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[Relevance of Simpson's grades in the resection of grade I meningiomas]
Pablo Ajler1, Sofía Beltrame1, Daniela Massa1
1Department of Neurosurgery, Hospital Italiano de Buenos Aires, Argentina.
Objective:
Compare the number of recurrences in patients with WHO Grade I meningiomas that underwent microsurgical resection.
Introduction:
In 1957 Simpson established five grades for surgical resection for intracranial meningiomas and recurrence rate. He thought that an aggressive removal of these tumors with dura and bone was necessary to cure them. Development of new diagnostic methods, advances in anatomopathology and microsurgical technique lead us to question if this scale has a value nowadays.
Methods:
A retrospective analysis was performed. All patients operated from grade I meningiomas between February 2006 to December 2015 were included. Pre and postoperative MRI as well as histology were analyzed. A multivariate analysis was performed, a P < 0.05 was considered statistically significant.
Results:
There was no statistical significant difference between patients undergoing Simpson Grade I, II, III or IV resection (P = 0,3117). This could be best stated for Simpson Grade I and II resection, where the number of patients included in the study was higher. When we analyze tumor location there was not significant difference in recurrence between groups (P = 0,2203).
Conclusion:
For grade I meningiomas there is no significant difference in the recurrence between patients with a Simpson Grade I or II resection, thus increasing morbidity of the surgery is not justified. A new resection scale should be designed taking into account the WHO classification.
Insights
For WHO Grade I meningiomas, aggressive surgical resection (Simpson Grade I or II) does not significantly reduce recurrence rates compared to less aggressive approaches. This suggests that extensive resection may not be necessary, potentially reducing surgical morbidity.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Context:
- The Simpson grading system, established in 1957, categorizes meningioma resection extent and recurrence rates.
- Advances in diagnostics, pathology, and microsurgery prompt re-evaluation of the Simpson scale's current relevance.
Purpose:
- To compare recurrence rates in patients with WHO Grade I meningiomas after microsurgical resection.
- To evaluate the clinical utility of the Simpson grading system for WHO Grade I meningiomas.
Summary:
- A retrospective analysis of WHO Grade I meningioma patients (Feb 2006-Dec 2015) found no statistically significant difference in recurrence rates across Simpson resection grades (I-IV).
- Recurrence rates did not significantly differ based on tumor location.
- The study highlights that Simpson Grade I and II resections showed no significant difference in recurrence, particularly in larger patient subgroups.
Impact:
- Findings suggest that extensive surgical resection (Simpson Grade I or II) for WHO Grade I meningiomas may not be justified due to increased morbidity without a significant reduction in recurrence.
- Recommends developing a new resection scale that incorporates the WHO classification for improved clinical guidance.
