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Show 21. Refermce: Ophthalmic Forum 3, Winter 1985. Contributing authors: Blodi, F. c., Char, D. H., Berlin, A. J., Trokel, S. L., Jakobiec, F. A., et al. Correspondence: F. H. Davidorf, M.D., Editor, Ophthalmic Forum, 456 Clinic Drive, Columbus, OH 43210. This issue is devoted to imaging of the orbit, endoscopy, and fine needle biopsy, and some discussion by orbital surgeons about the management of orbital lesions. The actual high-resolution CT studies are stunning, with phenomenal detail (i.e., posterior ethmoidal artery, frontal nerve, etc.). Some less remarkable nuclear magnetic resonance scans are included as well. LYIl A. Sedwick, M.D. • • • 22. Reference: Mirimanoff, R. c., Dosoretz, D. E., Linggood, R. M., et al.: Meningioma: analysis of recurrence and progression following neurosurgical resection. J. Ncuroslirg. 62: 18-23, 1985. Reprints: R. M. Linggood, M.D., Department of Radiation Medicine, Massachusetts General Hospital, Fruit St., Boston, MA 02114. Rates of survival, tumor recurrence, and progression were analyzed in 225 patients undergoing surgery as the only treatment for meningioma. If the tumors were totally resected, 93, 80, and 68% of patients were free of tumor at 5, 10, and 15 years of follow-up, respectively. If tumors were subtotally resected, only 63, 45, and 9% of patients were tumor free at 5, 10, and 15 years of follow-up. If the meningioma was totally excised, the probability of requiring a second operation was 6, 15, and 20% at 5, 10 and 15 years of follow-up versus 25, 44, and 84% over the same periods after subtotal resection. Patients whose tumors were totally excised did far better than did those with subtotal resections. The patient's age, sex, and duration of symptoms had no relationship to the incidence of recurrence or progression. Total versus subtotal excision was the determining factor. Of ophthalmic interest: There were too few perioptic orbital meningiomas to be significant. Fifty-seven percent of parasellar meningiomas were totally excised. Nineteen percent recurred or progressed at 5 years. Only 28% of sphenoid ridge meningiomas were totally excised. The probability of recurrence or progression was 34% at 5 years and 54% at 10 years. Seventy-seven percent of olfactory groove meningiomas were totally resected. However the probability of recurrence or progression was 30% at 5 years and 41% at 10 years. This study documents the high incidence of meningioma progression after subtotal resection, as well as the better prognosis for patients whose meningiomas are totally excised. It also indicates that surgery may prove insufficient as the only method of therapy. Thomas C. Spoor, M.D., FACS • • • September 1985 Literature Abstracts 23. Reference: Symon, L., and Vajda, J.: Surgical experiences with giant intracranial aneurysms. ]. Neurosurg. 61: 1009-1028, 1984. Reprints: L. Symon, T. D., Gough-Cooper Department of Neurologic Surgery, Institute of Neurology, The National Hospital, Queen Square, London WCIE 3BG, England. Surgical experience with 35 patients having 36 giant aneurysms is presented. Surgical technique is reviewed. Thirteen patients presented with subarachnoid hemorrhage and 22 with evidence of a spaceoccupying lesion. Of these 22, 7 patients presented with visual loss. Visual function improved appreciably in 6 of 7 patients postoperatively. Four of seven patients with extraocular motility dysfunction improved postoperatively. Three patients presenting with trigeminal distribution pain were relieved postoperatively. Thomas C. Spoor, M.D., FACS • • • 24. Reference: D' Avella, D., Russo, A., Santoro, G., et al.: Diagnosis of superior sagittal sinus thrombosis by computerized tomography. ]. Neurosurg. 61: 1129-1131, 1984. Reprints: D. D' Avella, M.D., lstria is 507, 98100 Mes-sina, Italy. Patients with aseptic thrombosis of the superior sagittal sinus may present to the ophthalmologist with headaches, papilledema, and decreased mentation. Cerebral angiography is the key to definitive diagnosis. However, diagnosis may be made with contrast-enhanced CT by observing the "empty triangle sign" in association with small ventricles. The empty triangle sign is associated with superior sagittal sinus thrombosis and represents an isodense clot within the longitudinal sinus. As the sinus recanalizes, the CT picture normalizes and becomes indistinguishable from a normal CT scan. We should look for this sign in patients with pseudotumor cerebri and include superior sagittal sinus thrombosis in our differential diagnosis. TlJomas C. Spoor. M.D.. FACS • • • 25. Reference: Michowitz, 5., Raspaport, H. Z., Shared, I., et al.: Thoracic disc herniation associated with papilledema. f. NClirosurg. 61: 11321134, 1984. Reprints: A. Sahatz, M.D., Department of Neurosurgery, The Chaim Sheba Medical Center, Tel-Hashomer, 5262 Israel. Apatient with swollen discs and decreased vision for 7 months is described. An association between thoracic disc herniation and papilledema is conjectured. No intracranial cause for papilledema 205 |