J Neurol Surg A Cent Eur Neurosurg 2021; 82(05): 417-423
DOI: 10.1055/s-0040-1720987
Original Article

The 2016 Edition of the WHO Classification of Primary Brain Tumors: Applicable to Assess Individual Risk of Recurrence in Atypical Meningioma? A Single-Center Experience

Meike Unteroberdörster
1   Department of Neurosurgery, University Hospital of Essen, Essen, Germany
2   Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
Anna Michel
1   Department of Neurosurgery, University Hospital of Essen, Essen, Germany
Marvin Darkwah Oppong
1   Department of Neurosurgery, University Hospital of Essen, Essen, Germany
Ramazan Jabbarli
1   Department of Neurosurgery, University Hospital of Essen, Essen, Germany
Nicolai El Hindy
1   Department of Neurosurgery, University Hospital of Essen, Essen, Germany
3   Werne Spine Center, Hospital Lünen/Werne GmbH – St. Christophorus Hospital, Werne, Germany
1   Department of Neurosurgery, University Hospital of Essen, Essen, Germany
Ulrich Sure
1   Department of Neurosurgery, University Hospital of Essen, Essen, Germany
Daniela Pierscianek
1   Department of Neurosurgery, University Hospital of Essen, Essen, Germany
› Author Affiliations


Background and Study Aims/Object Despite the relevance of molecular criteria for brain tumor diagnosis and prognosis, meningioma grading is still solely based on histologic features. Atypical meningiomas (AMs; WHO grade II) display a great histologic heterogeneity and individual courses of disease can differ significantly. This study aimed to identify clinically aggressive AMs that are prone to early recurrence after gross total resection (GTR) by assessing a specific histologic score.

Patients and Methods A retrospective analysis of 28 consecutive patients (17 females and 11 males; mean age of 62 years [range: 35–88 years]) treated in our institution between January 2006 and December 2015 was performed. Basic demographic and clinical characteristics were assessed. A scoring scale was designed to address the histologic diversity by summing up the individual histologic features in every tumor sample. According to that, points were awarded as follows: major AM defining criterion (3 points) and minor criterion (1 point).

Results The subclassification based on our specific histologic score revealed no significant difference in frequency of one (46.4%) or two (42.9%) AM defining features; three criteria were less frequently seen (10.7%). Mean follow-up was 61.89 ± 9.03 months. Local recurrence occurred in 35.7% after a mean time of 37.4 ± 22.6 months after primary surgery. Age > 60 years was significantly associated with a shorter progression-free survival (PFS). There was a trend toward shorter PFS with increasing scores, tantamount with the presence of several AM defining histologic criteria in one sample. No tumor relapse was seen when diagnosis was based only on minor criteria.

Conclusion AMs display a histologic diversity. There is a trend toward shorter PFS with increasing numbers of AM defining histologic features. The inclusion of this score in the decision algorithm regarding further treatment for patients >60 years after GTR might be helpful and should be evaluated in further studies.

Publication History

Received: 27 May 2020

Accepted: 25 August 2020

Article published online:
12 April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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