World Health Organization Grade I Convexity Meningiomas: Study on Outcomes, Complications and Recurrence Rates.

World Health Organization Grade I Convexity Meningiomas: Study on Outcomes, Complications and Recurrence Rates.

World Neurosurg. 2015 Dec 15;

Authors: Nanda A, Bir SC, Konar S, Maiti TK, Bollam P

Abstract
BACKGROUND: The clinical significance of the Simpson grading system of extent of meningioma resection and its role as a predictor for recurrence of World Health Organization (WHO) grade I meningiomas has been questioned in the past, as microsurgery and knowledge of pathological details have advanced.
METHODS: Clinical and radiological information of 112 patients with WHO grade I convexity meningiomas who underwent surgery over the past 20 years was retrospectively reviewed.
RESULTS: The recurrence rate in grade 0-I resection group was 2.9%, whereas in grade II-IV resection group, recurrence rate was 31% (p=0.0001). In Cox regression analysis, Simpson grade 0-I resection was revealed as a significant predictor of RFS (p=0.021). The hazard ratio for recurrence after II-IV resection was 10.98 times higher than grade 0- I. Like Simpson grading of resection, a similar trend of recurrence (grade I, 1.6% vs. grade II-IV, 28%, p=0.0001) was observed in Shinshu grade of resection. In univariate analysis, female gender and using of neuronavigation were also identified as independent predictors of RFS after resection of WHO grade I meningiomas. Six months after surgery, using of anti-epileptic medication was less in grade 0-I compared to other grades.
CONCLUSION: When histological grade is fixed, Simpson's grading system is the prime predictor for recurrence of meningioma after resection. Grade 0-I resection is also beneficial to cut off anti-epileptic medication in patients with convexity meningiomas. Although complete tumor resection (grade 0-I) is the goal, surgical approach should be tailored to each patient depending on the risks and surgical morbidity.

PMID: 26704204 [PubMed - as supplied by publisher]

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