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Simpson Grade Revisited – Intraoperative Estimation of the Extent of Resection in Meningiomas Versus Postoperative Somatostatin Receptor Positron Emission Tomography/Computed Tomography and Magnetic Resonance Imaging
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Simpson Grade Revisited – Intraoperative Estimation of the Extent of Resection in Meningiomas Versus Postoperative Somatostatin Receptor Positron Emission Tomography/Computed Tomography and Magnetic Resonance Imaging
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Journal Article
Simpson Grade Revisited – Intraoperative Estimation of the Extent of Resection in Meningiomas Versus Postoperative Somatostatin Receptor Positron Emission Tomography/Computed Tomography and Magnetic Resonance Imaging
2021
Overview
Abstract
BACKGROUND
Surgeon's intraoperative estimation of meningioma extent of resection (Simpson Grade, SG) is widely used as a prognostic factor for recurrence. However, the validity of SG is still a matter of debate. In preoperative imaging, 68Ga-DOTATATE/PET-CT has been shown to detect meningioma tissue even more sensitively than magnetic resonance imaging (MRI).
OBJECTIVE
To evaluate the Simpson grading within the framework of modern postoperative imaging techniques (MRI; PET-CT).
METHODS
At first, patients with WHO grade I meningioma, surgical resection, and postoperative 68Ga-DOTATATE/PET-CT within 6 mo after surgery were retrospectively analyzed. Second, an analogous prospective cohort of patients with WHO grade I meningioma was investigated by comparing SG after meningioma removal with postoperative MRI and 68Ga-DOTATATE/PET-CT within 6 mo after surgery.
RESULTS
A total of 37 patients were retrospectively analyzed. In total, 5/8 patients with SG-I and II resections showed tumor remnants according to postoperative PET-CT (SG 62.5% false negative). In the prospective cohort of 52 tumors, PET-CT displayed tracer uptake in 15/37 SG-I or II resections indicating unexpected tumor remnants (SG 40.5% false negative). MRI was false negative in 7 of these 15 cases (MRI 18.9% false negative) (P = .037). Discordant results according to PET-CT were more often found in convexity (40%) and falcine (46.7%) meningiomas than in skull base meningiomas (18.2%).
CONCLUSION
Intraoperative Simpson grading is at risk to underestimate tumor remnants, predominantly in grade I and II resections. Postoperative PET-CT improves detection rates compared to MRI. Prognostic impact of postoperative meningioma remnants according to PET-CT needs to be investigated prospectively.
Publisher
Oxford University Press,Copyright by the Congress of Neurological Surgeons,Wolters Kluwer Health, Inc
Subject
/ Aged
/ Female
/ Humans
/ Magnetic Resonance Imaging - methods
/ Male
/ Meningeal Neoplasms - diagnostic imaging
/ Meningeal Neoplasms - surgery
/ Meningioma - diagnostic imaging
/ Neoplasm, Residual - diagnostic imaging
/ Positron Emission Tomography Computed Tomography - methods
/ Surgeons
/ Surgery
/ Tumors
