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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Simpson grading revisited: Surgeon's estimation of meningioma removal vs. postoperative 68GA-DOTATATE PET/CT

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  • Moritz Ueberschaer - Neurochirurgische Klinik und Poliklinik, Klinikum der Universität München, München, Deutschland
  • Franziska Vettermann - Klinik für Nuklearmedizin, Klinikum der Universität München, München, Deutschland
  • Peter Bartenstein - Klinik für Nuklearmedizin, Klinikum der Universität München, München, Deutschland
  • Jörg-Christian Tonn - Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • Natalie Albert - Klinik für Nuklearmedizin, Klinikum der Universität München, München, Deutschland
  • Christian Schichor - Neurochirurgische Klinik und Poliklinik, Klinikum der Universität München, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.17.02

doi: 10.3205/17dgnc477, urn:nbn:de:0183-17dgnc4770

Published: June 9, 2017

© 2017 Ueberschaer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: The intraoperatively assessed Simpson-Score (SimS) has been used as a predictor for meningioma recurrence for decades. Nevertheless the validity of the scoring system in contemporary neurosurgical practice has recently been called into question. Therefore we investigated the congruence of the surgeon’s estimated SimS with postoperative 68Ga-DOTATATE PET/CT Scans that are known to be more sensitive in diagnosis of meningioma tissue than MRI.

Methods: In this retrospective study 37 adult patients with primary or recurrent WHO°I meningioma and surgical resection between January 2011 and July 2016 were investigated. Inclusion criteria were the documented Simpson Score and a postoperative 68Ga-DOTATATE PET/CT scan, obtained shortly after tumour resection (median time between resection and PET scan: 20 days). The PET parameters SUVmax, SUVmean and threshold-based biological tumor volume (BTV; SUV>2.3) were assessed by an experienced rater from nuclear medicine being blinded for MRI results and the intraoperatively estimated SimS (complete removal with resection (I) or coagulation (II) of dural attachment, III: complete removal without coagulation or resection of dural attachment, IV: subtotal resection, V: decompression/biopsy only).

Results: There were 4 SimS I, 4 SimS II, 4 SimS III and 25 SimS IV resections according to surgeon’s estimate. Among the cases with SimS I and II, only 3/8 showed no pathological uptake, while 5/8 presented with high tracer uptake typical for meningioma tissue (3/4 SimS I: median SUVmax=14.7; SUVmean=5.06; BTV=11.5 cm3, and 2/4 SimS II: median SUVmax= 8.0; SUVmean= 3.8; BTV=5.4 cm3). Of the SimS III cases, all 4 showed pathological 68Ga-DOTATATE uptake, but 2/4 with relatively low uptake intensity and volumes (SUVmax= 2.6 and 2.4; BTV=0.03 and 0.02 cm3). All 25 SimS IV tumours had high uptake of 68Ga-DOTATATE (median SUVmax= 23.2; SUVmean=6.4) with a wide range of remaining BTV (median 21.6 cm3; range 2.7-101.2 cm3).

Conclusion: 68Ga-DOTATATE-PET/CT seems to provide more sensitive information to delineate postoperative remaining meningioma tissue compared to surgeon’s estimated SimS, especially in cases with Simpson I and II resections. This should be taken into account for follow-up management.