Stephanie Schipmann1, Michael Schwake2, Peter B Sporns3, Kira Marie Voß2, Johanna Sicking2, Dorothee Cäcilia Spille2, Katharina Hess4, Werner Paulus4, Walter Stummer2, Benjamin Brokinkel2. 1. Department of Neurosurgery, University Hospital Münster, Münster, North Rhine-Westphalia, Germany. Electronic address: Stephanie.schipmann@ukmuenster.de. 2. Department of Neurosurgery, University Hospital Münster, Münster, North Rhine-Westphalia, Germany. 3. Department of Clinical Radiology, University Hospital Münster, Münster, North Rhine-Westphalia, Germany. 4. Institute of Neuropathology, University Hospital Münster, Münster, North Rhine-Westphalia, Germany.
Abstract
OBJECTIVE: We analyzed the applicability of the Simpson grading system to estimate the risk of tumor recurrence after microsurgery for recurrent meningiomas. METHODS: Correlations between the Simpson grade and the extent of resection (EOR) (gross total resection [Simpson grade I and II] vs. subtotal resection [Simpson grade ≥III]) with tumor relapse after microsurgery for meningioma recurrence were investigated compared with the findings in primary diagnosed tumors. Location-specific differences were further elucidated in subgroup analyses. RESULTS: A total of 829 individuals (88% in group A) with primary diagnosed meningioma and 109 patients with first postoperative recurrence (12% in group B) who underwent surgery were included. In group A, both Simpson grade (P = 0.003) and EOR (P < 0.001) correlated strongly with recurrence. In group B, Simpson grade correlated with tumor location (P = 0.030), and the risk of subtotal resection was greater in the posterior fossa (odds ratio, 5.26; P = 0.018) and skull base (odds ratio, 6.16; P = 0.002) meningiomas. Older age at tumor relapse (hazard ratio [HR], 1.05; P = 0.001), male sex (HR, 2.19; P = 0.02), and grade 2/3 histologic findings (HR, 2.18; P = 0.02). However, neither the Simpson grade nor dichotomized EOR correlated with further tumor recurrence. The frequency of postoperative complications was similar in both groups. CONCLUSIONS: Surgery for recurrent meningiomas is not generally associated with an increased risk of postoperative complications compared with resection of primary diagnosed tumors. However, the Simpson grade and EOR in recurrent meningiomas correlated poorly with further tumor relapse. The lower prognostic value of the tumor remnants left behind during microsurgery for recurrent meningiomas should be considered when operating on lesions that can be surgically challenging.
OBJECTIVE: We analyzed the applicability of the Simpson grading system to estimate the risk of tumor recurrence after microsurgery for recurrent meningiomas. METHODS: Correlations between the Simpson grade and the extent of resection (EOR) (gross total resection [Simpson grade I and II] vs. subtotal resection [Simpson grade ≥III]) with tumor relapse after microsurgery for meningioma recurrence were investigated compared with the findings in primary diagnosed tumors. Location-specific differences were further elucidated in subgroup analyses. RESULTS: A total of 829 individuals (88% in group A) with primary diagnosed meningioma and 109 patients with first postoperative recurrence (12% in group B) who underwent surgery were included. In group A, both Simpson grade (P = 0.003) and EOR (P < 0.001) correlated strongly with recurrence. In group B, Simpson grade correlated with tumor location (P = 0.030), and the risk of subtotal resection was greater in the posterior fossa (odds ratio, 5.26; P = 0.018) and skull base (odds ratio, 6.16; P = 0.002) meningiomas. Older age at tumor relapse (hazard ratio [HR], 1.05; P = 0.001), male sex (HR, 2.19; P = 0.02), and grade 2/3 histologic findings (HR, 2.18; P = 0.02). However, neither the Simpson grade nor dichotomized EOR correlated with further tumor recurrence. The frequency of postoperative complications was similar in both groups. CONCLUSIONS: Surgery for recurrent meningiomas is not generally associated with an increased risk of postoperative complications compared with resection of primary diagnosed tumors. However, the Simpson grade and EOR in recurrent meningiomas correlated poorly with further tumor relapse. The lower prognostic value of the tumor remnants left behind during microsurgery for recurrent meningiomas should be considered when operating on lesions that can be surgically challenging.
Authors: Jean-Michel Lemée; Marco V Corniola; Michele Da Broi; Holger Joswig; David Scheie; Karl Schaller; Eirik Helseth; Torstein R Meling Journal: Sci Rep Date: 2019-04-11 Impact factor: 4.379