Is Simpson Grade I Removal Necessary in All Cases of Spinal Meningioma? Assessment of Postoperative Recurrence during Long-Term Follow-up

Abstract

It is generally accepted that the first choice of treatment for spinal meningiomas is "radical" surgical removal. However, Simpson grade I removal is sometimes difficult, especially in cases with ventral dural attachment, because of the risk of spinal cord damage or the difficulty of dural repair after radical resection. In addition, there is no consensus on a surgical strategy for radicality, whether or not Simpson grade I resection should be performed in all cases of spinal meningioma. In this study, we retrospectively analyzed clinical and radiological data of surgically treated 14 patients with spinal meningioma, to assess the influence of the Simpson grade to tumor recurrences during long-term follow-up (median 8.2 years, 1.3-27.9). The number of patients in Simpson grades I, II, III, and IV were 2, 8, 0, and 3, respectively; Simpson grading was not applicable to one patient with non-dura-based meningioma. No postoperative permanent neurological worsening was encountered. The recurrence rate was 21.4% (3 out of 14 cases). Of these 3 recurrent cases, 1 was a case of non-dura-based meningioma and another was a case of neurofibromatosis type 2 (NF2); both of them are known as risk factors for recurrence after surgical removal of spinal meningiomas. Considering this background of these two recurrences, the clinical results of the present study are consistent with previous results. Therefore, we propose that surgeons do not always have to achieve Simpson grade I removal if dural repair is complicated and postoperative cerebrospinal fluid (CSF) leakage or neurological worsening are estimated after resection of dural attachment and repair of dural defect.

Simpson grade 2 resection and tumor recurrence in ventrally localized spinal meningiomas

“…However, we only analyzed cases with ventral localization that underwent Simpson grade 2 resection. When the literature on ventrally located spinal meningiomas with Simpson grade 2 resection is reviewed, the number of patients studied is similar to that in our study (1)(2)(3)6,11,15,17,18).…”

“…A B C is often impossible (1,3,8,11,18). It has been reported that the gross total resection is often sufficient in preventing tumor recurrences (2,8,11,15,18). Nakamura et al have reported high recurrence rates in cases who underwent Simpson grade 2 resection (10), with recurrence in 6 of 19 cases.…”

EANO guidelines for the diagnosis and treatment of meningiomas

“…The presence of type 2 neurofibromatosis (NF2) implies a risk of developing malignant or multiple meningiomas, whereas the role of NF2 in developing grade II or III meningiomas is not clear. There are increasing dData allowing thefor a molecular genetic characterization of atypic and malignant meningiomas accumulate, e.g., TERT mutations are associated with higher meningioma grades 9,48 .…”

New Developments in Management of Meningioma

“…Contrary to commonly opinions, there is no evidence of an increased prevalence of meningiomas in cancer survivors [9]. Spinal meningiomas represents 25-46% of spinal tumors, affecting more commonly middle-aged women and having thoracic laterality [10,11].…”

“…However, more than 9% of all meningiomas are characterized by aggressive clinical behavior with increased risk of tumor recurrence [20], with 1,3 -14,7% recurrence rate at the spinal cord meningiomas [11].…”