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Haslund-Vinding J, Skjoth-Rasmussen J, Poulsgaard L, et al. Proposal of a new grading system for meningioma resection: the Copenhagen Protocol. Acta Neurochir (Wien). 2021;164(1):229-238doi: 10.1007/s00701-021-05025-5.
Haslund-Vinding, J., Skjoth-Rasmussen, J., Poulsgaard, L., Fugleholm, K., Mirian, C., Maier, A. D., Santarius, T., Rom Poulsen, F., Meling, T., Bartek, J. J., Förander, P., Larsen, V. A., Kristensen, B. W., Scheie, D., Law, I., Ziebell, M., & Mathiesen, T. (2022). Proposal of a new grading system for meningioma resection: the Copenhagen Protocol. Acta neurochirurgica, 164(1), 229-238. https://doi.org/10.1007/s00701-021-05025-5
Haslund-Vinding, Jeppe, et al. "Proposal of a new grading system for meningioma resection: the Copenhagen Protocol." Acta neurochirurgica vol. 164,1 (2022): 229-238. doi: https://doi.org/10.1007/s00701-021-05025-5
Haslund-Vinding J, Skjoth-Rasmussen J, Poulsgaard L, Fugleholm K, Mirian C, Maier AD, Santarius T, Rom Poulsen F, Meling T, Bartek JJ, Förander P, Larsen VA, Kristensen BW, Scheie D, Law I, Ziebell M, Mathiesen T. Proposal of a new grading system for meningioma resection: the Copenhagen Protocol. Acta Neurochir (Wien). 2022 Jan;164(1):229-238. doi: 10.1007/s00701-021-05025-5. Epub 2021 Oct 29. PMID: 34714434.
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Acta Neurochir (Wien). 2022 Jan;164(1):229-238. doi: 10.1007/s00701-021-05025-5. Epub 2021 Oct 29.

Proposal of a new grading system for meningioma resection: the Copenhagen Protocol.

Acta neurochirurgica

Jeppe Haslund-Vinding, Jane Skjoth-Rasmussen, Lars Poulsgaard, Kaare Fugleholm, Christian Mirian, Andrea Daniela Maier, Thomas Santarius, Frantz Rom Poulsen, Torstein Meling, Jiri Junior Bartek, Petter Förander, Vibeke Andrée Larsen, Bjarne Winther Kristensen, David Scheie, Ian Law, Morten Ziebell, Tiit Mathiesen

Affiliations

  1. Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. [email protected].
  2. Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
  3. Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
  4. Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
  5. Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden.
  6. Department of Neurosurgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
  7. Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
  8. Department of Clinical Medicine and Biotech Research and Innovation Center (BRIC), University of Copenhagen, Copenhagen, Denmark.
  9. Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark.
  10. Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland.
  11. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
  12. Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.

PMID: 34714434 DOI: 10.1007/s00701-021-05025-5

Abstract

INTRODUCTION: The extent of meningioma resection is the most fundamental risk factor for recurrence, and exact knowledge of extent of resection is necessary for prognostication and for planning of adjuvant treatment. Currently used classifications are the EANO-grading and the Simpson grading. The former comprises radiological imaging with contrast-enhanced MRI and differentiation between "gross total removal" and "subtotal removal," while the latter comprises a five-tiered differentiation of the surgeon's impression of the extent of resection. The extent of resection of tumors is usually defined via analyses of resection margins but has until now not been implemented for meningiomas. PET/MRI imaging with

OBJECTIVE: To develop an objective grading system based on microscopic analyses of resection margins and sensitive radiological analyses to improve management of follow-up, adjuvant therapy, and prognostication of meningiomas. Based on the rationale of resection-margin analyses as gold standard and superior imaging performance of

RESULTS: Copenhagen Grading was described for six pilot patients with examples of positive and negative findings on histopathology and DOTATOC PET scanning. The grading could be traceably implemented and parameters of grading appeared complementary. Copenhagen Grading is prospectively implemented as a clinical standard at Rigshospitalet, Copenhagen.

CONCLUSION: Copenhagen Grading provided a comprehensive, logical, and reproducible definition of the extent of resection. It offers promise to be the most sensitive and specific imaging modality available for meningiomas. Clinical and cost-efficacy remain to be established during prospective implementation.

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.

Keywords: Meningioma; Neurooncology; Neuropathology; Neuroradiology; Neurosurgery

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