The role of Simpson grading in meningiomas after integration of the updated WHO classification and adjuvant radiotherapy
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ORIGINAL ARTICLE
The role of Simpson grading in meningiomas after integration of the updated WHO classification and adjuvant radiotherapy Felix Behling 1,2,3 & Christina Fodi 1,2,3 & Elgin Hoffmann 2,3,4 & Mirjam Renovanz 1,2,3,5 & Marco Skardelly 1,2,3 & Ghazaleh Tabatabai 1,2,3,5,6,7 & Jens Schittenhelm 3,8 & Jürgen Honegger 1,2,3 & Marcos Tatagiba 1,2,3 Received: 19 August 2020 / Revised: 21 September 2020 / Accepted: 20 October 2020 # The Author(s) 2020
Abstract Since the introduction of the Simpson grading for the extent of resection in meningiomas in 1957, its usefulness in modern neurosurgery has been challenged. Especially, the updated WHO classification regarding brain invasion and the efficacy of radiation therapy has not been taken into account when evaluating the prognostic role of the Simpson grading in this era. We analyzed the clinical and histopathological data of 1571 meningiomas that were surgically resected in the authors’ institution between July 2003 and March 2017. Operative reports were reviewed regarding the extent of resection according to Simpson grading. Meningioma subtype according to the updated WHO classification of 2016 and clinical characteristics and time to tumor progression were analyzed. The mean follow-up was 38.4 months (range 1.2 to 195.6). A higher rate of tumor recurrence was observed for male gender, younger age, recurrent tumors, non-spinal tumor localization, higher WHO, and Simpson grades in the univariate analysis. In the multivariate analysis older age, recurrent tumors and higher WHO grades remained negative prognostic factors. Among the different Simpson grades, the relative risk for recurrence was highest for grade IV compared to all other grades (each p < 0.0001), while there was no difference between Simpson grades I and II. Adjuvant radiotherapy showed lower rates of tumor recurrence. Subtotal microsurgical resection remains an independent prognostic factor with a higher rate of tumor recurrence. The prognostic benefit of radical treatment of the dural attachment is questionable and needs to be considered when weighing the intraoperative risks of radicality. Keywords Meningioma . Simpson grading . Prognosis . Progression-free survival . Recurrence . Radiotherapy
Introduction Meningioma remains the most common non-malignant primary tumor of the central nervous system, making up one-
third of newly diagnosed tumors [11]. Complete tumor resection is the treatment of choice if surgically feasible [3]. However, depending on the location and infiltration into adjacent structures, a complete microsurgical excision is not
Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10143-02001428-7. * Felix Behling [email protected] 1
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Department of Neurosurgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler Street 3, Tuebingen, Germany Center for CNS Tumors, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital Tuebingen, Eberhard-Karls-University Tuebi
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