Simpson Classification Research Articles

Refracture-related bone transport of tibia: technical notes and preliminary clinical results in nineteen cases.

Refracture is one of the main complications of bone transport, which brings additional physical and mental burden to surgeries and patients. We aimed to raise a new classification system of refracture-related bone transport based on the Simpson classification and to present our experience on treatment. This retrospective analysis included 19 patients with refracture-related bone transport (average age of 37.7years; 18 men). We developed a modified Simpson classification system to assist decision-making (conservative versus surgical). The ASAMI criteria were used to assess the outcomes at last follow-up. The mean follow-up was 12.3 ± 3.2months. Complete union was achieved in all patients, with no reinfection. Based on the modified Simpson classification, refracture was Ia type (within regeneration area) in three cases, Ib (collapsed fracture at the regeneration area) in one case, Ic (stress fracture) in three cases, II (at the junction between the regenerate and original bone) in one case, III (at the docking site) in nine cases, and V (at distant site) in two cases. Refracture was managed conservatively in six cases and surgically in 13 cases. Average time to bone union was 2.8 ± 1.2months in the conservative group versus 4.4 ± 1.4months in the surgery group. Assessment at the final follow-up using the ASAMI criteria revealed excellent bone result in all patients, excellent functional results in six patients (31.6%), and good functional results in 13 patients. The modified Simpson classification could include refracture at the docking site and stress fracture in the regeneration zone and provide some guidance in determining the appropriate treatment strategy.

A Retrospective Cohort Study Evaluating the Comparative Effectiveness of Unilateral Hemilaminectomy and Bilateral Laminectomy in the Resection of Spinal Meningiomas.

The primary treatment modality for spinal meningiomas (SM) is surgical resection. In recent years, minimal invasive spine surgery has gained considerable popularity, attributing its growth to advancements in surgical technologies and improved training of surgeons. Nonetheless, the suitability and effectiveness of minimal invasive spine surgery for intradural spinal tumor resection remain a subject of debate. In this cohort study, we aimed to compare the extent of resection of the unilateral hemilaminectomy approach, a less invasive technique, with the more traditional and invasive bilateral laminectomy. We performed a retrospective cohort study including patients with SM who underwent surgery at our department between 1996 and 2020. Cohorts included patients who underwent tumor resection through bilateral laminectomy and patients who underwent a unilateral hemilaminectomy. The primary end point was extent of resection according to the Simpson classification. Of 131 with SM, 36 had a bilateral laminectomy and 95 were operated through a unilateral hemilaminectomy. In both groups, gross total resection, Simpson grades 1 and 2, was achieved in 94.44% and 94.74%, respectively (P = .999). The neurological outcome was also comparable in both cohorts (P = .356). Both length of hospital stay and estimated blood loss were significantly lower in the unilateral cohort (P < .05). The results of this study indicate that the unilateral hemilaminectomy yields comparable results in both oncological and neurological outcome when compared with the bilateral laminectomy. Thus, unilateral hemilaminectomy may serve as a viable and safe alternative for the surgical removal of SM.

Factors Influencing the Degree of Resection and Proposed Preoperative Scale for The Management of Skull Base Meningiomas

Objectives: to identify factors involved in the degree of resection of skull base meningiomas and to propose a scale to calculate the probability of total resection. Materials and methods: unicenter, observational, retrospective study of patients operated on in the period 06/2018 – 06/2022. The following variables were used: age, clinic, location, size, previous embolization, perilesional edema, intertumoral calcium, characteristics in T2 and T1 and bone invasion. The degree of resection was measured with the traditional Simpson classification and was also divided into total (Simpson I, II and III) and subtotal (Simpson IV and V) resection. With the results, a scale was proposed taking into account the variables with statistical significance (p &lt; 0.05). A literature review of the topic was conducted. Results: A total of 23 patients were operated. They were statistically significant associated with Simpson's grade, location (p 0.002) and size (p 0.001). Associated with total and subtotal resection, bone invasion (p 0.013). For the scale we use: location (anterior 1 point, posterior 2 points, medial 2 points and medial involving cavernous sinus 3 points), size (&lt;5 cm 1 point, &gt;5 cm 2 points) and bone invasion (not 1 point and if 2 points). We performed an inferential analysis and an association was observed between the scale performed and the degree of resection (p 0.005). Conclusion: In our study, an association was observed between bone size, location and invasion with the degree of resection achieved. We proposed a scale to measure the probability of total resection.

Outcome of extradural devascularization in resection of giant olfactory groove meningioma in bilateral subfrontal approach

BackgroundOlfactory groove meningioma (OGM) is characterized by slow-growing tumors that are frequently bilateral as opposed to unilateral & asymmetrical and may cause progressive frontal lobe compression. We aimed to evaluate the value of extradural devascularization as a golden step in bilateral subfrontal approach in management of OGM.ResultsThe mean operative time was 158.32 ± 24.88. Blood loss ranged from 500 to 1000 cc with a mean value of 763.64 ± 155.98. The number of patients requiring blood transfusion was 5 (22.7%). Based on Simpson classification, 19 (86.4%) patients had whole tumor excision (grade I, II) & 3 (13.6%) patients had grade III and IV. The incidence of complications among the studied patients is: CSF leak did not occur to any case, pneumocephalus occurred in 1 (4.5%) patient, anosmia occurred in 1 (4.5%) patient, focal CNS deficit occurred in 1 (4.5%) patient, wound infection occurred in 1 (4.5%) patient and hematoma occurred in 1 (4.5%) patient. Only 1 (4.5%) case died due to pulmonary embolism, whereas behavioral manifestations occurred in 9.09% of patients.ConclusionsThe extradural devascularization is a golden step in this approach in management of OGM associated with lower incidence of blood loss intraoperatively (total blood loss was 500–1000 mL, recurrence rate, mortality and additional neurological deficits postoperatively.

Clinical therapeutic strategies of refracture after bone transport for tibial bone defect

To explore the clinical therapeutic strategies of refracture after Ilizarov bone transport technique in the treatment of tibial bone defect. A retrospective study was performed on 19 patients with infected tibial bone defect treated by Ilizarov bone transport technique and then refracture from August 2010 to January 2020, including 18 males and 1 female with an average age of (37.7±13.0) years old ranging from 15 to 66 years old. Cause of injury invlved falling injury in 4 cases, crashing injury 1 case, crushing injury in 1 case and without obvious injury history in 13 cases. The ipsilateral distal femoral fracture in 2 cases occurred before the external fixator of tibia was removed, and the other 17 cases had a minimum of 1 day and a maximum of 30 months after the external fixator had been removed. The site of refracture was at regenerative zone in 8 cases, at docking site in 9 cases, at ipsilateral femoral shaft in 2 cases. According to the modified Simpson classification proposed by the author, the refracture was classified. The treatment of refracture include plaster splint, traction or external fixation. Bone healing and function were evaluated according to the standards of the Association for the Study and Application of the Method of Ilizarov(ASAMI). All patients were followed up, and the duration ranged from 9 to 17 months with an average of (12.3±3.2) months. According to the modified Simpson classification, there were 3 cases of type Ⅰa, 1 case of type Ⅰb, 3 cases of type Ⅰc, 1 case of type Ⅱ, 9 cases of type Ⅲ and 2 cases of type Ⅴ. All the refractures healed without infection or malunion. The fracture healing time of conservative treatment for 6 cases were 3, 5, 3, 2, 2, 2 months fespectively;and the healing time of fracture treated by surgery for 13 cases was 2 to 6 months, with an average of(4.4±1.4) months. According to ASAMI evaluation criteria, bony results showed all patients obtained excellent results, and functional results showed 6 patients got excellent results, 13 good beacause of ankle or knee stiffness. The modified Simpson classification could contain most clinical types of refracture after bone transport, and the external fixation is a simple and effective method for refracture.

Symptom burden and surgical outcome in non-skull base meningiomas.

PurposeNon-skull base meningiomas (NSBM) are a distinct entity and frequently present with focal neurological deficits. This study was designed to analyze functional and oncological outcome following microsurgical tumor resection in patients with NSBM.Patients and methodsAn analysis of 300 patients that underwent NSBM resection between 2003 and 2013 was performed. Assessment measures for functional outcome were Karnofsky Performance Scale (KPS), Medical Research Council - Neurological Performance Scale (MRC-NPS), and improvement rates of focal deficits and seizures. The extent of resection; recurrence-free survival (RFS) and tumor-specific survival (TSS) were also determined.ResultsImpaired KPS and MRC-NPS were present in 73.3% and 45.7%, respectively. Focal neurological deficits were recorded in 123 patients (41.0%), with hemiparesis (21.7%) and aphasia (9.3%) the most prevalent form of impairment. Most meningiomas were localized at the convexity (64.0%), followed by falcine tumors (20.3%). Both KPI and MRC-NPS scores were significantly improved by surgical resection. Postoperative improvement rates of 96.6%, 89.3%, 72.3%, 57.9%, and 27.3% were observed for aphasia, epilepsy, hemiparesis, cranial nerve, and visual field deficits, respectively. Long-term improvement was achieved in 83.2%, 89.3%, 80.0%, 68.4% and 54.6% of patients, respectively. Gross total resection (GTR) over subtotal resection (STR) significantly improved preoperative seizures and visual field deficits and correlated with reduced risk of new postoperative hemiparesis. Poor Simpson grade was the only significant prognostic factor in multivariate analysis for long-term functional deficit, which occurred in 7.3%. Median RFS was 45.9 months (6.0 - 151.5 months), while median TSS was 53.7 months (3.1 – 153.2 months). Both WHO grade (p= 0.001) and Simpson classification (p= 0.014 and p= 0.031) were independent significant prognostic factors for decreased RFS and TSS by multivariate analysis, respectively. Furthermore, tumor diameter > 50 mm (p= 0.039) significantly correlated with decreased TSS in multivariate analysis.ConclusionSurgical resection significantly and stably improves neurological deficits in patients with NSBM.

Cranial Morphology and Phylogenetic Relationships of Trigonostylops wortmani, an Eocene South American Native Ungulate

In 1933 George G. Simpson described a remarkably complete skull of Trigonostylops, an Eocene South American native ungulate (SANU) whose relationships were, in his mind, quite uncertain. Although some authorities, such as Florentino Ameghino and William B. Scott, thought that a case could be made for regarding Trigonostylops as an astrapothere, Simpson took a different position, emphasizing what would now be regarded as autapomorphies. He pointed out a number of features of the skull of Trigonostylops that he thought were not represented in other major clades of SANUs, and regarded these as evidence of its phyletic uniqueness. Arguing that the lineage that Trigonostylops represented must have departed at an early point from lineages that gave rise to other SANU orders, Simpson reserved the possibility that Astrapotheriidae might still qualify (in modern terms) as its sister group. Even so, he argued that the next logical step was to place Trigonostylops and its few known allies in a separate order, Trigonostylopoidea, coordinate with Astrapotheria, Notoungulata, Litopterna, and Pyrotheria. Simpson's classification was not favored by most later authors, and in recent decades trigonostylopids have been almost universally assigned to Astrapotheria. However, his evaluation of the allegedly unique characters of Trigonostylops and its allies has never been systematically treated, which is the objective of this paper. Using computed tomography, the skull of Trigonostylops is compared, structure by structure, to a variety of representative SANUs as well as extant perissodactylans (which together comprise the clade Panperissodactyla) and the “condylarthran” Meniscotherium. In addition to placing Simpson's character evaluations in a comparative context, we also provide detailed assessments of many vascular and pneumatization-related features of panperissodactylans never previously explored. Overall, we found that this new assessment strengthened the placement of Trigonostylops within a monophyletic group that includes Astrapotherium and Astraponotus, to the exclusion of other SANU clades. Although Trigonostylops cannot be considered as morphologically distinct or unusual as Simpson thought, our comparative and phylogenetic analyses have helped to generate a number of hypotheses about character evolution and function in SANUs that may now be fruitfully tested using other taxon combinations.Reconstruction of Trigonostylops wortmani by Jorge Blanco.

Radiotherapy versus observation after surgical resection of atypical meningiomas

ObjectivesTo describe the treatment and clinical results in patients diagnosed with atypical meningioma treated at the Donostia University Hospital. We evaluated recurrence, overall survival, and disease-free survival. MethodsFrom 284 meningiomas treated in our center over 16 years, 32 cases of grade II atypical meningioma were selected. Clinical and surgical notes were retrospectively evaluated. Pre and postoperative clinical and radiological parameters, the modality of radiotherapeutic treatment and its clinical results were evaluated. The histological classification was consistent with the 2007 WHO (World Health Organization) classification. The Simpson classification system was used to assess the degree of surgical resection. Resultswe found 18 men and 14 women with a mean age of 60 years. Parasagittal location and convexity were the most frequent locations respectively (14 and 12 cases). The mean follow-up was 50 months. Simpson I-III resection was performed in 28 cases (87%). 22 patients (20 Simpson I-III and 2 Simpson IV) received postoperative radiotherapy (20 cases fractionated radiotherapy and radiosurgery in 2), while 10 patients (8 Simpson I-II and 2 Simpson IV) did not receive postoperative radiotherapy. The recurrence rate in patients who received radiotherapy was 45% and 60% in those who did not receive radiotherapy. Recurrence-free survival and overall survival in patients under radiotherapy was 36 and 48 months, respectively. On the contrary, in those who did not receive radiotherapy it was 44 and 56 months. ConclusionsIn this study, the most important prognostic factor related to survival was the degree of surgical resection. Therefore, adjuvant radiotherapy should be used in those cases without complete surgical resection. In addition, we recommend evaluating reoperation in recurrent symptomatic cases.

Surgical resection of tuberculum sellae meningiomas through lateral supraorbital approach: A report of 34 cases

Objective To assess the reliability and safety of lateral supraorbital (LSO) approach in the surgical treatment of tuberculum sellae meningiomas (TSMs). Methods A total of 34 patients underwent operation through LSO approach between June 2013 and June 2017 at Department of Neurosurgery at Qilu Hospital of Shandong University and their clinical data were retrospectively analyzed in this study. All patients underwent surgical resection of the tumor via LSO approach. The extent of resection of the tumor was assessed using the Simpson classification. The effectiveness of the procedure was evaluated based on the patient's postoperative MRI and improvement in neurological symptoms, and the safety of the procedure was assessed based on the occurrence of postoperative complications. Results All patients were followed up for 3-36 months with an average of 12±5 months. Of the 34 patients, 30 underwent Simpson Ⅰ-Ⅱ resection and 4 received Simpson Ⅲ resection. Postoperative visual acuity was improved in 23 cases, no change was reported in 8 cases, and visual impairment was worse than preoperative conditions in 3 cases. There were 3 cases of postoperative fever, 3 cases of hyponatremia, 1 case of psychiatric symptoms, 1 case of cerebral edema, and 2 cases of epileptic seizures. In 1 (3%) patient, postoperative imaging findings confirmed recurrence. Conclusions LSO approach has multiple advantages including simplified and fast skull opening and closing, clean operative field and small trauma, and it could be used in the effective treatment of TSMs. Key words: Meningioma; Microsurgery; Treatment outcome; Lateral supraorbital approach; Tuberculum sellae

Effects of minimally invasive tumor resection under microscope on symptoms improvement, Simpson classification and prognosis in patients with sagittal sinus and falx cerebri meningioma

Objective To analyze the effects of minimally invasive tumor resection under microscope on symptoms improvement, Simpson classification and prognosis in patients with sagittal sinus and falx cerebri meningioma. Methods From December 2012 to December 2016, 123 patients with parasagittal and falx meningioma in the People's Hospital of Shanxi Province were randomly divided into two groups according to the digital table.The control group(61 cases) underwent conventional craniotomy, and the study group(62 cases) performed minimally invasive tumor resection.The symptoms improvement, Simpson classification and postoperative recurrence were compared between the two groups. Results The operation time between the two groups had no statistically significant difference (t=1.13, P>0.05). The intraoperative blood loss in the study group was (119.05±26.94)mL, which was lower than (172.05±27.43)mL in the control group (t=10.81, P<0.01). The postoperative symptoms improvement of movement of limbs(3.22%), epilepsy(4.65%), sensory dysfunction(1.61%) in the study group were significantly better than those in the control group(14.75%, 31.15%, 27.87%)(χ2=5.02, 6.34, 4.14, all P<0.05). The Simpson classification of tumor resection rate in the study group was better than that in the control group(χ2=12.23, P<0.01). The incidence rates of complications such as epilepsy(0.00%) and intracranial hemorrhage(1.61%), and recurrence rate(0.00%) in the study group were lower than those in the control group(26.23%, 27.87%, 27.87%)(χ2=4.05, 4.14, 4.65, all P<0.05). Conclusion Minimally invasive tumor resection under the microscope can effectively improve clinical symptoms of patients with sagittal sinus and falx cerebri meningioma, which can improve tumor resection rate, effectively reduce the incidence of postoperative complications and recurrence rate. Key words: Meningeal neoplasms; Microscopy, electron; Tumor resection; Superior sagittal sinus; Falx cerebri

Dynamic retraction microneurosurgery for the treatment of medial tentorial meningiomas

Objective: To investigate the effectiveness and clinical significance of dynamic retraction microneurosurgery for the treatment of medial tentorial meningiomas. Methods: From January 2011 to December 2016, a cohort of 28 patients with medial tentorial meningiomas were treated by microneurosurgery at the First Affiliated Hospital of Chongqing Medical University. Patients who treated intraoperatively with dynamic retraction surgery from January 2014 to December 2016 were assigned into dynamic retraction group, and those with fixed retractors intraoperatively from January 2011 to December 2013 were assigned into retractor group. The surgical approaches tailored in our patients were based on predominant direction of tumor extension. The extent of tumor resection was scored according to the Simpson's classification scale. Comparisons of tumor size, operation time, hospitalization time, retraction-related injury, tumor Simpson resection grade and Karnofsky Performance Scale(KPS) score six months after surgery were also made between two groups. Results: A total of 12 patients(retractor group) were treated with the use of self-retaining brain retractors intraoperatively and dynamic retraction surgical procedure was performed intraoperatively in 16 patients(dynamic retraction group). The difference between two groups with regard to sex, age, tumor size, operation time and tumor Simpson resection grade was not statistically significant(all P>0.05). The mean duration of hospital time was shorter in the dynamic retraction group than that in the retractor group(18.3 d±1.8 d vs 20.2 d±1.3 d, P=0.004). The dynamic retraction group had lower incidence of retraction-related injury compared with the retractor group(1/16 vs 6/12), P=0.022]. The dynamic retraction group had better neurological recovery rate with KPS >80 evaluated six months after surgery compared with the retractor group(14/16 vs 5/12, P=0.017). Conclusions: Dynamic retraction microneurosurgery for the treatment of medial tentorial meningiomas is feasible, which can obviate or reduce the amount of brain retraction needed, and may be of help in lowering the risk of postoperative neurological deficits and complications and leading to reduced hospitalization cost and improved surgical outcomes.

The curative effect analysis of unilateral subfrontal combined with interhemispheric approach on the microsurgery of large anterior skull base meningioma

Objective: To explore the surgical technique and curative effect of microsurgical resection of large anterior skull base meningioma via unilateral subfrontal and interhemispheric approach. Method: The clinical data of 14 patients with large anterior skull base meningioma who received surgical treatment in the Department of neurosurgery in First Affiliated Hospital of Bengbu Medical College from April 2015 to September 2017 were analysed retrospectively.Of 9 cases were olfactory groove meningioma and 5 cases were tuberculum sellae meningioma.The microsurgical resection approach of all the patients was the unilateral subfrontal combined with interhemispheric approach. Results: According to the Simpson classification of meningioma resection, 13 cases(92.8%) were Simpson grade Ⅰand Ⅱ, 1 case was grade Ⅲ.The clinical symptoms were improved in 12 cases (85.7%), and no improvement in 2 cases.Fourteen patients had postoperative complications in 2 cases (14.2%), and all of them were no cerebrospinal fluid leakage and death. Conclusion: Microsurgical removal of large anterior skull base meningioma through unilateral frontal and interhemispheric approach is safe and effective, providing a new way for surgical treatment of large anterior skull base meningioma. It had a positive significance for the prognosis of patients.

The Simpson grading in meningioma surgery: does the tumor location influence the prognostic value?

In meningiomas, location-specific differences of the prognostic value of the Simpson classification are sparsely investigated but can influence strategy of surgery. We therefore compared the prognostic value of the Simpson classification in different tumor locations. Progression was compared with Simpson grade in 826 meningioma patients (median age 58 years, female:male ratio 2.4) in location-specific uni- and multivariate analyses. Simpson grade strongly correlated with tumor location (p < .001). Within a median follow-up of 50 months, recurrence was observed in 107 of 803 patients (13%). In general, increasing Simpson grade (p = .002) and subtotal resection (STR, ≥grade III) were correlated with tumor recurrence [hazard ratio (HR): 1.87; p = .004]. In 268 convexity meningiomas, frequency of tumor recurrence correlated with Simpson grade (p = .034). Risk of recurrence was similar after grade I and II resections, tended to increase after grade III (HR: 2.35; p = .087) but was higher after grade IV resections (HR: 7.35; p = .003). Risk of recurrence was higher after STR (HR: 4.21; p = .001) than after gross total resection (GTR, ≤grade II). Contrarily, increasing Simpson grade and STR were not correlated with progression in 102 falx, 38 posterior fossa and nine intraventricular meningiomas. In 325 skull base lesions, risk of recurrence was similar after GTR and STR (p = .198) and was only increased after grade IV resections (HR: 3.26; p = .017). Simpson grading and extent of resection were not equally prognostic in all locations. Lower impact of extent of resection should be considered during surgery for skull base, posterior fossa and falx meningiomas.

Relevance of Simpson grading system and recurrence-free survival after surgery for World Health Organization Grade I meningioma.

OBJECTIVE The clinical significance of the Simpson system for grading the extent of meningioma resection and its role as a predictor of the recurrence of World Health Organization (WHO) Grade I meningiomas have been questioned in the past, echoing changes in meningioma surgery over the years. The authors reviewed their experience in resecting WHO Grade I meningiomas and assessed the association between extent of resection, as evaluated using the Simpson classification, and recurrence-free survival (RFS) of patients after meningioma surgery. METHODS Clinical and radiological information for patients with WHO Grade I meningiomas who had undergone resective surgery over the past 20 years was retrospectively reviewed. Simpson and Shinshu grading scales were used to evaluate the extent of resection. Statistical analysis was conducted using Kaplan-Meier curves and Cox proportional-hazards regression. RESULTS Four hundred fifty-eight patients were eligible for analysis. Overall tumor recurrence rates for Simpson resection Grades I, II, III, and IV were 5%, 22%, 31%, and 35%, respectively. After Cox regression analysis, Simpson Grade I (extensive resection) was revealed as a significant predictor of RFS (p = 0.003). Patients undergoing Simpson Grade I and II resections showed significant improvement in RFS compared with patients undergoing Grade III and IV resections (p = 0.005). Extent of resection had a significant effect on recurrence rates for both skull base (p = 0.047) and convexity (p = 0.012) meningiomas. Female sex and a Karnofsky Performance Scale score > 70 were also identified as independent predictors of RFS after resection of WHO Grade I meningioma. CONCLUSIONS In this patient cohort, a significant association was noted between extent of resection and rates of tumor recurrence. In the authors' experience the Simpson grading system maintains its relevance and prognostic value and can serve an important role for patient education. Even though complete tumor resection is the goal, surgery should be tailored to each patient according to the risks and surgical morbidity.

Clinical and Radiological Characteristics of Angiomatous Meningiomas.

BackgroundAngiomatous meningioma is a rare histological subtype of meningioma. Therefore, this specific medical condition is rarely reviewed in the literature. In the present work, we report the clinical and radiological features with postoperative outcomes of angiomatous meningioma.MethodsThis retrospective study included the patients who were pathologically diagnosed with angiomatous meningioma after surgical resection between February 2010 and September 2015 in our institute. We analyzed the clinical data, radiological manifestation, treatment and prognosis of all patients.ResultsThe 15 patients (5 males and 10 females) were diagnosed with angiomatous meningioma during the study period. The median age of patients at the time of surgery was 63 years (range: 40 to 80 years). According to Simpson classification, 7, 5, and 3 patients achieved Simpson grade I, II, and IV resection, respectively. In the follow-up period, recurrence was noted in one patient. Ten out of the 15 patients showed homogeneous enhancement. Two patients demonstrated cystic changes. There was no occurrence of calcification or hemorrhage in our patients. Characteristically, 14 out of 15 patients showed signal voids of vessels. Significant peritumoral edema was observed in the majority of tumors (67%).ConclusionAngiomatous meningiomas are rare benign meningioma. Brain images of angiomatous meningioma usually demonstrate signal void signs and peritumoral edema. In the present study, angiomatous meningiomas showed good prognosis after surgical resection.

Efficacy of resection of petroclival meningiomas via modified subtemporal anterior transpetrosal approach

Objective To investigate the efficacy of resection of petroclival meningiomas via modified subtemporal anterior transpetrosal approach. Methods Twenty-three patients with petroclival meningioma within the internal auditory canal and above the bridge grike resected by using the modified subtemporal anterior transpetrosal approach at the Department of Neurosurgery, the Second Affiliated Hospital of Nanchang University from January 2012 to June 2014 were analyzed retrospectively. Results None of the 23 patients died in this group. The tumors of 16 patients were totally resected (Simpson's classification, grade Ⅰ-Ⅱ) and those of 7 patients were subtotally resected (Simpson's classification, grade Ⅳ). They were followed up for 3 to 24 months. The tumor of 1 patient with subtotal resection increased slightly. Of the 20 patients with obvious symptoms before procedure, 13 were improved after procedure. They had transient neurological deficit after procedure, including 1 with oculomotor nerve palsy, 1 with dysphagia, 4 with facial paralysis, 4 with facial numbness, 2 with diplopia, and 2 with contralateral limb movement disorder. The symptoms were not improved significantly during follow-up period, including 1 with oculomotor nerve palsy, 4 with deafness, 2 with facial numbness, and 2 with esotropia. Conclusions Resection of petroclival meningiomas within the internal auditory canal and above the bridge grike via subtemporal anterior transpetrosal approach has certain advantages. Although some patients have neurological deficits after procedure, most of them are mild, reversible, and acceptable. Key words: Meningioma; Microsurgery; Petroclival; Subtemporal anterior transpetrosal approach

Radiation-associated grade 2 meningiomas: A nine patient-series and review of the literature

IntroductionRadiation-associated meningiomas (RAM) remain rare but recognized to harbor a high potential of aggressiveness. Only few studies focused on grade 2 histological variants. ObjectiveOur study aims to report the natural history of patients with radiation-associated grade 2 meningiomas followed in a single institution. Materials and methodsThis retrospective study included all patients with grade 2 RAM operated in our institution between 1994 and 2011. We used the WHO 2007 classification for histological grading. The degree of resection was evaluated using Simpson Classification. The tumor was considered radiation-associated, if the patient had a medical history of cranial irradiation for another medical condition (1 year before at least). Patients benefited from a post-operative close clinical and radiological (cranial MRI) follow-up every 4 months during 2 years and annually thereafter, to detect any tumor progression. Adjuvant therapy and/or monitoring were systematically decided during a multidisciplinary team meeting. ResultsNine patients (6 men and 3 women) were included in the study. The mean age at diagnosis was 34 years old (range 20–55 years). The mean follow-up was 77 months (range 31–180 months). The mean delay between initial cranial radiation therapy and the diagnosis of grade 2 RAM was 23 years (range 16–33 years). Among all patients, 4 harbored a meningiomatosis, while 5 patients harbored a single tumor. Post-operative local tumor progression was noted in 4 patients. Progression free survival (PFS) after the first surgery in these 4 patients was 15, 23, 35, and 47 months. In these 4 progressive patients, 7 surgical resections, 3 GKS and 1 fractionated radiation therapy have been performed. Post-operative tumor progression was noted at distance from the operated meningioma in 1 patient with meningiomatosis. At final control, 2 patients had severe oculomotor palsy and 1 patient needed palliative cares related to progressive meningiomatosis with anorexia and swallowing disturbance. ConclusionGrade 2 RAM is a severe radiation-associated disease occurring preferentially in younger male patients. Although, surgery remains the mainstay treatment, the high potential of tumor progression often requires adjuvant therapeutic tools. Thus, new radiation therapy should be discussed in some cases and the role of radio surgery is still to be better defined.

Microsurgical Treatment of Tuberculum Sellae Meningiomas with Visual Impairments: A Chinese Experience of 56 Cases.

Tuberculum sellae meningiomas (TSMs) are suprasellar lesions that commonly extend to the medial side of the optic nerve, resulting in visual impairments in the affected eye as the initial and most common symptoms. The primary goal of surgical treatment for TSM is the preservation or improvement of visual function. The aim of the present study was to assess the clinical outcomes of TSMs treated with microsurgery at our center. A retrospective analysis was performed on 56 patients with TSMs associated with visual impairments who visited our neurosurgery center between January 2008 and January 2012. These patients underwent microsurgery using the unilateral subfrontal approach (n=22), the lateral frontal base approach (n=28), or the frontotemporal approach (n=6). Outcomes were complete tumor removal, improvements of visual impairments and survival to the surgery. After surgery, patients were classified according to Simpson classification: Grade I in 22 cases, grade II in 28 cases, and grade IV in 6 cases. Postoperatively, visual impairments were improved in 47 cases, unchanged in 7 cases, and worsened in 2 cases. There was no patient's death. TSMs are operated in China with favorable outcomes.

Intracranial meningiomas: Two-years experience of Mustafa Kemal University

Meningiomas are the most common type of brain tumors. We have analyzed clinical, radiological and pathological characteristics of meningiomas that were diagnosed and operated in our centre. Twenty three meningioma cases operated in our hospital between 2010-2012 were reviewed retrospectively. Sixteen (69.1%) of cases were female and 7 (30.9%) of cases were male. The age range was 22-75. The most common symptoms of patients were headache, seizure, nausea and vomitting. Localizations of tumors were flax, cortex, sphenoid wing, posterior fossa-tentorium, olphactor, and sulcus. The surgical sizes were graded according to Simpson classification and 16 (69.1%) of cases were Grade 2 and 7 (30.9%) of cases were Grade I. At the histopathological examination; meningotheliomatous type was the most common type followed by fibrous, angiomatous, transitional, psammomatous and atypical types. Meningiomas are usually benign tumors with good prognosis which are often encountered in daily pathology and neurosurgery practice. J. Exp. Clin. Med., 2013; 30:45-48

Surgical management of posterior petrous meningiomas

Background and purposeThe aim of the study is to present our experience in the surgical treatment of posterior petrous meningiomas in regard to clinical presentation, surgical anatomy, complications and long-term functional postoperative results. Material and methodsA series of 48 consecutive patients operated on for posterior petrous meningiomas at the authors’ institution between 2002 and 2011 is reported. The main symptom on first admission was hypoacusis, impairment of the fifth cranial nerve and cerebellar ataxia. The tumour was found to be attached to the premeatal dura in 46%, the inframeatal dura in 29% and the postmeatal dura in 25% of cases. Tumour resection was categorized as grade I in 16 patients, grade II in 29 patients, grade III in 1 patient and grade IV in 2 patients, according to the Simpson classification system. The petrosal approach and retrosigmoid approach were suitable for posterior petrous meningiomas. ResultsPostoperative facial nerve dysfunction appeared in 8 and further deteriorated in 2 patients. Hearing function deteriorated after surgery in 8 and improved in 2 cases. Perioperative death occurred in two patients. Tumour recurrence was observed in two patients, and both underwent a second operation and postoperative stereotactic radiotherapy. ConclusionsSurgical treatment of posterior petrous meningiomas has become increasingly safe but these tumours still remain a surgical challenge because of the relatively high incidence of permanent complications associated with their removal. The site of displacement of the cranial nerves depending on the dural origin of the tumour has the most influence on the related difficulties in its removal.