Abstract
The Simpson grading scale for the classification of the extent of meningioma resection
provided a tremendous movement forward in 1957 suggesting increasing the extent of
resection improves recurrence rates. However, equal, if not greater, movements forward
have been made in the neurosurgical community over the last half a century owing to
improvements in neuroimaging capabilities, microsurgical techniques, and radiotherapeutic
strategies. Sughrue et al proposed the idea that these advancements have altered what
a “recurrence” and “subtotal resection” truly means in modern neurosurgery compared
with Simpson's era, and that a mandated use of the Simpson Scale is likely less clinically
relevant today. A subsequent period of debate ensued in the literature which sought
to re-examine the clinical value of using the Simpson Scale in modern neurosurgery.
While a large body of evidence has recently been provided, these data generally continue
to support the clinical importance of gross tumor resection as well as the value of
adjuvant radiation therapy and the importance of recently updated World Health Organization
classifications. However, there remains a negligible interval benefit in performing
overly aggressive surgery and heroic maneuvers to remove the last bit of tumor, dura,
and/or bone just for the simple act of achieving a lower Simpson score. Ultimately,
meningioma surgery may be better contextualized as a continuous set of weighted risk–benefit
decisions throughout the entire operation.
Keywords
Simpson Scale - meningiomas - recurrence - neuroimaging - subtotal resection - neurosurgery
- gross total resection
