Schwartz Theodore H, McDermott Michael W
1Department of Neurosurgery, Otolaryngology and Neuroscience, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York; and.
2Division of Neuroscience, Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
J Neurosurg. 2020 Oct 9;135(2):488-495. doi: 10.3171/2020.6.JNS201904. Print 2021 Aug 1.
The Simpson grading scale, developed in 1957 by Donald Simpson, has been considered the gold standard for defining the surgical extent of resection for WHO grade I meningiomas. Since its introduction, the scale and its modifications have generated enormous controversy. The Simpson grade is based on an intraoperative visual assessment of resection, which is subjective and notoriously inaccurate. The majority of studies in which the grading system was used were performed before routine postoperative MRI surveillance was employed, rendering assessments of extent of resection and the definition of recurrence inconsistent. The infiltration and proliferation potential of tumor components such as hyperostotic bone and dural tail vary widely based on tumor location, as does the molecular biology of the tumor, rendering a universal scale for all meningiomas unfeasible. While extent of resection is clearly important at reducing recurrence rates, achieving the highest Simpson grade resection should not always be the goal of surgery. Donald Simpson's name and his scale deserve to be recognized and preserved in the historical pantheon of pioneering and transformative neurosurgical concepts. Nevertheless, his eponymous scale is no longer relevant in modern meningioma surgery. While his message of maximizing extent of resection and minimizing morbidity is still germane, a single measure using subjective criteria cannot be applied universally to all meningiomas, regardless of location. Meningioma surgery should be performed with the goal of achieving maximal safe resection, ideally guided by molecularly tagged fluorescent labeling and assessed using objective criteria, including postoperative MRI as well as molecularly tagged scans such as [68Ga]-DOTATATE-PET.
1957年由唐纳德·辛普森开发的辛普森分级量表，一直被视为定义世界卫生组织I级脑膜瘤手术切除范围的金标准。自引入以来，该量表及其修改版本引发了巨大争议。辛普森分级基于术中对切除情况的视觉评估，这种评估主观且极不准确。大多数使用该分级系统的研究是在术后常规MRI监测应用之前进行的，这使得对切除范围的评估和复发的定义不一致。肿瘤成分如骨质增生和硬脑膜尾征的浸润和增殖潜能因肿瘤位置而异，肿瘤的分子生物学也是如此，因此为所有脑膜瘤制定一个通用量表是不可行的。虽然切除范围在降低复发率方面显然很重要，但实现最高的辛普森分级切除并不总是手术的目标。唐纳德·辛普森的名字和他的量表值得在开创性和变革性神经外科概念的历史殿堂中得到认可和保留。然而，他的同名量表在现代脑膜瘤手术中已不再适用。虽然他关于最大化切除范围和最小化发病率的观点仍然相关，但使用主观标准的单一衡量方法不能普遍适用于所有脑膜瘤，无论其位置如何。脑膜瘤手术应以实现最大安全切除为目标，理想情况下由分子标记的荧光标记引导，并使用客观标准进行评估，包括术后MRI以及分子标记扫描，如[68Ga]-DOTATATE-PET。
