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simpson_grading_system

Simpson Grading System

Since 1957, Simpson grading system is considered a predictive system for meningiomas recurrences. However, since then, there has been a great development of surgical equipment and neurosurgical technique, so the re-evaluation of this grading system should be considered.

Simpson Grading System for removal of meningiomas.

I

Macroscopically complete removal of tumour, with excision of its dural attachment, and of any abnormal bone. Includes resection of venous sinus if involved.

II

Macroscopically complete removal of tumour and its visible extensions with coagulation of its dural attachment.

III

Macroscopically complete removal of the intradural tumour, without resection or coagulation of its dural attachment or its extradural extensions.

IV

Partial removal, leaving intradural tumour in situ.

V

Simple decompression, with or without biopsy 1).

Relevance

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 grade 1 meningiomas has been questioned in the past, as microsurgery and knowledge of pathological details have advanced.

The relevance of Simpson grading system grade I and II resection as a sole predictor of recurrence in meningiomas surgery was diminished in the work of Sughrue et al. 2).


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 3).


A Simpson Grade II rather than Grade I resection more than doubled the risk of recurrence at 10 years in the overall series (18.8% vs 8.5%). The impact of aggressive resections was much stronger in higher grade meningiomas.

A policy of maximal safe resections for meningiomas prolongs progression free survival (PFS) and is not associated with increased morbidity 4).

1)
Donald Simpson THE RECURRENCE OF INTRACRANIAL MENINGIOMAS AFTER SURGICAL TREATMENT J Neurol Neurosurg Psychiatry 1957; 20: 22-39.
2)
Sughrue ME, Kane AJ, Shangari G, Rutkowski MJ, McDermott MW, Berger MS, et al. The relevance of Simpson Grade I and II resection in modern neurosurgical treatment of World Health Organization Grade I meningiomas. J Neurosurg. 2010;113:1029–35.
3)
Nanda A, Bir SC, Konar S, Maiti TK, Bollam P. World Health Organization Grade I Convexity Meningiomas: Study on Outcomes, Complications and Recurrence Rates. World Neurosurg. 2015 Dec 15. pii: S1878-8750(15)01651-4. doi: 10.1016/j.wneu.2015.11.050. [Epub ahead of print] PubMed PMID: 26704204.
4)
Gousias K, Schramm J, Simon M. The Simpson grading revisited: aggressive surgery and its place in modern meningioma management. J Neurosurg. 2016 Sep;125(3):551-60. doi: 10.3171/2015.9.JNS15754. Epub 2016 Jan 29. PubMed PMID: 26824369.
simpson_grading_system.txt · Last modified: 2017/01/09 12:45 (external edit)