Jeppe Haslund-Vinding1, Jane Skjoth-Rasmussen2, Lars Poulsgaard2, Kaare Fugleholm2, Christian Mirian2, Andrea Daniela Maier2,3, Thomas Santarius4, Frantz Rom Poulsen2,3,4,5,6,7,8,9,10,11,12, Torstein Meling10, Jiri Junior Bartek2,5,12, Petter Förander5,12, Vibeke Andrée Larsen7, Bjarne Winther Kristensen5,8, David Scheie5, Ian Law9, Morten Ziebell2, Tiit Mathiesen2,5,11. 1. Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. jeppe.lohfert.haslund-vinding.01@regionh.dk. 2. Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 3. Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 4. Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. 5. Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden. 6. Department of Neurosurgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark. 7. Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 8. Department of Clinical Medicine and Biotech Research and Innovation Center (BRIC), University of Copenhagen, Copenhagen, Denmark. 9. Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark. 10. Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland. 11. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 12. Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
Abstract
INTRODUCTION: The extent of meningioma resection is the most fundamental risk factor for recurrence, and exact knowledge of extent of resection is necessary for prognostication and for planning of adjuvant treatment. Currently used classifications are the EANO-grading and the Simpson grading. The former comprises radiological imaging with contrast-enhanced MRI and differentiation between "gross total removal" and "subtotal removal," while the latter comprises a five-tiered differentiation of the surgeon's impression of the extent of resection. The extent of resection of tumors is usually defined via analyses of resection margins but has until now not been implemented for meningiomas. PET/MRI imaging with 68Ga-DOTATOC allows more sensitive and specific imaging than MRI following surgery of meningiomas. OBJECTIVE: To develop an objective grading system based on microscopic analyses of resection margins and sensitive radiological analyses to improve management of follow-up, adjuvant therapy, and prognostication of meningiomas. Based on the rationale of resection-margin analyses as gold standard and superior imaging performance of 68Ga DOTATOC PET, we propose "Copenhagen Grading" for meningiomas. RESULTS: Copenhagen Grading was described for six pilot patients with examples of positive and negative findings on histopathology and DOTATOC PET scanning. The grading could be traceably implemented and parameters of grading appeared complementary. Copenhagen Grading is prospectively implemented as a clinical standard at Rigshospitalet, Copenhagen. CONCLUSION: Copenhagen Grading provided a comprehensive, logical, and reproducible definition of the extent of resection. It offers promise to be the most sensitive and specific imaging modality available for meningiomas. Clinical and cost-efficacy remain to be established during prospective implementation.
INTRODUCTION: The extent of meningioma resection is the most fundamental risk factor for recurrence, and exact knowledge of extent of resection is necessary for prognostication and for planning of adjuvant treatment. Currently used classifications are the EANO-grading and the Simpson grading. The former comprises radiological imaging with contrast-enhanced MRI and differentiation between "gross total removal" and "subtotal removal," while the latter comprises a five-tiered differentiation of the surgeon's impression of the extent of resection. The extent of resection of tumors is usually defined via analyses of resection margins but has until now not been implemented for meningiomas. PET/MRI imaging with 68Ga-DOTATOC allows more sensitive and specific imaging than MRI following surgery of meningiomas. OBJECTIVE: To develop an objective grading system based on microscopic analyses of resection margins and sensitive radiological analyses to improve management of follow-up, adjuvant therapy, and prognostication of meningiomas. Based on the rationale of resection-margin analyses as gold standard and superior imaging performance of 68Ga DOTATOC PET, we propose "Copenhagen Grading" for meningiomas. RESULTS: Copenhagen Grading was described for six pilot patients with examples of positive and negative findings on histopathology and DOTATOC PET scanning. The grading could be traceably implemented and parameters of grading appeared complementary. Copenhagen Grading is prospectively implemented as a clinical standard at Rigshospitalet, Copenhagen. CONCLUSION: Copenhagen Grading provided a comprehensive, logical, and reproducible definition of the extent of resection. It offers promise to be the most sensitive and specific imaging modality available for meningiomas. Clinical and cost-efficacy remain to be established during prospective implementation.
Authors: Marco V Corniola; Pierre-Hugues Roche; Michaël Bruneau; Luigi M Cavallo; Roy T Daniel; Mahmoud Messerer; Sebastien Froelich; Paul A Gardner; Fred Gentili; Takeshi Kawase; Dimitrios Paraskevopoulos; Jean Régis; Henry W S Schroeder; Theodore H Schwartz; Marc Sindou; Jan F Cornelius; Marcos Tatagiba; Torstein R Meling Journal: Brain Spine Date: 2022-01-21