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Related Experiment Videos

Atypical meningiomas: WHO moved the goalposts?

S J Smith1, S Boddu, D C Macarthur

  • 1Department of Neurosurgery, Queens Medical Centre, Nottingham, UK. sjsmith@doctors.net.uk

British Journal of Neurosurgery
|December 12, 2007
PubMed
Summary
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The 2000 WHO classification revision significantly increased atypical meningioma diagnoses. This change impacts treatment strategies and patient referrals for radiotherapy/radiosurgery.

Area of Science:

  • Neurosurgery
  • Pathology
  • Oncology

Background:

  • The World Health Organization (WHO) revised meningioma histological grading in 2000, standardizing definitions for atypical and malignant subtypes.
  • Prior to 2000, the histological criteria for atypical and malignant meningiomas were less precisely defined, potentially leading to diagnostic variability.

Purpose of the Study:

  • To retrospectively analyze meningioma cases operated on between 1993 and 2003 to assess the impact of the 2000 WHO classification changes on the proportion of tumors diagnosed as atypical.
  • To investigate the epidemiology of meningioma, including associations with prior irradiation and surgical excision difficulty.

Main Methods:

  • Retrospective analysis of 565 meningioma cases operated on between 1993 and 2003.
  • Comparison of tumor grading proportions before and after the adoption of the 2000 WHO classification.

Related Experiment Videos

  • Epidemiological analysis to identify risk factors and surgical outcomes associated with atypical meningiomas.

    • Main Results:

    • A significant increase in the percentage of tumors graded as WHO II (atypical meningiomas) was observed after the 2000 WHO classification changes (from 18.3% to 23.1%, p=0.0408).
    • Previous irradiation was found to be associated with atypical meningiomas (p=0.038).
    • Surgeons reported greater difficulty in achieving complete excision of atypical tumors, with poorer intraoperative Simpson grades noted.

    Conclusions:

    • The 2000 WHO classification revision has led to a significant increase in the diagnosis of atypical meningiomas.
    • The rise in atypical meningioma diagnoses may necessitate increased referrals for radiotherapy/radiosurgery, warranting examination of the evidence base for these treatments.
    • Further investigation is needed to determine if these findings are replicated across other institutions and to evaluate the long-term implications for patient management.