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Gousias K, Hoyer A, Mazurczyk L, Bartek J, Bruneau M, Celtikci E, Foroglou N, Freyschlag C, Grossman R, Jungk C, Metellus P, Netuka D, Rola R, Schucht P, Senft C, Signorelli F, Vincent A, Simon M. Expertise in surgical neuro-oncology. Results of a survey by the EANS neuro-oncology section. BRAIN & SPINE 2024; 4:102822. [PMID: 38831935 PMCID: PMC11145419 DOI: 10.1016/j.bas.2024.102822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 06/05/2024]
Abstract
Introduction Technical advances and the increasing role of interdisciplinary decision-making may warrant formal definitions of expertise in surgical neuro-oncology. Research question The EANS Neuro-oncology Section felt that a survey detailing the European neurosurgical perspective on the concept of expertise in surgical neuro-oncology might be helpful. Material and methods The EANS Neuro-oncology Section panel developed an online survey asking questions regarding criteria for expertise in neuro-oncological surgery and sent it to all individual EANS members. Results Our questionnaire was completed by 251 respondents (consultants: 80.1%) from 42 countries. 67.7% would accept a lifetime caseload of >200 cases and 86.7% an annual caseload of >50 as evidence of neuro-oncological surgical expertise. A majority felt that surgeons who do not treat children (56.2%), do not have experience with spinal fusion (78.1%) or peripheral nerve tumors (71.7%) may still be considered experts. Majorities believed that expertise requires the use of skull-base approaches (85.8%), intraoperative monitoring (83.4%), awake craniotomies (77.3%), and neuro-endoscopy (75.5%) as well as continuing education of at least 1/year (100.0%), a research background (80.0%) and teaching activities (78.7%), and formal interdisciplinary collaborations (e.g., tumor board: 93.0%). Academic vs. non-academic affiliation, career position, years of neurosurgical experience, country of practice, and primary clinical interest had a minor influence on the respondents' opinions. Discussion and conclusion Opinions among neurosurgeons regarding the characteristics and features of expertise in neuro-oncology vary surprisingly little. Large majorities favoring certain thresholds and qualitative criteria suggest a consensus definition might be possible.
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Affiliation(s)
- K. Gousias
- Department of Neurosurgery, Athens Medical Center, Athens, Greece
- University of Nicosia Medical School, Nicosia, Cyprus
- University of Münster Medical School, Germany
| | - A. Hoyer
- Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | | | - J. Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - M. Bruneau
- Department of Neurosurgery, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - E. Celtikci
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - N. Foroglou
- Department of Neurosurgery, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - C. Freyschlag
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - R. Grossman
- Department of Neurosurgery, Brain tumor center, Rambam Health Care Campus, Rappaport Faculty of Medicine, Haifa, Israel
| | - C. Jungk
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - P. Metellus
- Department of Neurosurgery, Clairval Private Hospital, Marseille, France
| | - D. Netuka
- Department of Neurosurgery, Central Military Hospital Prague, Prague, Czech Republic
| | - R. Rola
- Department of Neurosurgery and Paediatric Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - P. Schucht
- Department of Neurosurgery, University Hospital of Bern, Bern, Switzerland
| | - C. Senft
- Department of Neurosurgery, Jena University Hospital, Jena, Germany
| | - F. Signorelli
- Department of Neurosurgery, Azienda Ospedaliero-Universitaria Consorziale Policlinico, University “Aldo Moro” of Bari, Bari, Italy
| | - A.J.P.E. Vincent
- Department of Neurosurgery, ErasmusMC /Brain Tumor Center, Rotterdam, the Netherlands
| | - M. Simon
- Department of Neurosurgery, Bethel Clinic, University of Bielefeld Medical School OWL, Bielefeld, Germany
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Simon M, Gousias K. Grading meningioma resections: the Simpson classification and beyond. Acta Neurochir (Wien) 2024; 166:28. [PMID: 38261164 PMCID: PMC10806026 DOI: 10.1007/s00701-024-05910-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/06/2023] [Indexed: 01/24/2024]
Abstract
Technological (and also methodological) advances in neurosurgery and neuroimaging have prompted a reappraisal of Simpson's grading of the extent of meningioma resections. To the authors, the published evidence supports the tenets of this classification. Meningioma is an often surgically curable dura-based disease. An extent of meningioma resection classification needs to account for a clinically meaningful variation of the risk of recurrence depending on the aggressiveness of the management of the (dural) tumor origin.Nevertheless, the 1957 Simpson classification undoubtedly suffers from many limitations. Important issues include substantial problems with the applicability of the grading paradigm in different locations. Most notably, tumor location and growth pattern often determine the eventual extent of resection, i.e., the Simpson grading does not reflect what is surgically achievable. Another very significant problem is the inherent subjectivity of relying on individual intraoperative assessments. Neuroimaging advances such as the use of somatostatin receptor PET scanning may help to overcome this central problem. Tumor malignancy and biology in general certainly influence the role of the extent of resection but may not need to be incorporated in an actual extent of resection grading scheme as long as one does not aim at developing a prognostic score. Finally, all attempts at grading meningioma resections use tumor recurrence as the endpoint. However, especially in view of radiosurgery/radiotherapy options, the clinical significance of recurrent tumor growth varies greatly between cases.In summary, while the extent of resection certainly matters in meningioma surgery, grading resections remains controversial. Given the everyday clinical relevance of this issue, a multicenter prospective register or study effort is probably warranted (including a prominent focus on advanced neuroimaging).
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Affiliation(s)
- Matthias Simon
- Department of Neurosurgery, Evangelisches Klinikum Bethel, Universitätsklinikum OWL, Bielefeld, Germany.
| | - Konstantinos Gousias
- Department of Neurosurgery, St. Marien Academic Hospital Luenen, University of Muenster, Luenen, Germany
- Medical School, University of Nicosia, Nicosia, Cyprus
- Department of Neurosurgery, Athens Medical Center, Athens, Greece
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