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Background: Advances in neurosurgical techniques and neuroimaging resolution questions the modern-day reliability of the Simpson grade for predicting meningioma recurrence. Therefore, we evaluated the reliability of predictors for recurrence and outcomes in detail in patients with non-skull base meningiomas (NSBMs). Methods: We retrospectively analyzed data from consecutive 175 NSBMs underwent surgical resection. We performed Kaplan–Meier analyses of recurrence-free survival (RFS) according to Simpson and World Health Organization (WHO) grades. Predictors of RFS and clinical deterioration were estimated by univariate and multivariate analyses. Correlation between the Simpson grade and change in Karnofsky Performance Scale scores was assessed by Fisher's exact test. Results: Log-rank tests revealed significant correlations of both the Simpson and WHO grades with RFS for the overall cohort, convexity, and falx/tentorium meningioma. Unlike patients undergoing Simpson grade I and II resections, RFS in patients with WHO grade I and II/III tumors differed significantly from the early postoperative stage. Multivariate analysis identified tumor size, Simpson grade, and MIB-1 labeling index as significant predictors of RFS. Clinical deterioration was more frequent among patients undergoing less aggressive resection. Tumor location was the only significant predictor of clinical deterioration. Conclusions: Our findings indicate that tumor size, Simpson and WHO grades, and MIB-1 labeling index are significant predictors of NSBM recurrence. Moreover, the risk of recurrence markedly decreases within the follow-up duration of 80 months. Aggressive resection appears to minimize the risk of recurrence without evidence of clinical deterioration. Follow-up schedules should be based on the WHO grade and extent of resection. Keywords: Meningioma, Non-skull base, Outcome, Recurrence, Simpson grade, WHO grade

Background: Several authors have reported the various patterns of coexistence of spinal dermoid cysts and lipoma; however, the association of intramedullary dermoid cysts with lipoma is extremely rare. In addition to the embryological and pathological aspects of this rare condition, we discuss the feasibility of combined microscopic and endoscopic procedures for the management of intramedullary dermoid cysts. Case description: An 18-year-old woman presented with right buttock pain. Magnetic resonance (MR) imaging revealed a large, well-defined mass extending from L2 to L4. The conus medullaris terminated in the mass and was tethered by a fatty filum. According to the signal intensities on MR images, the mass could be divided into two components. The upper component existed intramedullary and was iso- to hypo-intense relative to the spinal cord on T1-weighted images. The lower component exhibited homogeneous hyper-intensity signals on both T1- and T2-weighted images. Partial removal of the cyst wall and evacuation of the cyst contents followed by untethering of the spinal cord were performed by the combined microscopic and endoscopic procedures. The patient's symptoms were relieved postoperatively and pathological studies confirmed the diagnosis of dermoid cysts associated with lipoma. Conclusions: We present a rare case of an embryological “collision” of an intramedullary dermoid cyst associated with filar lipoma underlining the spectrum of intradural pathologies in spinal dysraphism. Surgical management is creative in these circumstances and multimodal. Our surgical management shows that the use of endoscopes can be effective in the surgical removal of long sectional spinal dermoid cysts. Keywords: Endoscope, Fatty filum, Filar lipoma, Intramedullary dermoid cyst, Tethered cord