Skip to main content

Advertisement

SpringerLink
Log in

Simpson grade: an opportunity to reassess the need for complete resection of meningiomas

  • Clinical Article - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

The relevance of the Simpson grading system as a predictor of meningioma progression or recurrence in modern neurosurgical practice has recently been called into question. The aim of our study was to compare the risk of progression/recurrence of tumours that had been treated with different Simpson grade resections in a contemporary population of benign (WHO grade I) meningioma patients.

Method

One hundred eighty-three patients with histologically confirmed WHO grade I meningioma were retrospectively analysed. All patients underwent first-time craniotomy as their initial therapy between 2004 and 2012. Univariate analysis was performed using log-rank testing and Kaplan-Meier analysis for progression/recurrence-free survival. Multivariate analysis was performed using Cox proportional hazards regression modelling.

Results

The three-year progression/recurrence-free survival rates for patients receiving Simpson grade 1, 2 or 4 resections were 95 %, 87 % and 67 %, respectively. Simpson grade 4 resections progressed/recurred at a significantly greater rate than Simpson grade 1 resections (hazard ratio [HR] = 3.26, P = 0.04), whereas Simpson grade 2 resections did not progress/recur at a significantly greater rate than Simpson grade 1 resections (HR = 1.78, P = 0.29). Subtotal resections progressed/recurred at a significantly greater rate than gross-total resections (HR = 2.47, P = 0.03).

Conclusions

Tumours that undergo subtotal resection are at a significantly greater risk of progression/recurrence than tumours that undergo gross-total resection. Gross-total resection should therefore be the aim of surgery. However, given modern access to follow-up imaging and stereotactic radiosurgery, these results should not be used to justify overly ‘heroic’ tumour resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Adegbite AB, Khan MI, Paine KW, Tan LK (1983) The recurrence of intracranial meningiomas after surgical treatment. J Neurosurg 58:51–56

    Article  CAS  PubMed  Google Scholar 

  2. Black PM (1993) Meningiomas. Neurosurgery 32:643–657

    Article  CAS  PubMed  Google Scholar 

  3. Flickinger JC, Kondziolka D, Maitz AH, Lunsford LD (2003) Gamma knife radiosurgery of imaging-diagnosed intracranial meningioma. Int j radiat oncol biol phys 56:801–806

    Article  PubMed  Google Scholar 

  4. Hashimoto N, Rabo CS, Okita Y, Kinoshita M, Kagawa N, Fujimoto Y, Morii E, Kishima H, Maruno M, Kato A, Yoshimine T (2012) Slower growth of skull base meningiomas compared with non-skull base meningiomas based on volumetric and biological studies. J Neurosurg 116:574–580

    Article  PubMed  Google Scholar 

  5. Hasseleid B, Meling T, Rønning P, Scheie D, Helseth E (2012) Surgery for convexity meningioma: Simpson Grade I resection as the goal. J Neurosurg 117:999–1006

    Article  PubMed  Google Scholar 

  6. Jääskeläinen J (1986) Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysis. Surg Neurol 26(5):461–469

    Article  PubMed  Google Scholar 

  7. Kondziolka D, Flickinger JC, Perez B (1998) Judicious resection and/or radiosurgery for parasagittal meningiomas: outcomes from a multicenter review. Neurosurgery 43:405–414

    Article  CAS  PubMed  Google Scholar 

  8. Kondziolka D, Levy EI, Niranjan A, Flickinger JC, Lunsford LD (1999) Long-term outcomes after meningioma radiosurgery: physician and patient perspectives. J Neurosurg 91:44–50

    Article  CAS  PubMed  Google Scholar 

  9. Kunishio K, Ohmoto T, Furuta T, Matsumoto K, Nishimoto A (1994) Factors influencing the recurrence rate of intracranial meningiomas after surgery. Neurol Med Chir (Tokyo) 34(2):81–85

    Article  CAS  Google Scholar 

  10. Mair R, Morris K, Scott I, Carroll TA (2011) Radiotherapy for atypical meningiomas. J Neurosurg 115(4):811–819

    Article  PubMed  Google Scholar 

  11. Naumann M, Meixenberger J (1990) Factors influencing meningioma recurrence rate. Acta Neurochir (Wein) 107:108–111

    Article  CAS  Google Scholar 

  12. Pearson BE, Markert JM, Fisher WS, Guthrie BL, Fiveash JB, Palmer CA, Riley K (2008) Hitting a moving target: evolution of a treatment paradigm for atypical meningiomas amid changing diagnostic criteria. Neurosurg Focus 24(5):E3

    Article  PubMed  Google Scholar 

  13. Pollock BE, Stafford SL, Utter A, Giannini C, Schreiner SA (2003) Stereotactic radiosurgery provides equivalent tumor control to Simpson Grade 1 resection for patients with small- to medium- size meningiomas. Int j radiat oncol biol phys 55:1000–1005

    Article  PubMed  Google Scholar 

  14. Sanai N, Sughrue ME, Shangari G, Chung K, Berger MS, McDermott MW (2010) Risk profile associated with convexity meningioma resection in the modern neurosurgical era. J Neurosurg 112:913–919

    Article  PubMed  Google Scholar 

  15. Simon M, Boström J, Koch P, Schramm J (2006) Interinstitutional variance of postoperative radiotherapy and follow up for meningiomas in Germany: impact of changes of the WHO classification. J Neurol Neurosurg Psychiatry 77:767–773

    Article  CAS  PubMed  Google Scholar 

  16. Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20(1):22–39

    Article  CAS  PubMed  Google Scholar 

  17. Stafford SL, Perry A, Suman VJ, Meyer FB, Scheithauer BW, Lohse CM, Shaw EG (1998) Primarily resected meningiomas: outcome and prognostic factors in 581 Mayo Clinic patients, 1978 through 1988. Mayo Clin Proc 73:936–942

    Article  CAS  PubMed  Google Scholar 

  18. Strassner C, Buhl R, Mehdorn HM (2009) Recurrence of intracranial meningiomas: did better methods of diagnosis and surgical treatment change the outcome in the last 30 years? Neurol Res 31:478–482

    Article  PubMed  Google Scholar 

  19. Sughrue ME, Kane AJ, Shangari G, Rutkowski MJ, McDermott MW, Berger MS, Parsa AT (2010) The relevance of Simpson Grade I and II resection in modern neurosurgical treatment of World Health Organization Grade I meningiomas. J Neurosurg 113(5):1029–1035

    Article  PubMed  Google Scholar 

  20. Willis J, Smith C, Ironside JW, Erridge S, Whittle IR, Everington D (2005) The accuracy of meningioma grading: a 10-year retrospective audit. Neuropathol Appl Neurobiol 31:141–149

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK, S102JF

    James Barry Heald, Thomas Anthony Carroll & Richard James Mair

Authors
  1. James Barry Heald
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas Anthony Carroll
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard James Mair
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas Anthony Carroll.

Additional information

This study has not yet been presented at a conference.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heald, J.B., Carroll, T.A. & Mair, R.J. Simpson grade: an opportunity to reassess the need for complete resection of meningiomas. Acta Neurochir 156, 383–388 (2014). https://doi.org/10.1007/s00701-013-1923-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-013-1923-6

Keywords

Search

Navigation