The relevance of Simpson grade resectionsin the modern neurosurgical treatment of World Health Organization Grade 1, 2, and 3meningiomas.

Abstract

OBJECT The Simpson grading system has played an important role in the surgical resections of meningiomas. This study set out to determine if this grading system predicts meningioma recurrence in a modern cohort of patients with tumors of all World Health Organization (WHO) grades. METHODS Adult patients who underwent primary, non-biopsy resection of a meningioma at a tertiary care institution between 2007 and 2015 were retrospectively reviewed. Stepwise multivariate proportional hazard analyses were used to identify associations with recurrence following resection. Log-rank analyses were used to compare Kaplan-Meier plots for time to recurrence between each Simpson grade. RESULTS Of the 572 patients who met the inclusion criteria, 72 (12.6%) presented with recurrence. The factors associated with recurrence after gross-total resection (Simpson I-III) were non-WHO grade 1 (HR [95 % CI] 6.215 [2.864-12.419], p < .0001) and preoperative neurological deficits (HR [95 % CI] 2.862 [1.512-5.499], p = 0.001). Factors associated with recurrence after subtotal resections (Simpson IV) were African-American patients (HR [95 % CI] 2.776 [1.232-5.890], p = 0.02) and parafalcine location (HR [95 % CI] 3.956 [1.624-8.775], p = 0.004). Notably, the Simpson grading scale was not an independent risk factor for recurrence. CONCLUSIONS The identification and consideration of the factors associated with recurrence after gross-total or subtotal resections may help guide treatment strategies for patients with meningiomas.

DOI: 10.1016/j.wneu.2017.10.028

Cite this paper

@article{Ehresman2017TheRO, title={The relevance of Simpson grade resectionsin the modern neurosurgical treatment of World Health Organization Grade 1, 2, and 3meningiomas.}, author={Jeff S Ehresman and T Garzon-Muvdi and Davis Rogers and Michael K. Lim and Gary L. Gallia and Jon D. Weingart and Henry Brem and Chetan Bettegowda and Kaisorn Lee Chaichana}, journal={World neurosurgery}, year={2017} }