Neurocirugía (English edition) Neurocirugía (English edition)
Clinical Research
Relevance of Simpson's grading system for resections in WHO grade I meningiomas
Relevancia de la escala de Simpson en la resección de meningiomas de grado I de la OMS
Alvaro Oteroa,, , María Dolores Tabernerob, María Cristina Muñozc, Pablo Sousaa, David Mirandaa, Daniel Pascuala, Jesús María Gonçalvesa, Laura Ruiza
a Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
b Instituto Biosanitario de Salamanca (IBSAL), Unidad de Investigación e IESCSYL, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
c Gerencia de Atención Primaria de Salamanca, Salamanca, Spain
Received 15 August 2016, Accepted 18 December 2016
Abstract
Object

The aim of this study is to assess if the recurrence rates and recurrence/progression-free survivals (RFS) are different after Simpson's grades I, II, III and IV resections in World Health Organisation (WHO) grade I meningiomas.

Material and methods

A retrospective review was conducted on the data of patients who underwent surgical treatment of WHO grade I meningiomas located in convexity, falx/parasagittal, and skull base (anterior/media/posterior) between June 1991 and December 2011. In Simpson's grade IV resections, surgical treatment was supplemented with radiotherapy/radiosurgery on the tumour remains. A comparison was made on the recurrence rates and RFSs between Simpson's grades I, II, III, and IV resections, both overall and in tumour subsets according to their location.

Results

A total of 208 meningiomas were included in this study. There were no significant differences in recurrence rates and RFSs between Simpson's grades I, II, III, and IV. No significant differences were noted between the different degrees of Simpson in any of the location groups. In convexity meningiomas, the recurrence rates were 7% and 33% in Simpson's grades I and III resections, respectively (p=.131).

Conclusions

It has been shown that the rates of tumour control in meningiomas are not related to Simpson grades. In falx/parasagittal and skull base meningiomas, more aggressive attempts of tumour resection must be balanced against the risks of damaging critical neurovascular structures. In convexity meningiomas, a Simpson's grade I resection should be attempted first.

Resumen
Objetivo

Evaluar si las tasas de recurrencia y las supervivencias libres de recurrencia/progresión (RFS) son diferentes en meningiomas de grado i de la Organización Mundial de la Salud (OMS) sometidos a resecciones grado i, ii, iii y iv de la escala de Simpson.

Materiales y métodos

Revisamos de manera retrospectiva los datos de los pacientes que se sometieron a tratamiento quirúrgico de meningiomas de grado i de la OMS localizados en la convexidad, hoz/parasagital y base de cráneo entre junio de 1991 y diciembre de 2011. En el caso de las resecciones grado iv de Simpson la cirugía se complementó con radiocirugía o radioterapia sobre el resto tumoral. Comparamos las tasas de recurrencia y las RFS de los diferentes grados de Simpson tanto de manera global como por localización.

Resultados

En el estudio se incluyeron 208 meningiomas. No existieron diferencias significativas en las tasas de recurrencia y en las RFS entre los diferentes grados de Simpson. Por localización, tampoco detectamos diferencias entre los grados de resección. En meningiomas de convexidad, las tasas de recurrencia en los grados i y iii fueron del 7 y del 33%, respectivamente (p=0,131).

Conclusiones

Este estudio sugiere que las tasas de control tumoral son independientes de los grados de Simpson. En meningiomas de hoz/parasagital y de base de cráneo debe valorarse la agresividad quirúrgica frente a los riesgos de lesionar estructuras neurovasculares. En meningiomas de convexidad, el objetivo inicial debería ser una resección grado i.

Keywords
Meningioma, Simpson's grade, Resection, Progression, Recurrence, Location
Palabras clave
Meningioma, Grados de Simpson, Resección, Progresión, Recurrencia, Localización

Article

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