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The Simpson Grading: Is It Still Valid?

Silky Chotai1, Theodore H Schwartz2

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The Simpson Grade is outdated for predicting meningioma recurrence. Modern techniques and molecular analysis offer better risk stratification for maximal safe resection, not just gross total resection.

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Area of Science:

  • Neurosurgery
  • Oncology
  • Medical Imaging

Background:

  • The Simpson Grade was developed during an era of limited surgical and imaging capabilities for meningioma resection.
  • Modern advancements in surgical techniques, imaging, and molecular analysis have evolved significantly since the Simpson Grade's inception.

Purpose of the Study:

  • To review the literature on the Simpson Grade's association with meningioma recurrence in contemporary neurosurgical practice.
  • To evaluate the continued utility of the Simpson Grade in light of advancements in meningioma treatment.

Main Methods:

  • A PubMed literature search was conducted using keywords related to Simpson Grade, meningioma, recurrence, and extent of resection.
  • A separate search focused on intraoperative imaging and meningioma was also performed.
  • The review included retrospective studies evaluating the prognostic value of Simpson Grades.

Main Results:

  • Simpson Grades I-III (gross total resection) were associated with lower recurrence rates than Grade IV (subtotal resection).
  • Tumor volume, not accounted for by the Simpson Grade, is a significant predictor of recurrence.
  • Subtotal resection followed by stereotactic radiosurgery showed comparable recurrence-free survival to gross total resection.

Conclusions:

  • The Simpson Grade is no longer a relevant scale for prognostication in modern meningioma surgery.
  • A new grading system should incorporate post-operative imaging (gross total resection vs. subtotal resection with volume assessment) and molecular markers for accurate recurrence risk stratification.