Importance of Simpson/Shinshu Grading in Meningioma’s Excision, Outcome and Recurrence

Objective:  The study was aimed to determine the recurrence rate and recurrence-free survival of meningioma surgery with reference to Simpson grading of excision. Material and Methods:  The study was conducted in the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore. Total 325 patients both male and female of age (13 – 70 years) with supratentorial grade I meningioma operated. The craniotomy with maximum safe excision of the meningioma was done in all patients under general anesthesia. All patients followed-up to one year clinically and radiologically. MRI brain plain and IV contrast were done at 6 months and then annually. The extent of resection was determined with the help of operative notes and post-op MRI and recurrences were studied with help of follow-up MRI. Results:  There were 227 female and 98 male patients in ages 13 – 70 years. The mean age of patients was 53.5 years. 227 (70%) skull base meningioma, 71 (22.0%) convexity meningioma, and 26 (8%) falx or tentorium meningioma were operated. We achieved Simpson grade I excision in 55 (17.45%), grade II in 208 (64%), grade III in 23 (7%), and grade IV in 36 (11%) cases. The median recurrence free survival (RFS) with reference to Simpson grading of excision was 250, 120, 98, 80 months for grades I, II, III, and IV excision; it was statistically significant according to the grading of excision.  Conclusion:  Excision of meningioma up to grades I and II had an excellent outcome with minimum chances of complications.