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Resection vs. coagulation of dural attachment in patients with spinal meningioma: an updated systematic review and
Marcos Paulo Rodrigues de Oliveira1, Pedro Henrique Ferreira Sandes2, Gabriel Teles de Oliveira Piñeiro2
1Federal University of Bahia, Salvador, Brazil. rodrigues.m@ufba.br.
Background:
The Simpson grading scale assumes dural resection (grade I) is more effective against recurrence than coagulation (grade II). However, the results of recent studies have raised doubts about this effectiveness in spinal meningiomas. Therefore, we aimed to perform a meta-analysis comparing outcomes between Simpson grades I and II in spinal meningiomas.
Methods:
According to the PRISMA statement, we systematically searched PubMed, EMBASE, and Web of Science for studies involving patients with spinal meningiomas who underwent Simpson grades I, II, III, or IV. Outcomes were radiological tumor recurrence, postoperative neurological deficits, and procedure-related complications.
Results:
We included 54 studies with a total of 3334 patients. Simpson grades I, II, III, and IV were performed in 674 (20%), 2205 (66%), 254 (8%), and 201 (6%) patients, respectively. The follow-up ranged from 9 to 192 months, and 95.4% of all tumors were WHO grade 1. There was no difference in radiological tumor recurrence (OR 0.80, 95% CI: 0.46-1.36, P = 0.41; I2 = 0%), postoperative neurological deficits (OR 0.74, 95% CI: 0.32-1.75, P = 0.50; I2 = 0%) or procedure-related complications (OR 2.22, 95% CI: 0.80-6.13, P = 0.12; I2 = 3%) between Simpson grades I and II. Furthermore, no significant difference in postoperative neurological deficits or procedure-related complications was detected when comparing all Simpson's to each other. However, radiological tumor recurrences in Simpson I and II were significantly lower than in III and IV, with Simpson III outperforming IV (OR 0.19, 95% CI: 0.09-0.40, P < 0.01; I2 = 0%).
Conclusion:
Simpson grade I is not more effective than grade II in any outcome, although both are superior to III and IV in tumor recurrence. Our results might suggest that dural coagulation is preferable over resection when the latter carries a higher risk of complications.
Insights
For spinal meningiomas, Simpson grade I resection is not more effective than grade II coagulation for recurrence or complications. Both grades I and II are superior to grades III and IV in preventing tumor recurrence.
Area of Science:
- Neurosurgery
- Oncology
- Spinal Surgery
Background:
- The Simpson grading scale traditionally favors dural resection (grade I) over coagulation (grade II) for spinal meningiomas.
- Recent studies question the superiority of grade I over grade II in preventing tumor recurrence.
- This meta-analysis evaluates the comparative effectiveness of Simpson grades I and II for spinal meningiomas.
Approach:
- Systematic literature search of PubMed, EMBASE, and Web of Science following PRISMA guidelines.
- Inclusion of studies reporting outcomes for Simpson grades I, II, III, or IV in spinal meningioma patients.
- Analysis of radiological tumor recurrence, postoperative neurological deficits, and procedure-related complications.
Key Points:
- No significant difference in tumor recurrence, neurological deficits, or complications between Simpson grades I and II.
- Both Simpson grades I and II demonstrated significantly lower radiological tumor recurrence rates compared to grades III and IV.
- Simpson grade III showed better outcomes than grade IV regarding tumor recurrence.
Conclusions:
- Simpson grade I resection offers no demonstrable advantage over grade II coagulation for spinal meningiomas in terms of recurrence or complications.
- Grades I and II are superior to grades III and IV in reducing tumor recurrence.
- Dural coagulation (grade II) may be preferable to resection (grade I) if resection increases complication risks.
