• Alvaro Otero-Rodriguez, Maria Dolores Tabernero, Maria Cristina Munoz-Martin, Pablo Sousa, Alberto Orfao, Daniel Pascual-Argente, Maria Gonzalez-Tablas, and Laura Ruiz-Martin.
• Department of Neurosurgery, Instituto Biosanitario de Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca, Salamanca, Spain. Electronic address: aoteror@saludcastillayleon.es.
• World Neurosurg. 2016 Dec 1; 96: 483-488.

BackgroundSince 1957, the Simpson grading system has been considered a predictive system for meningioma recurrence. However, since then, surgical equipment and neurosurgical technique have developed extensively, so this grading system should be re-evaluated. This study aims to assess if the recurrence rate and recurrence-free survival (RFS) are different after Simpson grade I, II, and III resections in World Health Organization (WHO) grade I meningiomas.MethodsWe retrospectively reviewed the data of patients who underwent surgical treatment of WHO grade I meningiomas located in the convexity (group 1), falx/parasagittal (group 2), skull base, and tentorium (group 3) between June 1991 and December 2011. We compared the recurrence rates and RFSs between Simpson grade I, II, and III resections in both overall cases and tumor subsets according to their localization.ResultsA total of 224 meningiomas were included in this study. There were no significant differences in recurrence rates and RFSs between Simpson grades I, II, and III. In each of the location groups, no significant differences were noted between the different degrees of Simpson.ConclusionsWe have shown that complete resection of WHO grade I meningiomas achieves excellent tumor control, regardless of Simpson grades. More aggressive attempts at tumor resection (ie, Simpson grade I) must be balanced against the risks of removing dura or damaging critical neurovascular structures.Copyright © 2016 Elsevier Inc. All rights reserved.

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