The Relevance of Simpson Grade Resections in Modern Neurosurgical Treatment of World Health Organization Grade I, II, and III Meningiomas

Jeff S. Ehresman, Tomas Garzon-Muvdi, Davis Rogers, Michael Lim, Gary L Gallia, Jon David Weingart, Henry Brem, Chetan Bettegowda, Kaisorn L. Chaichana

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Abstract

Objective The Simpson grading system has played an important role in surgical resections of meningiomas. The aim of this study was to determine if this grading system predicts meningioma recurrence in a modern cohort of patients with tumors of all World Health Organization grades. Methods Adult patients who underwent primary, nonbiopsy resection of a meningioma at a tertiary care institution between 2007 and 2015 were retrospectively reviewed. Stepwise multivariate proportional hazard analyses were used to identify associations with recurrence after resection. Log-rank analyses were used to compare Kaplan-Meier plots for time to recurrence between each Simpson grade. Results Of 572 patients who met inclusion criteria, 72 (12.6%) presented with recurrence. Factors associated with recurrence after gross total resection (Simpson grades I–III) were non–World Health Organization grade I (hazard ratio [HR] [95% confidence interval (CI)] 6.215 [2.864–12.419], P < 0.0001) and preoperative neurologic deficits (HR [95% CI] 2.862 [1.512–5.499], P = 0.001). Factors associated with recurrence after subtotal resections (Simpson IV) were African American race (HR [95% CI] 2.776 [1.232–5.890], P = 0.02) and parafalcine location (HR [95% CI] 3.956 [1.624–8.775], P = 0.004). Simpson grade was not an independent risk factor for recurrence. Conclusions Identification and consideration of factors associated with recurrence after gross total or subtotal resections may help guide treatment strategies for patients with meningiomas.

Original languageEnglish (US)
Pages (from-to)e588-e593
JournalWorld Neurosurgery
Volume109
DOIs
StatePublished - Jan 1 2018

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Meningioma
Recurrence
Confidence Intervals
Therapeutics
Tertiary Healthcare
Neurologic Manifestations
African Americans
Organizations
Health

Keywords

  • Meningioma
  • Recurrence
  • Risk factors
  • Simpson grade
  • WHO grade

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

The Relevance of Simpson Grade Resections in Modern Neurosurgical Treatment of World Health Organization Grade I, II, and III Meningiomas. / Ehresman, Jeff S.; Garzon-Muvdi, Tomas; Rogers, Davis; Lim, Michael; Gallia, Gary L; Weingart, Jon David; Brem, Henry; Bettegowda, Chetan; Chaichana, Kaisorn L.

In: World Neurosurgery, Vol. 109, 01.01.2018, p. e588-e593.

Research output: Contribution to journalArticle

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abstract = "Objective The Simpson grading system has played an important role in surgical resections of meningiomas. The aim of this study was to determine if this grading system predicts meningioma recurrence in a modern cohort of patients with tumors of all World Health Organization grades. Methods Adult patients who underwent primary, nonbiopsy resection of a meningioma at a tertiary care institution between 2007 and 2015 were retrospectively reviewed. Stepwise multivariate proportional hazard analyses were used to identify associations with recurrence after resection. Log-rank analyses were used to compare Kaplan-Meier plots for time to recurrence between each Simpson grade. Results Of 572 patients who met inclusion criteria, 72 (12.6{\%}) presented with recurrence. Factors associated with recurrence after gross total resection (Simpson grades I–III) were non–World Health Organization grade I (hazard ratio [HR] [95{\%} confidence interval (CI)] 6.215 [2.864–12.419], P < 0.0001) and preoperative neurologic deficits (HR [95{\%} CI] 2.862 [1.512–5.499], P = 0.001). Factors associated with recurrence after subtotal resections (Simpson IV) were African American race (HR [95{\%} CI] 2.776 [1.232–5.890], P = 0.02) and parafalcine location (HR [95{\%} CI] 3.956 [1.624–8.775], P = 0.004). Simpson grade was not an independent risk factor for recurrence. Conclusions Identification and consideration of factors associated with recurrence after gross total or subtotal resections may help guide treatment strategies for patients with meningiomas.",
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AU - Gallia, Gary L

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N2 - Objective The Simpson grading system has played an important role in surgical resections of meningiomas. The aim of this study was to determine if this grading system predicts meningioma recurrence in a modern cohort of patients with tumors of all World Health Organization grades. Methods Adult patients who underwent primary, nonbiopsy resection of a meningioma at a tertiary care institution between 2007 and 2015 were retrospectively reviewed. Stepwise multivariate proportional hazard analyses were used to identify associations with recurrence after resection. Log-rank analyses were used to compare Kaplan-Meier plots for time to recurrence between each Simpson grade. Results Of 572 patients who met inclusion criteria, 72 (12.6%) presented with recurrence. Factors associated with recurrence after gross total resection (Simpson grades I–III) were non–World Health Organization grade I (hazard ratio [HR] [95% confidence interval (CI)] 6.215 [2.864–12.419], P < 0.0001) and preoperative neurologic deficits (HR [95% CI] 2.862 [1.512–5.499], P = 0.001). Factors associated with recurrence after subtotal resections (Simpson IV) were African American race (HR [95% CI] 2.776 [1.232–5.890], P = 0.02) and parafalcine location (HR [95% CI] 3.956 [1.624–8.775], P = 0.004). Simpson grade was not an independent risk factor for recurrence. Conclusions Identification and consideration of factors associated with recurrence after gross total or subtotal resections may help guide treatment strategies for patients with meningiomas.

AB - Objective The Simpson grading system has played an important role in surgical resections of meningiomas. The aim of this study was to determine if this grading system predicts meningioma recurrence in a modern cohort of patients with tumors of all World Health Organization grades. Methods Adult patients who underwent primary, nonbiopsy resection of a meningioma at a tertiary care institution between 2007 and 2015 were retrospectively reviewed. Stepwise multivariate proportional hazard analyses were used to identify associations with recurrence after resection. Log-rank analyses were used to compare Kaplan-Meier plots for time to recurrence between each Simpson grade. Results Of 572 patients who met inclusion criteria, 72 (12.6%) presented with recurrence. Factors associated with recurrence after gross total resection (Simpson grades I–III) were non–World Health Organization grade I (hazard ratio [HR] [95% confidence interval (CI)] 6.215 [2.864–12.419], P < 0.0001) and preoperative neurologic deficits (HR [95% CI] 2.862 [1.512–5.499], P = 0.001). Factors associated with recurrence after subtotal resections (Simpson IV) were African American race (HR [95% CI] 2.776 [1.232–5.890], P = 0.02) and parafalcine location (HR [95% CI] 3.956 [1.624–8.775], P = 0.004). Simpson grade was not an independent risk factor for recurrence. Conclusions Identification and consideration of factors associated with recurrence after gross total or subtotal resections may help guide treatment strategies for patients with meningiomas.

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