Agreement Between Extent of Meningioma Resection Based on Surgical Simpson Grade and Based on Postoperative Magnetic Resonance Imaging Findings

Slot, K. Mariam; Verbaan, Dagmar; Bosscher, Lisette; Vandertop, W. Peter; Peerdeman, Saskia M.

doi:10.1016/j.wneu.2017.12.178

Cited by 25 publications

(21 citation statements)

References 16 publications

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“…The Simpson grades were retrospectively obtained from operative reports and not adjusted after postoperative imaging, hence potentially suffering from inaccurate intraoperative assessment or bias in some cases. In fact, postoperative imaging in another series revealed an intraoperative overrating of the extent of resection in a considerable portion of surgeries [ 21 ]. As data were only gained from one tertiary neurosurgical department, a general transferability of our results remains unclear and should be further investigated in multicenter analyses.…”

Section: Discussionmentioning

confidence: 99%

The Simpson grading: defining the optimal threshold for gross total resection in meningioma surgery

et al. 2020

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Classification of the extent of resection into gross and subtotal resection (GTR and STR) after meningioma surgery is derived from the Simpson grading. Although utilized to indicate adjuvant treatment or study inclusion, conflicting definitions of STR in terms of designation of Simpson grade III resections exist. Correlations of Simpson grading and dichotomized scales (Simpson grades I–II vs ≥ III and grade I–III vs ≥ IV) with postoperative recurrence/progression were compared using Cox regression models. Predictive values were further compared by time-dependent receiver operating curve (tdROC) analyses. In 939 patients (28% males, 72% females) harboring WHO grade I (88%) and II/III (12%) meningiomas, Simpson grade I, II, III, IV, and V resections were achieved in 29%, 48%, 11%, 11%, and < .5%, respectively. Recurrence/progression was observed in 112 individuals (12%) and correlated with Simpson grading (p = .003). The risk of recurrence/progression was increased after STR in both dichotomized scales but higher when subsuming Simpson grade ≥ IV than grade ≥ III resections (HR: 2.49, 95%CI 1.50–4.12; p < .001 vs HR: 1.67, 95%CI 1.12–2.50; p = .012). tdROC analyses showed moderate predictive values for the Simpson grading and significantly (p < .05) lower values for both dichotomized scales. AUC values differed less between the Simpson grading and the dichotomization into grade I–III vs ≥ IV than grade I–II vs ≥ III resections. Dichotomization of the extent of resection is associated with a loss of the prognostic value. The value for the prediction of progression/recurrence is higher when dichotomizing into Simpson grade I–III vs ≥ IV than into grade I–II vs ≥ III resections.

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Section: Discussionmentioning

confidence: 99%

The Simpson grading: defining the optimal threshold for gross total resection in meningioma surgery

et al. 2020

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“…In the same series, the authors revealed an intraclass correlation coefficient of 0.613 and an absolute agreement of 76% between the tumor volume on postoperative imaging and the intraoperatively assessed Simpson grade, and proposed a new radiological scale to quantify the EOR based on postoperative MRI (MEGA grading system). 34 In our study, despite a sufficient reliability according to Cohen's kappa value, residual tumor tissue of up to 33.5 cm 3 was detected in 8% of surgeries in which visible tumor tissue had been totally removed according to the intraoperative impression of the neurosurgeon (Simpson grade I-III resections). These findings indicate that correct intraoperative assessment might be complicated, such as in cases of limited overview of the entire resection cavity, and can lead to substantial misjudgment of the EOR.…”

Section: Postoperative Imaging and Important Information About Tumor Remnantscontrasting

confidence: 59%

“…tions are sparsely investigated, and volumetric analyses are mostly restricted to meningioma subgroups and small patient groups. 23,[34][35][36][37] In 2018, Hunter et al 23 reported a strong correlation between the postoperative tumor volume and recurrence in a series of 23 petroclival meningiomas. Similarly, Shakir et al 35 showed that local control is strongly correlated with the postoperative tumor volume prior to adjuvant radiation in a series of 70 atypical meningiomas and delineated a critical cutoff value of approximately 9 cm 3 .…”

Section: Prognostic Value Of the Postoperative Tumor Volume Compared To Intraoperatively Assessed Eormentioning

confidence: 99%

“…To the best of our knowledge, no previous studies exist that directly compare the predictive value of surgical and radiological EOR. While the informative gain of early postoperative imaging after meningioma surgery remains to be further elucidated, 22,34 these findings suggest that tumor volumetry on the initial postoperative MRI should be additionally considered when estimating the risk of recurrence in patients with meningioma. In Fig.…”

Section: Prognostic Value Of the Postoperative Tumor Volume Compared To Intraoperatively Assessed Eormentioning

confidence: 99%

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Risk of tumor recurrence in intracranial meningiomas: comparative analyses of the predictive value of the postoperative tumor volume and the Simpson classification

Spille¹,

Heß²,

Bormann

et al. 2021

Journal of Neurosurgery

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OBJECTIVEIn meningiomas, the Simpson grading system is applied to estimate the risk of postoperative recurrence, but might suffer from bias and limited overview of the resection cavity. In contrast, the value of the postoperative tumor volume as an objective predictor of recurrence is largely unexplored. The objective of this study was to compare the predictive value of residual tumor volume with the intraoperatively assessed extent of resection (EOR).METHODSThe Simpson grade was determined in 939 patients after surgery for initially diagnosed intracranial meningioma. Tumor volume was measured on initial postoperative MRI within 6 months after surgery. Correlation between both variables and recurrence was compared using a tree-structured Cox regression model.RESULTSRecurrence correlated with Simpson grading (p = 0.003). In 423 patients (45%) with available imaging, residual tumor volume covered a broad range (0–78.5 cm3). MRI revealed tumor remnants in 8% after gross-total resection (Simpson grade I–III, range 0.12–33.5 cm3) with a Cohen’s kappa coefficient of 0.7153. Postoperative tumor volume was correlated with recurrence in univariate analysis (HR 1.05 per cm3, 95% CI 1.02–1.08 per cm3, p < 0.001). A tree-structured Cox regression model revealed any postoperative tumor volume > 0 cm3 as a critical cutoff value for the prediction of relapse. Multivariate analysis confirmed the postoperative tumor volume (HR 1.05, p < 0.001) but not the Simpson grading (p = 0.398) as a predictor for recurrence.CONCLUSIONSEOR according to Simpson grading was overrated in 8% of tumors compared to postoperative imaging. Because the predictive value of postoperative imaging is superior to the Simpson grade, any residual tumor should be carefully considered during postoperative care of meningioma patients.

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“…Imaging techniques that enable noninvasive, preoperative assessment of tumor biology and WHO grade could potentially be helpful in surgical planning. Suspicion for malignancy in a meningioma will influence timing of surgery, and surgical strategy in terms of extent of resection and the risk a surgeon should take to achieve a total resection, as well as the indication for early postoperative imaging 9–11 …”

Section: Introductionmentioning

confidence: 99%

Prediction of Meningioma WHO Grade Using PET Findings: A Systematic Review and Meta‐Analysis

Slot

Verbaan

Buis

et al. 2020

Journal of Neuroimaging

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Background and Purpose World Health Organization (WHO) grading of meningiomas reflects recurrence rate and prognosis. Positron emission tomography (PET) investigates metabolic activity, allowing for distinction between low‐ and high‐grade tumors. As preoperative suspicion for malignant meningioma will influence surgical strategy in terms of timing, extent of resection, and risks taken to achieve a total resection, we systematically reviewed the literature on PET‐imaging in meningiomas and relate these findings to histopathological analysis. Methods Searches in PubMed, EMBASE, and The Cochrane Library, from inception to September 2019, included studies of patients who had undergone surgery for a histologically verified intracranial meningioma, with a PET‐scan prior to surgery and description of (semi)quantitative PET values for meningiomas from two different WHO groups. Studies comparing more than 1 patient per WHO group were included in the meta‐analysis. Results Twenty‐two studies (432 patients) were included. 18fluor‐fluorodesoxyglucose (18F‐FDG) PET was mostly described to differentiate benign from malignant meningiomas. Pooled data showed differences in mean (95% CI) Standardized Uptake Value (SUV) for WHO II/III compared to WHO I of 2.51 (1.36, 3.66), and in tumor‐to‐normal (T/N) ratio (T/N ratio) for WHO II/III versus WHO I of .42 (.12, .73). Conclusions We found that SUV and T/N ratio in 18F‐FDG PET may be useful to noninvasively differentiate benign from malignant meningiomas. T/N ratio seems to have a high specificity for the detection of high‐grade meningiomas. Other PET tracers were studied too infrequently to draw definitive conclusions. Before treatment strategies can be adapted based on 18F‐FDG PET, prospective studies in larger cohorts are warranted to validate the optimal T/N ratio cutoff point.

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Agreement Between Extent of Meningioma Resection Based on Surgical Simpson Grade and Based on Postoperative Magnetic Resonance Imaging Findings

Cited by 25 publications

References 16 publications

The Simpson grading: defining the optimal threshold for gross total resection in meningioma surgery

The Simpson grading: defining the optimal threshold for gross total resection in meningioma surgery

Risk of tumor recurrence in intracranial meningiomas: comparative analyses of the predictive value of the postoperative tumor volume and the Simpson classification

Prediction of Meningioma WHO Grade Using PET Findings: A Systematic Review and Meta‐Analysis

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