• Stephanie Schipmann, Michael Schwake, Peter B Sporns, Kira Marie Voß, Johanna Sicking, Dorothee Cäcilia Spille, Katharina Hess, Werner Paulus, Walter Stummer, and Benjamin Brokinkel.
• Department of Neurosurgery, University Hospital Münster, Münster, North Rhine-Westphalia, Germany. Electronic address: Stephanie.schipmann@ukmuenster.de.
• World Neurosurg. 2018 Nov 1; 119: e589-e597.

ObjectiveWe analyzed the applicability of the Simpson grading system to estimate the risk of tumor recurrence after microsurgery for recurrent meningiomas.MethodsCorrelations between the Simpson grade and the extent of resection (EOR) (gross total resection [Simpson grade I and II] vs. subtotal resection [Simpson grade ≥III]) with tumor relapse after microsurgery for meningioma recurrence were investigated compared with the findings in primary diagnosed tumors. Location-specific differences were further elucidated in subgroup analyses.ResultsA total of 829 individuals (88% in group A) with primary diagnosed meningioma and 109 patients with first postoperative recurrence (12% in group B) who underwent surgery were included. In group A, both Simpson grade (P = 0.003) and EOR (P < 0.001) correlated strongly with recurrence. In group B, Simpson grade correlated with tumor location (P = 0.030), and the risk of subtotal resection was greater in the posterior fossa (odds ratio, 5.26; P = 0.018) and skull base (odds ratio, 6.16; P = 0.002) meningiomas. Older age at tumor relapse (hazard ratio [HR], 1.05; P = 0.001), male sex (HR, 2.19; P = 0.02), and grade 2/3 histologic findings (HR, 2.18; P = 0.02). However, neither the Simpson grade nor dichotomized EOR correlated with further tumor recurrence. The frequency of postoperative complications was similar in both groups.ConclusionsSurgery for recurrent meningiomas is not generally associated with an increased risk of postoperative complications compared with resection of primary diagnosed tumors. However, the Simpson grade and EOR in recurrent meningiomas correlated poorly with further tumor relapse. The lower prognostic value of the tumor remnants left behind during microsurgery for recurrent meningiomas should be considered when operating on lesions that can be surgically challenging.Copyright © 2018 Elsevier Inc. All rights reserved.

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