gms | German Medical Science

71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

The prognostic role of Simpson grading in meningioma –still relevant after 62 years?

Die prognostische Rolle des Simpson Grads in Meningeomen – nach 62 Jahren noch relevant?

Meeting Abstract

  • presenting/speaker Felix Behling - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Christina-Katharina Fodi - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Irina Gepfner-Tuma - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland; Universitätsklinikum Tübingen, Klinik für Neurologie, Tübingen, Deutschland
  • Kathrin Machetanz - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Kristina Kaltenbacher - Universitätsklinikum Tübingen, Klinik für Neurologie, Tübingen, Deutschland
  • Mirjam Renovanz - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Marco Skardelly - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Ghazaleh Tabatabai - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland; Universitätsklinikum Tübingen, Klinik für Neurologie, Tübingen, Deutschland
  • Jens Schittenhelm - Universitätsklinikum Tübingen, Institut für Neuropathologie, Tübingen, Deutschland
  • Marcos Tatagiba - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP172

doi: 10.3205/20dgnc455, urn:nbn:de:0183-20dgnc4559

Published: June 26, 2020

© 2020 Behling 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: Since the proclamation of the Simpson grading for the extent of resection in meningiomas in 1957, many more insights have been gained regarding the biology, histopathological classification and treatment of meningiomas. Until today the Simpson grading determines the intraoperative course during meningioma resection, believing that a Simpson grade II resection is better for the patient than grade III for example. In the light of the established prognostic factors in meningiomas, this retrospective analysis aims to clarify to what extent the Simpson grading in its single cutoffs is still of prognostic significance for our patients.

Methods: We analyzed the clinical and histopathological data of 429 meningiomas that were surgically resected in the authors' institution between 04/2011 bis 12/2015. Operative reports were reviewed regarding the extent of resection according to the Simpson grading system. Meningioma subtype according to the WHO classification of 2016 as well as histopathological brain invasion and time of progression were retrieved from clinical records. Univariate and multivariate analyses were applied.

Results: Altogether 49 meningiomas showed tumor recurrence (49/429, 11.4%) after a mean follow-up of 31 months (1.7-95.7 months). The rate of recurrence increased with each Simpson grading step. Meningiomas operated according to Simpson grade I showed only 4.4% recurrences (4/90) while grade II and III had highe rates of 5.5% (7/126) and 12.6% (12/95). Tumors resected according to Simpson grade IV, meaning a subtotal resection, had the highest rate of recurrence with 23.3 % (24/103) (Pearson's chi-squared test, p<.0001). Multivariate analysis including WHO grade and Simpson grade at all different cutoffs revealed that next to the WHO grading (p=0.0443) only the cut off at Simpson grade 3 and 4 has independent prognostic value (p=0.0423). Cut offs between Simpson grade 1 and 2 as well as 2 and 3 have no independent prognostic significance.

Conclusion: Incomplete tumor resection after microsurgical meningioma resection remains an independent prognostic factor with a higher rate of tumor recurrence. The multivariate analysis of this cohort does not show a prognostic benefit between Simpson grades 1/2 and 2/3, suggesting that the efforts we make and the risks we take when encountering the dural attachment of meningiomas have a questionable prognostic impact.