title: Simpson Grade I-III Resection of Spinal Atypical (World Health Organization Grade II) Meningiomas is Associated With Symptom Resolution and Low Recurrence.
abstract: BACKGROUND
  Because of their rarity, outcomes regarding spinal atypical meningiomas (AMs) remain unclear.
  
  
  OBJECTIVE
  To describe the recurrence rate and postoperative outcomes after resection of spinal AMs, and to discuss an appropriate resection strategy and adjuvant therapy for spinal AMs.
  
  
  METHODS
  Data from all patients who presented with spinal AMs to 2 tertiary referral centers between 1998 and 2013 were obtained by chart review.
  
  
  RESULTS
  From 102 patients with spinal meningioma, 20 AM tumors (7 cervical, 11 thoracic, 2 thoracolumbar) were identified in 18 patients (median age, 50 years [range, 19-75] at time of resection; 11% male; median follow-up, 32 months [range, 1-179] after resection). Before resection, patients had sensory deficits (70%), pain (70%), weakness (60%), ataxia (50%), spasticity (65%), and incontinence (35%). One tumor presented asymptomatically. Simpson grade I, II, III, and IV resection were achieved in 3 (15%), 13 (65%), 2 (10%), and 2 (10%) tumors, respectively. One patient that underwent Simpson grade III resection received adjuvant radiation therapy. After Simpson grade I-III or gross total resection, no tumors recurred (0%; confidence interval, 0%-17.6%). After Simpson grade IV resection, 1 tumor recurred (50%; confidence interval, 1.3%-98.7%). With the exception of 1 patient who had bilateral paraplegia perioperatively, all other patients experienced improvement of preoperative symptoms after surgery (median time, 3.6 months [range, 1-13] after resection).
  
  
  CONCLUSIONS
  Despite published cases suggesting an aggressive clinical course for spinal AMs, this series of spinal AMs reports that gross total resection without adjuvant radiation therapy resulted in symptom resolution and low recurrence.
authors.affiliation: *Washington University School of Medicine, Saint Louis, Missouri; ‡Department of Pathology and Immunology, Washington University, St. Louis, Missouri; §Department of Neurosurgery, University of Utah, Salt Lake City, Utah; ¶Department of Neurosurgery, Washington University, St. Louis, Missouri; ‖Department of Radiation Oncology, Washington University, St. Louis, Missouri.
authors.forename: Sam Q
authors.initials: SQ
authors.lastname: Sun
authors.forename: Chunyu
authors.initials: C
authors.lastname: Cai
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Ravindra
authors.forename: Paul
authors.initials: P
authors.lastname: Gamble
authors.forename: Chester K
authors.initials: CK
authors.lastname: Yarbrough
authors.forename: Ralph G
authors.initials: RG
authors.lastname: Dacey
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Dowling
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Zipfel
authors.forename: Neill M
authors.initials: NM
authors.lastname: Wright
authors.forename: Paul
authors.initials: P
authors.lastname: Santiago
authors.forename: Clifford G
authors.initials: CG
authors.lastname: Robinson
authors.forename: Meic H
authors.initials: MH
authors.lastname: Schmidt
authors.forename: Albert H
authors.initials: AH
authors.lastname: Kim
authors.forename: Wilson Z
authors.initials: WZ
authors.lastname: Ray
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014944:World Health Organization; D055815:Young Adult