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MENINGIOMA SIMPSON GRADING

The Simpson grading system has four grades, each indicating how completely the meningioma is removed during surgery, with associated recurrence risks. Grade I is the most thorough resection. Here, we remove the tumor along with the underlying bone and the associated dura. This is the gold standard for achieving the lowest recurrence rates, around 5 to 9% over 10 years. However, this level of resection may not always be possible due to location or risk of damaging nearby structures. Next, Grade II still involves complete tumor removal but with coagulation of the dural attachment instead of resecting it. The recurrence rate here is slightly higher—around 15 to 19%. We typically aim for Grade II if removing the entire dura is not feasible or necessary. Now, Grade III involves complete removal of the tumor itself but without resecting the dura or coagulating it. This leaves a greater chance of microscopic remnants. Consequently, recurrence rates range from 12 to 29%. This approach is sometimes used when dura involvement is extensive or when preserving dura is essential for patient safety. Finally, Grade IV is a subtotal resection, where we cannot remove the entire tumor, often due to involvement of critical neurovascular structures. Unfortunately, the recurrence rate for Grade IV is the highest, between 19 and 40%. In clinical practice, achieving Grade I or II resection is ideal, but the complexity of the tumor location, adjacent brain involvement, and the patient’s condition can limit the extent of resection. When radical removal isn’t possible, adjuvant therapies like radiation may be necessary to reduce recurrence risk. So, understanding the Simpson grading system is essential for both surgical planning and patient counseling, helping us balance aggressive resection with preservation of function.