The Simpson grading in meningioma surgery: does the tumor location influence the prognostic value?

Voß, Kira Marie; Spille, Dorothee Cäcilia; Sauerland, Cristina; Molina, Eric Suero; Brokinkel, Caroline; Paulus, Werner; Stummer, Walter; Holling, Markus; Jeibmann, Astrid; Brokinkel, Benjamin

doi:10.1007/s11060-017-2481-1

Cited by 97 publications

(71 citation statements)

References 40 publications

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“…This represents a 1% risk of surgical retreatment per patient-year of follow-up. Patient-and tumor-characteristics were similar to previous studies reported in the literature 15,16 . However, the recurrence rate was significantly lower than in previously reported data 5,16 .…”

Section: Discussionsupporting

confidence: 83%

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Benefits of re-do surgery for recurrent intracranial meningiomas

Lemée

Corniola

Meling

2020

Sci Rep

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Meningiomas are the most common intracranial extra-axial tumor. While the literature is abundant on the therapeutic management of meningioma recurrence after the initial surgery, the natural history of repeated recurrences is poorly described, as well as and their respective management. A partly retrospective, partly prospective review was conducted in a Norwegian cohort of 1469 consecutive cases of meningioma surgically treated, totaling 11 414 patient-years of follow-up. 114 recurrences (7.7%) were treated surgically with a risk a surgical retreatment of 1% per patient-year of follow-up. 36 patients were operated on 3 times or more. The time-to-retreatment (TTR) decreased significantly and steadily between surgeries, from 4.3 ± 4 years after the first surgery to 2.4 ± 2.9 years after the third surgery. The primary driver for recurrence was the WHO grade (OR 7.13 [4.40;11.55], p < 0.001 for the first recurrence and OR 4.13 [1.49;12.15], p 0.008 for the second), the second predictive factor being a skull base location (OR 2.76 [1.95;3.99] p < 0.001 and OR 0.24 [0.09;0.65], p0.006 respectively). The rates of postoperative hematomas and infections were not influenced by the number of surgeries, whereas the rate of postoperative neurological worsening increased from 3.9% to 16.6% and 13.9%, respectively, after the first, second, and third surgeries. We observed that the TTR decreased significantly between surgeries in patients requiring repeated resections, indicating that surgical treatment of recurrences does not reset the clock but is indeed a "race against time". This should be considered when assessing the benefit-to-risk ratio of patients undergoing repeated surgeries for a recurrent meningioma. Meningiomas are the most frequent intracranial extra-cerebral tumors 1,2. They are classified according to the World Health Organization (WHO) in histopathological grades from I to III 3. The therapeutic management is primarily surgical, aimed at a complete resection of the tumor with its dural tail 4 , followed by a clinico-radiological follow-up 5,6. This "intervention-first" paradigm allows for high rates of disease-control 6,7. However, the majority of meningiomas show slow growth, making their therapeutic management similar to a chronic disease with a lengthy clinico-radiological follow-up 8,9. Should the tumor recur, the treatment is surgical whenever possible, according to the patient's functional status and Karnofsky Performance Scale (KPS). Stereotactic or conventional radiation therapies are privileged otherwise. Therefore, early recognition of recurrence and its management is of paramount importance for neurosurgeons. While the literature is abundant on the therapeutic management of meningioma recurrence after the initial surgery, the natural history of repeated recurrences and their therapeutic management is poorly described. Furthermore, there is little information regarding the interval between surgeries (or any treatment) and successive recurrences. Such information would be useful to assess the benefit-...

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Section: Discussionsupporting

confidence: 83%

“…Patient-and tumor-characteristics were similar to previous studies reported in the literature 15,16 . However, the recurrence rate was significantly lower than in previously reported data 5,16 . This is especially noteworthy as we have a high proportion of skull-base meningiomas in our overall cohort (47%).…”

Section: Discussionsupporting

confidence: 83%

Benefits of re-do surgery for recurrent intracranial meningiomas

Lemée

Corniola

Meling

2020

Sci Rep

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“…This was not surprising; these are all WHO grade I cranial base tumors; there is abundant literature that substantiates the impact age, Simpson's grade, and PR receptor status have on tumor recurrence. [39][40][41] Our cohort was reflective of the usual reported pattern of WHO grade I cranial base meningiomas; 72% of the patients were female and the average age was 61.8 years. The PR receptor status was also consistent with that reported for WHO grade I cranial base meningiomas; among the 234 patients, in whom this information was available, 96% were PRþ.…”

Section: Discussionmentioning

confidence: 93%

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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“…This fact justifies the recommendation made by Sughrue et al 6 to be no aggressive in the resection of small tumor remnants in skull base meningiomas if this significantly increases the risk of neurological deficits for the patient. However, recently Voss et al 7 show that Simpson's grading and extent of resection were not similarly important in all locations. It is remarkable that the recurrence in the SWMs has been reported in the literature as very high.…”

Section: Discussionmentioning

confidence: 96%

“…In medial meningiomas the recurrence rate at 10 years varies between 30% and 100% of cases, where the rates of complete resection of the meningiomas of this location are very low in the historical series, between 60% and 85%. 7 On the other hand, the new 2016 WHO classification modifies the diagnostic criteria for grade II meningiomas and with these criteria some grade I tumors have one or more pathological criteria for grade II meningiomas. 2 In our series, cases of grade I meningiomas showing a rapid growth is not exceptional, as well as regional recurrences or the synchronic presence of multiple lesions.…”

Section: Discussionmentioning

confidence: 99%

Combined Extradural and Intradural Pterional Transzygomatic Approach to Large Sphenoid Wing Meningiomas. Operative Technique and Surgical Results

González-Darder

2018

J Neurol Surg B

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Objectives Describe a unique and safe surgical procedure for the microsurgical management of large sphenoid wing meningiomas (SWMs) aimed to a radical resection of these tumors. Design A prospective series of 26 cases with SWMs larger than 3 cm in one of its main diameter is presented. All patients were studied following the same clinical and imaging procedures. The surgical approach was through a pterional transzygomatic craniotomy. The surgical procedure has the following steps: 1. Extradural tumor devascularization and resection of the hyperostotic and/or infiltrated bone and then intradurally; 2. Intradural tumor debunking; 3. Microdissection of vascular branches and perforators from the capsule; 4. Identification of the optic and oculomotor nerves and internal carotid artery; 5. Tumor capsule dissection and resection; 6. Dural resection or cauterization; 7. Dural and bone reconstruction and closing. Results All lesions were completely removed. Most complications were transient. The most relevant complication was a large middle cerebral artery infarct with permanent hemiplegia despite a decompressive craniotomy. Conclusion Large SWMs can be considered as a single pathology regarding the surgical approach and intraoperative microsurgical procedure strategies. The pterional transzygomatic approach allows an extradural devascularization of the tumor and an extensive bone resection that facilitates the intradural stage of tumor resection. The proposed approach allows a wide and radical resection of the duramater and bone that increases the Simpson grade. However, surgery does not control other biological or molecular prognostic factors involved in tumor recurrence.

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The Simpson grading in meningioma surgery: does the tumor location influence the prognostic value?

Cited by 97 publications

References 40 publications

Benefits of re-do surgery for recurrent intracranial meningiomas

Benefits of re-do surgery for recurrent intracranial meningiomas

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

Combined Extradural and Intradural Pterional Transzygomatic Approach to Large Sphenoid Wing Meningiomas. Operative Technique and Surgical Results

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