Predictors of visual functional outcome following treatment for cavernous sinus meningioma

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  • 1 Department of Neurosurgery, and
  • 2 Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
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OBJECTIVE

Cavernous sinus meningioma (CSM) can affect visual function and require expeditious treatment to prevent permanent visual loss. Authors of this retrospective study sought to determine the factors associated with visual functional outcomes in CSM patients treated with surgery, stereotactic radiosurgery (SRS), or stereotactic radiation therapy (SRT), alone or in combination.

METHODS

Consecutive patients with CSM who had presented at an academic tertiary care hospital from 2000 to 2018 were identified through retrospective chart review. Visual function—visual eye deficit (VED), optic disc (OD) appearance, intraocular pressure (IOP), and extraocular movement (EOM)—was assessed before and after treatment for CSM. VED with visual acuity (VA) ≤ 20/200 and visual field defect ≥ −11 dB, pale OD appearance in the ipsilateral or contralateral eye, increased ipsilateral IOP, and/or EOM restriction were defined as a poor visual functional outcome. Multivariable logistic regression was used to evaluate the associations between pretreatment visual functional assessment and posttreatment visual outcomes.

RESULTS

The study cohort included 44 patients (73% female; median age 55 years), with a median clinical follow-up of 14 months. Ipsilateral VED improved, remained stable, or worsened, respectively, in 0%, 33.4%, and 66.6% of the patients after subtotal resection (STR) alone; in 52.6%, 31.6%, and 15.8% after STR plus radiation treatment; in 28.5%, 43.0%, and 28.5% after gross-total resection (GTR) alone; and in 56.3%, 43.7%, and 0% after radiation treatment (SRS or SRT) alone. Contralateral VED remained intact in all the patients after STR alone and those with radiation treatment (SRS or SRT) alone; however, it improved, remained stable, or worsened in 10.5%, 84.2%, and 5.3% after STR plus radiation treatment and in 43.0%, 28.5%, and 28.5% after GTR alone. EOM remained intact, fully recovered, remained stable, and worsened, respectively, in 0%, 50%, 50%, and 0% of the patients after STR alone; in 36.8%, 47.4%, 15.8%, and 0% of the patients after STR with radiation treatment; in 57.1%, 0%, 28.6%, and 14.3% of the patients after GTR alone; and in 56.2%, 37.5%, 6.3%, and 0% of the patients after radiation treatment (SRS or SRT) alone.

In multivariable analyses adjusted for age, tumor volume, and treatment modality, initial ipsilateral poor VED (OR 10.1, 95% CI 1.05–97.2, p = 0.04) and initial ipsilateral pale OD appearance (OR 21.1, 95% CI 1.6–270.5, p = 0.02) were associated with poor ipsilateral VED posttreatment. Similarly, an initial pale OD appearance (OR 15.7, 95% CI 1.3–199.0, p = 0.03), initial poor VED (OR 21.7, 95% CI 1.2–398.6, p = 0.03), and a higher IOP in the ipsilateral eye (OR 55.3, 95% CI 1.7–173.9, p = 0.02) were associated with an ipsilateral pale OD appearance posttreatment. Furthermore, a higher initial ipsilateral IOP (OR 35.9, 95% CI 3.3–400.5, p = 0.004) was indicative of a higher IOP in the ipsilateral eye posttreatment. Finally, initial restricted EOM was indicative of restricted EOM posttreatment (OR 20.6, 95% CI 18.7–77.0, p = 0.02).

CONCLUSIONS

Pretreatment visual functional assessment predicts visual outcomes in patients with CSM and can be used to identify patients at greater risk for vision loss.

ABBREVIATIONS CSM = cavernous sinus meningioma; EBRT = external beam radiation therapy; EOM = extraocular movement; GTR = gross-total resection; IMRT = intensity-modulated radiation therapy; IOP = intraocular pressure; NLP = no light perception; OD = optic disc; SRS = stereotactic radiosurgery; SRT = stereotactic radiation therapy; STR = subtotal resection; VA = visual acuity; VF = visual field; VED = visual eye deficit.

Supplementary Materials

    • Supplemental Tables 1 and 2 (PDF 520 KB)

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Contributor Notes

Correspondence Antonio Meola: Stanford University School of Medicine, Stanford, CA. ameola@stanford.edu.

INCLUDE WHEN CITING Published online May 15, 2020; DOI: 10.3171/2020.2.JNS193009.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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