The Simpson grading revisited: aggressive surgery and its place in modern meningioma management

Gousias, Konstantinos; Schramm, Johannes; Simon, Matthias

doi:10.3171/2015.9.jns15754

Cited by 162 publications

(149 citation statements)

References 19 publications

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“…16,19,24,27 Postoperative complication rates of 15%-20% have been described in recent studies. 7,20,27 In our series, surgical complications totaled 14%, while an additional 5% were identified as medical complications. Unfortunately, twothirds of patients with surgical complications had to be managed surgically; patients who required lumbar drains are included in this percentage.…”

Section: Complications After Microsurgery Decreased With a Multimodalmentioning

confidence: 61%

“…The Simpson resection grade had a significant impact on time to progression or recurrence when Simpson Grade IV patients and all WHO tumor grades were considered. 7,17 However, among patients who underwent total macroscopic tumor resection (Simpson Grades I-III), there was no significant difference in time to recurrence. Moreover, when benign meningiomas alone were considered, the Simpson resection grade did not have a significant impact on time to recurrence or progression.…”

Section: Influence Of Simpson Resection Grade On Time To Progression mentioning

confidence: 95%

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Multimodal treatment of parasagittal meningiomas: a single-center experience

Gatterbauer¹,

Gevsek²,

Höftberger³

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Treatment of parasagittal meningiomas is still considered a challenge in modern microsurgery. The use of microsurgical resection, radiosurgery, or a microsurgery-radiosurgery combination treatment strategy is often debated. The aim of this study was to evaluate the treatment of parasagittal meningioma and provide evidence that a multimodal approach reduces complication rates and achieves good tumor control rates. METHODS The authors retrospectively reviewed long-term follow-up data on 117 patients who had been treated for parasagittal meningiomas at their institution between 1993 and 2013. Treatment included microsurgery, Gamma Knife radiosurgery (GKRS), and radiotherapy. RESULTS The median tumor volume prior to the first microsurgical resection was largest in the microsurgery-radiosurgery combination treatment group. Invasion of the superior sagittal sinus was significantly associated with a Simpson Grade IV resection and subsequent radiosurgery treatment. The Simpson resection grade did not influence time to progression or recurrence in benign meningioma cases. Complete sinus occlusion was followed by microsurgical resection of the occluded sinus, by tumor resection without resection of the sinus, or by GKRS. Histopathology revealed WHO Grade I tumors in most patients. However, a high percentage (33%) of atypical or malignant meningiomas were diagnosed after the last microsurgical resection. The time to recurrence or progression after microsurgery was significantly longer in patients with WHO Grade I meningiomas than in those with Grade II or III meningiomas. At follow-up, tumor control rates after GKRS were 91% for presumed meningioma, 85% for benign meningioma, 71% for atypical meningioma, and 38% for malignant meningioma. CONCLUSIONS A multimodal treatment approach to parasagittal meningiomas reduces the rate of complications. Thus, microsurgery, radiotherapy, and radiosurgery are complementary treatment options. Gamma Knife radiosurgery is safe and effective in patients with meningiomas invading the superior sagittal sinus. The procedure can be part of a multimodal treatment plan or administered as a single treatment in well-selected patients.

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Section: Complications After Microsurgery Decreased With a Multimodalmentioning

confidence: 61%

Section: Influence Of Simpson Resection Grade On Time To Progression mentioning

confidence: 95%

Multimodal treatment of parasagittal meningiomas: a single-center experience

Gatterbauer¹,

Gevsek²,

Höftberger³

et al. 2017

Journal of Neurosurgery

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“…Consequently, many surgeons have shifted to combined‐treatment paradigms with STR followed by adjuvant therapy of the remnant. Nonetheless, recent studies have demonstrated a strong inverse correlation between the extent of tumor resection, a risk of radiologic progression, and rate of volumetric growth . The latter is especially true for cases where <70% of the preoperative tumor volume was resected, with disease progression rates ranging from 2.9% to 66.7% .…”

Section: Intradural Tumorsmentioning

confidence: 99%

“…By contrast, GTR has been equated with lower recurrence rates. Despite this, a lack of correlation between GTR and higher survival rates has been observed …”

Section: Intradural Tumorsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

151

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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“…In fact, along with our anecdotal observation, Gousias et al [5] found in their series of 901 consecutive meningioma resections that the influence of Simpson grade on progression-free survival (PFS) was even greater in grade II and III than grade I meningiomas.…”

mentioning

confidence: 99%

A quest towards personalised medicine for grade II meningiomas—will need to zoom in

2016

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In the end, 206 cases were included in the study and only two patients were lost to follow-up. The median follow-up was 4.1 years, with the interquartile range of 1.6-7.3 years.Overall survival probabilities at 1, 5 and 10 years were respectively: 95, 84 and 73 %-easy numbers to remember. Even based on the relatively low numbers, the 95 %-confidence intervals are fairly tight: 93-98, 78-90, and 65-82 %, respectively. When the 5-year overall survival of the Glasgow cohort is viewed in the context of other series (Table 3) [2], it seems that 5-year survival of surgically treated atypical meningiomas ranges from approximately 75-90 % (an apparent outlier series put aside).Univariate analysis of the cohort revealed age, Simpson grade, presence of brain invasion, venous sinus invasion, tumour volume and reoperation to be associated with survival. These variables were then entered into the Cox multivariate regression model, which identified age (62 years and lower), Simpson resection grade (grades 1-3 versus 4-5) and absence of brain invasion as predictors of longer overall survival.Although questioned by some [14], Simpson grade remains a powerful determinant of prognosis for meningiomas, including atypical meningiomas. In fact, along with our anecdotal observation, Gousias et al. [5] found in their series of 901 consecutive meningioma resections that the influence of Simpson grade on progression-free survival (PFS) was even greater in grade II and III than grade I meningiomas.Radiotherapy was not a factor predictive of survival, even in the univariate model. The specific role of adjuvant radiotherapy for individual tumours remains unclear and has not been rigorously assessed in the existing literature [11,12]. For grade II meningioma, two phase-2 dose-escalation studies by the EORTC and RTOG are due to report soon and the upcoming ROAM/EORTC 1308 trial will address the role of early radiotherapy following gross total resection [6]. Not surprisingly, at least for now, meningiomas remain a Bsurgical^disease with regards to their treatment.Brain invasion was the basis of the last modification of the meningioma grading published in the in the 2007 edition of the WHO classification of the tumours of the central nervous system [10]. In the 1993 classification, when atypical meningioma was first introduced, brain invasion was a feature that automatically upgraded the tumour to an anaplastic category [8]. The next edition, the 2000 WHO classification [7], saw major changes introduced to the grading of meningiomas. The previously vague histological descriptions were tightened up with explicitly defined mitotic rates for each grade. Brain invasion in the context of otherwise benign histological

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The Simpson grading revisited: aggressive surgery and its place in modern meningioma management

Cited by 162 publications

References 19 publications

Multimodal treatment of parasagittal meningiomas: a single-center experience

Multimodal treatment of parasagittal meningiomas: a single-center experience

ICAR: endoscopic skull‐base surgery

A quest towards personalised medicine for grade II meningiomas—will need to zoom in

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