Since the introduction of the Simpson grading for the extent of resection in meningiomas in 1957, its usefulness in modern neurosurgery has been challenged. Especially, the updated WHO classification regarding brain invasion and the efficacy of radiation therapy has not been taken into account when evaluating the prognostic role of the Simpson grading in this era. We analyzed the clinical and histopathological data of 1571 meningiomas that were surgically resected in the authors’ institution between July 2003 and March 2017. Operative reports were reviewed regarding the extent of resection according to Simpson grading. Meningioma subtype according to the updated WHO classification of 2016 and clinical characteristics and time to tumor progression were analyzed. The mean follow-up was 38.4 months (range 1.2 to 195.6). A higher rate of tumor recurrence was observed for male gender, younger age, recurrent tumors, non-spinal tumor localization, higher WHO, and Simpson grades in the univariate analysis. In the multivariate analysis older age, recurrent tumors and higher WHO grades remained negative prognostic factors. Among the different Simpson grades, the relative risk for recurrence was highest for grade IV compared to all other grades (each p < 0.0001), while there was no difference between Simpson grades I and II. Adjuvant radiotherapy showed lower rates of tumor recurrence. Subtotal microsurgical resection remains an independent prognostic factor with a higher rate of tumor recurrence. The prognostic benefit of radical treatment of the dural attachment is questionable and needs to be considered when weighing the intraoperative risks of radicality.

自 1957 年引入 Simpson 分级脑膜瘤切除范围以来，其在现代神经外科中的实用性受到了挑战。特别是，在评估 Simpson 分级在这个时代的预后作用时，没有考虑更新的 WHO 关于脑浸润和放射治疗疗效的分类。我们分析了 2003 年 7 月至 2017 年 3 月期间在作者所在机构手术切除的 1571 例脑膜瘤的临床和组织病理学数据。根据辛普森分级对手术报告的切除范围进行了审查。分析了根据 2016 年更新的 WHO 分类的脑膜瘤亚型以及临床特征和肿瘤进展时间。平均随访时间为 38.4 个月（范围 1.2 至 195.6）。在单变量分析中，男性、年龄较小、肿瘤复发、非脊柱肿瘤定位、较高的 WHO 和 Simpson 分级的肿瘤复发率较高。在多变量分析中，高龄、复发性肿瘤和更高的 WHO 分级仍然是不利的预后因素。在不同的辛普森等级中，与所有其他等级（每个等级）相比，IV 级的复发相对风险最高。p  < 0.0001），而 Simpson I 级和 II 级之间没有差异。辅助放疗显示出较低的肿瘤复发率。次全显微手术切除仍然是一个独立的预后因素，具有较高的肿瘤复发率。硬脑膜附件根治性治疗的预后益处值得怀疑，在权衡术中根治性风险时需要考虑。