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Simpson grade: an opportunity to reassess the need for complete resection of meningiomas
James Barry Heald1, Thomas Anthony Carroll, Richard James Mair
1Department of Neurosurgery, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK, S102JF.
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.
Insights
Gross-total resection of benign (WHO grade I) meningiomas is associated with lower recurrence rates compared to subtotal resection. While gross-total resection is ideal, overly aggressive surgery should be avoided due to advances in imaging and radiosurgery.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- The Simpson grading system's predictive value for meningioma recurrence is debated.
- Benign (WHO grade I) meningiomas are common intracranial tumors.
Purpose of the Study:
- To compare the risk of progression/recurrence in benign meningiomas treated with different Simpson grade resections.
- To evaluate the efficacy of Simpson grading in contemporary neurosurgical practice.
Main Methods:
- Retrospective analysis of 183 patients with WHO grade I meningioma.
- Comparison of progression/recurrence-free survival using Kaplan-Meier and Cox regression analyses.
- Inclusion of patients who underwent first-time craniotomy between 2004 and 2012.
Main Results:
- Simpson grade 4 resections showed a significantly higher recurrence rate than grade 1 (HR=3.26, P=0.04).
- Subtotal resections had a significantly greater risk of progression/recurrence than gross-total resections (HR=2.47, P=0.03).
- Simpson grade 2 resections did not show a significantly higher recurrence rate than grade 1 (HR=1.78, P=0.29).
Conclusions:
- Subtotal resection of meningiomas is linked to a significantly higher risk of recurrence.
- Gross-total resection should be the primary surgical goal for meningiomas.
- Modern follow-up imaging and radiosurgery support conservative resection strategies when necessary.
