Article Text

Download PDFPDF
Interinstitutional variance of postoperative radiotherapy and follow up for meningiomas in Germany: impact of changes of the WHO classification
  1. M Simon1,
  2. J Boström1,
  3. P Koch2,
  4. J Schramm1
  1. 1Neurochirurgische Klinik, Universitätskliniken Bonn, Bonn, Germany
  2. 2Institut für Neuropathologie, Universitätskliniken Bonn
  1. Correspondence to:
 Dr Matthias Simon
 Neurochirurgische Universitätsklinik, Sigmund-Freud-Str 25, 53105 Bonn; Matthias.Simon{at}


Objective: To document and critically analyse the impact of the revised WHO 2000 histological classification for meningiomas on postoperative radiotherapy/radiosurgery indications and MRI follow up protocols.

Methods: The current (2000) WHO classification was used to grade 57 meningiomas treated surgically at one institution. These had been reviewed previously in 1999. All German neurosurgical departments carrying out intracranial microsurgery were asked to detail their guidelines for radiation therapy and follow up for meningiomas of different WHO grades.

Results: Use of the current criteria downgraded seven of 15 atypical meningiomas (WHO grade II, MII) to grade I (MI), and four of six anaplastic tumours (WHO grade III, MIII) to grade II. Indications for radiotherapy/radiosurgery and MRI follow up protocols varied substantially with the histological grade and between institutions—for example, after an incomplete resection, radiotherapy/radiosurgery recommendations differed between MI and MII in 30 of 58 units (52%), and between MII and MIII in 34 of 56 units (61%).

Conclusions: Correlative studies combining treatment and outcome data with a standardised histopathological analysis are warranted to define properly the indications for radiotherapy/radiosurgery and follow up protocols after surgery for meningiomas of different histological grades. The use of changing grading paradigms during recent years renders decision making based on local and published experience difficult. The relatively large number of meningiomas classified as atypical/WHO grade II in current practice would argue against an uncritically aggressive approach to these tumours.

  • EBR, external beam radiotherapy
  • HPF, high power field
  • meningioma
  • WHO classification
  • radiotherapy
  • radiosurgery
  • follow up

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Published Online First 25 November 2005

  • Competing interests: None declared.