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Grading meningioma resections: the Simpson classification and beyond.

Matthias Simon1, Konstantinos Gousias2,3,4

  • 1Department of Neurosurgery, Evangelisches Klinikum Bethel, Universitätsklinikum OWL, Bielefeld, Germany. Matthias.Simon@evkb.de.

Acta Neurochirurgica
|January 23, 2024
PubMed
Summary

The Simpson classification for meningioma resection extent is supported by evidence but has limitations. Advances in neuroimaging may help overcome subjectivity and improve grading for better surgical outcomes.

Keywords:
Extent of resectionMeningiomaMeningioma surgerySimpson grading

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Area of Science:

  • Neurosurgery
  • Oncology
  • Medical Imaging

Background:

  • Meningiomas are often surgically curable dura-based tumors.
  • Technological advances necessitate reappraisal of Simpson's meningioma resection grading.
  • Current classification has limitations in applicability and subjectivity.

Purpose of the Study:

  • To re-evaluate the Simpson classification for meningioma resection extent.
  • To identify limitations and potential improvements in current grading systems.
  • To explore the role of advanced neuroimaging in meningioma surgery.

Main Methods:

  • Review of published evidence on Simpson's classification.
  • Analysis of limitations including applicability and intraoperative subjectivity.
  • Consideration of neuroimaging advancements like somatostatin receptor PET scanning.

Main Results:

  • Published evidence supports the tenets of Simpson's classification.
  • Significant limitations exist regarding applicability across tumor locations and intraoperative subjectivity.
  • Advanced neuroimaging may mitigate subjectivity issues.

Conclusions:

  • Extent of resection is crucial in meningioma surgery, but grading remains controversial.
  • Multicenter prospective studies focusing on advanced neuroimaging are warranted.
  • Improved grading systems are needed to reflect surgical achievability and clinical significance.