The Relevance of Simpson Grade Resections in Modern Neurosurgical Treatment of World Health Organization Grade I, II, and III Meningiomas

Ehresman, Jeff; Garzón-Muvdi, Tomás; Rogers, Davis; Lim, Michael; Gallia, Gary L.; Weingart, Jon; Brem, Henry; Bettegowda, Chetan; Chaichana, Kaisorn L.

doi:10.1016/j.wneu.2017.10.028

Cited by 45 publications

(36 citation statements)

References 26 publications

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“…The risk of recurrence or progression of residual cranial base meningiomas following surgery is generally predicated by the Simpson's grade of resection and the WHO grade of the tumor. 10,11,13,14 Other factors, such as the presence of a neurological deficit prior to surgery, parasagittal location or involvement of the venous sinuses, a "mushroom" shape of the tumor, or a thick dural tail, may also be predictive of a higher risk of tumor recurrence. 13,14,18,25 A higher WHO grade (II or III) or incomplete tumor removal risks higher rates of progression of residual tumor or regrowth.…”

Section: Discussionmentioning

confidence: 99%

“…10,11,13,14 Other factors, such as the presence of a neurological deficit prior to surgery, parasagittal location or involvement of the venous sinuses, a "mushroom" shape of the tumor, or a thick dural tail, may also be predictive of a higher risk of tumor recurrence. 13,14,18,25 A higher WHO grade (II or III) or incomplete tumor removal risks higher rates of progression of residual tumor or regrowth. 13,14 These are the parameters used by most clinicians when making decisions for adjuvant treatment, following surgical removal of a meningioma.…”

Section: Discussionmentioning

confidence: 99%

“…9 A complete surgical removal of the tumor and its dural base with any involved bone is considered the best therapeutic option for patients with intracranial meningiomas. [10][11][12][13][14] Other options include single fraction radiosurgery, or fractionated radiation for symptomatic or enlarging tumors in surgically inaccessible locations, or in patients in whom surgery is contraindicated or not feasible due to medical comorbidities. [15][16][17][18] Meningiomas are classified into 3 grades of ascending anaplasia by the World Health Organization (WHO) based largely on their appearance on hematoxylin & eosin stained slides.…”

Section: Introductionmentioning

confidence: 99%

“…7 The WHO and Simpson's grades have the most significant impact on the risk of recurrence or progression of a meningioma, although location of the tumor and the presence of a preoperative neurological deficit may also have an impact on this. 10,13,14 A higher WHO grade (II or III) or incomplete tumor removal risks higher rates of progression of residual tumor or regrowth. Among grade I meningiomas, some atypical features, such as necrosis or prominent nucleoli, also correlate with a higher risk of recurrence.…”

Section: Introductionmentioning

confidence: 99%

“…Among grade I meningiomas, some atypical features, such as necrosis or prominent nucleoli, also correlate with a higher risk of recurrence. 13,14 On the other hand, positive progesterone receptor (PR) staining represents a good prognostic indicator of tumor behavior. 1,19,20 The nuclear antigen K i -67, found in all active phases of the cell cycle, is an excellent marker of neoplastic cell proliferative capacity.…”

Section: Introductionmentioning

confidence: 99%

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Value of Ki-67 Labeling Index in Predicting Recurrence of WHO Grade I Cranial Base Meningiomas

et al. 2018

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Objectives Assess impact of Ki-67 labeling index (LI; Ki-67 LI) on risk of recurrence or progression of WHO grade I meningiomas. Study Design Retrospective study of adult patients who underwent resection of cranial base meningioma between 2004 and 2016. Results 272 patients fulfilled criteria for inclusion in the study. Average age was 61.8 years; 196 (72%) were females. Simpson's grade 1 resection was noted in 77 patients (32%), grade 2 in 39 (16%), grade 3 in 36 (15%), and grade 4 in 88 (37%). The Ki-67 LI was low (1–4%) in 214 (78.7%), intermediate (5–9%) in 44 (16.2%), and high (>10%) in 14 (5.2%). Median follow-up was 39 months (IQR: 16–71 months); 221 (87.1%) tumors remained stable or did not recur, 19 (7.4%) recurred, and 14 (5.5%) progressed. Compared with tumors with low Ki-67 LI, those with intermediate Ki-67 LI had 2.47 times (2.47 [1.09–5.59], p = 0.03), and those with high Ki-67 LI had 3.38 times (3.38 [1.16–9.89], p = 0.03) higher risk of recurrence or progression. Tumors with Ki-67 LI > 4% had a shorter time to recurrence or progression (p = 0.01). Recurrence or progression-free survival rates at 3, 5, and 10 years for tumors with low Ki-67 LI were 95%, 89%, and 75%, respectively; tumors with intermediate Ki-67 LI, 87%, 69%, and 52%, respectively; tumors with high Ki-67 LI, 78%, 49%, and 49%, respectively. Conclusions Following surgical resection of a WHO grade I cranial base meningioma, Ki-67 LI > 4% may predict an increased risk of recurrence or progression of residual tumor.

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