{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T20:29:35Z","timestamp":1791836975686,"version":"4.3.4"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2020,10,26]],"date-time":"2020-10-26T00:00:00Z","timestamp":1603670400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,10,26]],"date-time":"2020-10-26T00:00:00Z","timestamp":1603670400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100012940","name":"Universit\u00e4tsklinikum T\u00fcbingen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100012940","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurosurg Rev"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Since the introduction of the Simpson grading for the extent of resection in meningiomas in 1957, its usefulness in modern neurosurgery has been challenged. Especially, the updated WHO classification regarding brain invasion and the efficacy of radiation therapy has not been taken into account when evaluating the prognostic role of the Simpson grading in this era. We analyzed the clinical and histopathological data of 1571 meningiomas that were surgically resected in the authors\u2019 institution between July 2003 and March 2017. Operative reports were reviewed regarding the extent of resection according to Simpson grading. Meningioma subtype according to the updated WHO classification of 2016 and clinical characteristics and time to tumor progression were analyzed. The mean follow-up was 38.4\u00a0months (range 1.2 to 195.6). A higher rate of tumor recurrence was observed for male gender, younger age, recurrent tumors, non-spinal tumor localization, higher WHO, and Simpson grades in the univariate analysis. In the multivariate analysis older age, recurrent tumors and higher WHO grades remained negative prognostic factors. Among the different Simpson grades, the relative risk for recurrence was highest for grade IV compared to all other grades (each <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001), while there was no difference between Simpson grades I and II. Adjuvant radiotherapy showed lower rates of tumor recurrence. Subtotal microsurgical resection remains an independent prognostic factor with a higher rate of tumor recurrence. The prognostic benefit of radical treatment of the dural attachment is questionable and needs to be considered when weighing the intraoperative risks of radicality.<\/jats:p>","DOI":"10.1007\/s10143-020-01428-7","type":"journal-article","created":{"date-parts":[[2020,10,26]],"date-time":"2020-10-26T06:02:50Z","timestamp":1603692170000},"page":"2329-2336","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["The role of Simpson grading in meningiomas after integration of the updated WHO classification and adjuvant radiotherapy"],"prefix":"10.1007","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1083-1276","authenticated-orcid":false,"given":"Felix","family":"Behling","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Fodi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elgin","family":"Hoffmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirjam","family":"Renovanz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Skardelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3542-8782","authenticated-orcid":false,"given":"Ghazaleh","family":"Tabatabai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9168-6209","authenticated-orcid":false,"given":"Jens","family":"Schittenhelm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Honegger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos","family":"Tatagiba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,10,26]]},"reference":[{"key":"1428_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2019.8.SPINE19859","volume":"32","author":"SM Barber","year":"2019","unstructured":"Barber SM, Konakondla S, Nakhla J, Fridley JS, Xia J, Oyelese AA, Telfeian AE, Gokaslan ZL (2019) Oncologic benefits of dural resection in spinal meningiomas: a meta-analysis of Simpson grades and recurrence rates. J Neurosurg Spine 32:1\u201311. https:\/\/doi.org\/10.3171\/2019.8.SPINE19859","journal-title":"J Neurosurg Spine"},{"key":"1428_CR2","doi-asserted-by":"publisher","first-page":"i18","DOI":"10.1093\/neuonc\/noy136","volume":"21","author":"PK Brastianos","year":"2019","unstructured":"Brastianos PK, Galanis E, Butowski N, Chan JW, Dunn IF, Goldbrunner R, Herold-Mende C, Ippen FM, Mawrin C, MW MD, Sloan A, Snyder J, Tabatabai G, Tatagiba M, Tonn JC, Wen PY, Aldape K, Nassiri F, Zadeh G, Jenkinson MD, Raleigh DR, International Consortium on M (2019) Advances in multidisciplinary therapy for meningiomas. Neuro-Oncology 21:i18\u2013i31. https:\/\/doi.org\/10.1093\/neuonc\/noy136","journal-title":"Neuro-Oncology"},{"key":"1428_CR3","doi-asserted-by":"publisher","first-page":"e383","DOI":"10.1016\/S1470-2045(16)30321-7","volume":"17","author":"R Goldbrunner","year":"2016","unstructured":"Goldbrunner R, Minniti G, Preusser M, Jenkinson MD, Sallabanda K, Houdart E, von Deimling A, Stavrinou P, Lefranc F, Lund-Johansen M, Moyal EC, Brandsma D, Henriksson R, Soffietti R, Weller M (2016) EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol 17:e383\u2013e391. https:\/\/doi.org\/10.1016\/S1470-2045(16)30321-7","journal-title":"Lancet Oncol"},{"key":"1428_CR4","doi-asserted-by":"publisher","first-page":"551","DOI":"10.3171\/2015.9.JNS15754","volume":"125","author":"K Gousias","year":"2016","unstructured":"Gousias K, Schramm J, Simon M (2016) The Simpson grading revisited: aggressive surgery and its place in modern meningioma management. 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Lasers Surg Med. https:\/\/doi.org\/10.1002\/lsm.23294","DOI":"10.1002\/lsm.23294"}],"container-title":["Neurosurgical Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10143-020-01428-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10143-020-01428-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10143-020-01428-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T01:42:52Z","timestamp":1635212572000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10143-020-01428-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,26]]},"references-count":17,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,8]]}},"alternative-id":["1428"],"URL":"https:\/\/doi.org\/10.1007\/s10143-020-01428-7","relation":{},"ISSN":["0344-5607","1437-2320"],"issn-type":[{"value":"0344-5607","type":"print"},{"value":"1437-2320","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,26]]},"assertion":[{"value":"19 August 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 September 2020","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 October 2020","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 October 2020","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was approved by the Clinical Ethics Committee of the University of T\u00fcbingen (project number: 618\/2014BO2).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Tumor tissue and clinical data were only used if patient consent was available as defined by the Clinical Ethics Committee of the University of T\u00fcbingen.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}}]}}