• Mauro Palmieri, Daniele Armocida, Raffaella De Pietro, Giuseppina Chiarello, Francesca Rizzo, Diego Garbossa, Francesco Marampon, Antonio Santoro, and Alessandro Frati.
• Human Neurosciences Department Neurosurgery Division "Sapienza" University, Rome (RM), Italy.
• World Neurosurg. 2023 Jul 1; 175: e1117e1123e1117-e1123.

BackgroundMaximal surgical resection remains the treatment of choice for grade II meningiomas, and for some authors it is sufficient to guarantee a long indolent course even without postsurgical radiotherapy (RT), but there is no consensus on the use of RT in this patient population.MethodsWe retrospectively compared clinical and radiologic outcomes between World Health Organization grade I (group A) and grade II (group B) surgically treated meningiomas, focusing on the role of adjuvant RT. We registered clinical, surgical, and radiologic data to detect differences in survival and functional outcome between the 2 groups.ResultsThe final cohort consisted of 284 patients for group A and 94 patients for group B. Group B showed a higher risk of developing recurrence independently of the extent of resection (7.75% for Group A vs. 27.7% for Group B, P = 0.01). Patients who did not undergo adjuvant RT documented recurrence in 50% of cases, compared with 19% of patients who underwent RT (P = 0.024). There is a weak difference in the risk of developing postoperative seizures in the group submitted to radiotherapy (P = 0.08). Performance status remained stable for both groups, but for Group B it tended to decrease significantly after 1 year with regard to extent of resection and RT.ConclusionsRecurrence is more frequent for grade II meningiomas, even though there are no significant differences in terms of complications and functional outcome. Radiotherapy in grade II meningiomas does indeed lead to better control of recurrence but leads to an increased risk of seizures and reduced performance status.Copyright © 2023 Elsevier Inc. All rights reserved.

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