J Neurol Surg B Skull Base
DOI: 10.1055/a-2021-8852
Original Article

Simpson's Grading Scale for WHO Grade I Meningioma Resection in the Modern Neurosurgical Era: Are We Really Asking the Right Question?

1   Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
Michael E. Sughrue
2   Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Randwick, New South Wales, Australia
3   Omniscient Neurotechnology, Sydney, New South Wales, Australia
› Author Affiliations


The Simpson grading scale for the classification of the extent of meningioma resection provided a tremendous movement forward in 1957 suggesting increasing the extent of resection improves recurrence rates. However, equal, if not greater, movements forward have been made in the neurosurgical community over the last half a century owing to improvements in neuroimaging capabilities, microsurgical techniques, and radiotherapeutic strategies. Sughrue et al proposed the idea that these advancements have altered what a “recurrence” and “subtotal resection” truly means in modern neurosurgery compared with Simpson's era, and that a mandated use of the Simpson Scale is likely less clinically relevant today. A subsequent period of debate ensued in the literature which sought to re-examine the clinical value of using the Simpson Scale in modern neurosurgery. While a large body of evidence has recently been provided, these data generally continue to support the clinical importance of gross tumor resection as well as the value of adjuvant radiation therapy and the importance of recently updated World Health Organization classifications. However, there remains a negligible interval benefit in performing overly aggressive surgery and heroic maneuvers to remove the last bit of tumor, dura, and/or bone just for the simple act of achieving a lower Simpson score. Ultimately, meningioma surgery may be better contextualized as a continuous set of weighted risk–benefit decisions throughout the entire operation.

Author Contributions

Conceptualization, M.E.S.; methodology, M.E.S and N.D.; formal analysis, N.D.; writing—original draft preparation, M.E.S and N.D.; writing—review and editing, M.E.S and N.D.; visualization, N.D.; supervision, M.E.S. All authors have read and agreed to the published version of the manuscript.

Publication History

Received: 05 October 2022

Accepted: 21 January 2023

Accepted Manuscript online:
29 January 2023

Article published online:
22 February 2023

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