title: Long-term recurrence rates after the removal of spinal meningiomas in relation to Simpson grades.
abstract: Simpson grade II removal (coagulation of the dural attachment after gross total removal) of spinal meningioma is considered an acceptable alternative, but increased recurrence after more than 10 years has been reported. More attention must be paid to the long-term surgical outcomes after Simpson grade II removal.
  
  
  
  A retrospective review was performed for 20 patients (M:F = 5:15; age, 59 ± 9 years) with Simpson grade II removal (mean follow-up period, 12.9 years; range 10.0-17.5). Magnetic resonance (MR) imaging was conducted in 17 patients at 88 ± 52 months (range 12-157). During the same period, Simpson grade I removal (removal of the dural origin) was performed in 21 patients (follow-up, 89 ± 87 months; range 9-316). Radiological recurrence was defined as a visible tumor on a follow-up MR image, and clinical tumor recurrence was defined as the recurrence of symptoms.
  
  
  
  At the final follow-up, neurological symptoms had improved in 16/20 patients and remained stable in 4/20. A recurrent tumor was detected in one patient due to increased back pain at 92 months postoperative, but the symptom was stable without surgery until the last follow-up (124 months). The radiological and clinical recurrence-free survival periods were 150 ± 7 months (95 % CI 136-163) and 204 ± 6 months (95 % CI 193-215), respectively. There was no recurrence after Simpson grade I removal, whereas neurological deterioration occurred in two patients after surgery.
  
  
  
  Simpson grade II removal may be an alternative option if the risk of complications with Simpson grade I removal is expected to be high.
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea.|Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea.|Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, South Korea.|Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Chi Heon
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea. chungc@snu.ac.kr.|Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea. chungc@snu.ac.kr.|Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, South Korea. chungc@snu.ac.kr.|Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea. chungc@snu.ac.kr.|Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea. chungc@snu.ac.kr.
authors.forename: Chun Kee
authors.initials: CK
authors.lastname: Chung
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Sun-Ho
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea.|Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, South Korea.|Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.|Department of Neurosurgery, Seoul National University Bundang Hospital, Sung-Nam, Kyung-gi, South Korea.
authors.forename: Tae-Ahn
authors.initials: TA
authors.lastname: Jahng
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea.|Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, South Korea.|Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.|Department of Neurosurgery, Seoul National University Bundang Hospital, Sung-Nam, Kyung-gi, South Korea.
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Hyun
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea.|Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, South Korea.|Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.|Department of Neurosurgery, Seoul National University Bundang Hospital, Sung-Nam, Kyung-gi, South Korea.
authors.forename: Ki-Jeong
authors.initials: KJ
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, The Armed Forces Capital Hospital, Sung-Nam, Kyung-gi, South Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Yoon
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Eun-Sang
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Whan
authors.initials: W
authors.lastname: Eoh
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea.|Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, South Korea.|Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.|Department of Neurosurgery, Seoul National University Bundang Hospital, Sung-Nam, Kyung-gi, South Korea.
authors.forename: Hyun-Jib
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Kyungpook National University Hospital, Taegu, Kyungpook, South Korea.
authors.forename: Kyoung-Tae
authors.initials: KT
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Kyungpook National University Hospital, Taegu, Kyungpook, South Korea.
authors.forename: Joo-Kyung
authors.initials: JK
authors.lastname: Sung
authors.affiliation: Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Yunhee
authors.initials: Y
authors.lastname: Choi
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D008579:Meningioma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000453:epidemiology; D012189:Retrospective Studies
keywords: Meningiomas; Recurrence; Simpson grade; Spinal meningiomas; Surgery