[Music] neurosurgeons love grading scales we do it's just in our blood and if you're talking about meningiomas a very very likely question that anyone could ask you is what is the simpson grading scale you say avm i say sputzer martin it's just one and two you say meningioma i say simpson grading scale you say glioblastoma i say what grade one two three four is it it's just it these are things that are in our lexicon that when you're saying that disease you might as well be saying simpson grading scale and so if you don't know the sims and grain scale you're going to look like you don't know the language or the alphabet or the bare basics the very basics of brain tumors and or neurosurgery so the grading scale goes one through five one two three four five and it's really best if you just put the biggest margins at the separate separate areas okay so five is just a biopsy five is just a biopsy simpson one is when you take out the entire tumor and you take up dura because the tumor is coming from the dura so you're taking out the entire tumor and its birthplace that's a simpson grade one the whole tumor out simpson grade two is where you take the whole tumor out and you coagulate the direct you don't cut the dura out you weren't able to so you leave the dirt then you bipolar it simpson three is you take the whole tumor out and you just leave the door alone you don't do anything to the direct it's just there and then four is a subtotal resection that simpson's four and a five is a biopsy five is a biopsy i think most times you're gonna see simpson one a simpson two rarely a simpson 3 and more likely a simpson 4. and the reason why simpson grades are important is because they portend to the recurrence rate that if you get a simpson 1 resection the rate of recurrence for the meningioma is going to be less and where it gets a little messy was well what if you get a simpson one on a grade two meningioma i think the resection recurrence rate is also less but not as good as if you got a grade one a one simpson one and so you really want a grade one meningioma with a simpson one resection that's the ideal but the molecular pathology whether it's a grade one grade two or grade three meningioma affects the simpson grading scale which is one two three four five and i know that's a lot of numbers but they're really important to know if you're gonna walk into the or or if you're gonna have a conversation about meningiomas with a surgeon because they're gonna be thinking about these things hey everyone ryan rad here from neurosurgerytraining.org if you like that video subscribe and donate to keep our content available for medical students across the world