved in holocavernous meningiomas, that cranial nerve mor bidity is significant, and that subtotal excision with or without postoperative radiotherapy is an effective short-term oncological strategy. Invited comments from other neurosurgeons that follow this article highlight the degree of controversy surrounding the management of these tumors. — Nancy J. Newman 'Editorial Office, Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Bethesda Ave, PO Box 670515, Cincinnati, OH, 45267-0515.
• Asymptomatic optic disc edema. Gordon RN, Burde RM*, Slamovits T. J Neuro-Ophthalmol 1997;17:29-32.
N
ONARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROP-
athy (AION) classically presents with visual loss, altitudinal visual field defects, and optic nerve swell ing. Anterior ischemic optic neuropathy presumably occurs secondary to an ischemic event to the anterior optic nerve. So-called premonitory AION refers to a syndrome in which patients at risk for nonarteritic AION are noted to have asymptomatic disk edema followed days to months later by loss of vision and visual field more classic for AION. The authors describe two patients who were at risk for developing nonarteritic AION who presented with optic disk edema but who did not have visual loss or visual field defects during 1 and 2 years of follow-up. The optic disk edema resolved spontaneously in both affected eyes. The authors conclude that the clinical spectrum of nonarteritic AION can range from a "full-blown" classic attack to a minimal attack characterized by disk swelling without visual loss. The amount and distribution of disk ischemia determines the individu al clinical picture. The failure of the affected eye to develop symptoms may represent a graded axonal V0L.124,
No. 3
atrophy with mechanical decompression of the optic nerve. — Nancy J. Newman 'Department of Ophthalmology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210 St, Bronx, NY 10467.
• Bilateral superior ophthalmic vein enlargement associated with diffuse cerebral swelling. Khanna RK, Pham CJ, Malik GM*, Spickler EM, Mehta B, Rosenblum ML. J Neurosurg 1997;86:893-897.
U
NILATERAL SUPERIOR OPHTHALMIC VEIN (SOV) EN-
largement is most commonly caused by local orbital pathology or carotid-cavernous fistulas. Bi lateral SOV enlargement can occur with carotidcavernous fistulas, septic or aseptic cavernous sinus thrombosis, or thyroid ophthalmopathy. The authors describe 11 patients with bilateral SOV enlargement in whom the only association was cerebral swelling as detected by computed tomography and increased intracranial pressure as documented by intracranial pressure monitoring. The bilaterally enlarged SOVs returned to a normal size following resolution of cerebral swelling and increased intracranial pressure. The authors believe that the bilateral SOV enlarge ment was caused by mechanical cavernous sinus venous stagnation from cerebral swelling, a syndrome that may occur more commonly than is currently appreciated. — Nancy J. Newman 'Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202.
• Local inhibition of natural killer cell activity promotes the progressive growth of intraocular tumors. Apte RS, Mayhew E, Niederkorn JY*. Invest Ophthalmol Vis Sci 1997;38:1277-1282.
T
HE AUTHORS TESTED THE EFFECT OF AQUEOUS HU-
mor (AH) on inhibiting natural killer (NK) cell antitumor activity in vitro and in vivo. Two NKsensitive tumor cell lines were tested, RMA-S lymphoma and OCM-3 uveal melanoma, for NK cellmediated lysis in vitro with a 51Cr release assay and in vivo by intraocular anterior chamber and subcutane ous implantation in C57BL/6 immunodeficient mice
ABSTRACTS
429