Management of intracranial meningiomas in Enugu, Nigeria

Abstract

Background:Meningiomas may range on presentation from incidentally identified small lesions to large symptomatic tumors in eloquent areas of the brain. Management options correspondingly vary and include careful observation, surgical excision, and palliative application of very limited therapeutic maneuvers in select cases. This paper discusses the options and difficulties in the management of meningiomas in a developing country.Methods:This study is a retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2006 and September 2011 at Memfys Hospital for Neurosurgery, Enugu. Radiographic diagnosis of meningioma was based on computed tomography (CT) and or magnetic resonance imaging (MRI) criteria in all cases, but only patients who had surgery and a histological diagnosis were analyzed.Results:Seventy-four patients were radiographically diagnosed with intracranial meningioma over the period under review. Fifty-five patients were operated upon and 52 (70.3%) with histological diagnosis of meningioma were further analyzed. Histological diagnosis was complete in 42 (56.8%) patients and in 10 (13.5%) patients the subtype of meningioma was not determined. The male to female ratio was 1:1.08. The peak age range for females was in the 6th decade and for males in the 5th decade. The locations were olfactory groove (26.9%), convexity (21.2%), parasagittal/falx (19.2%), sphenoid ridge (15.4%), tuberculum sellae (7.7%), tentorial (3.8%), and posterior fossa (5.8%). The most common clinical presentation was headaches in 67.3% followed by seizures (40.4%) and visual impairment (38.5%). Histology was benign (World Health Organization [WHO] grade 1) in 39 patients. One patient harbored an atypical and two had anaplastic tumors. Gross total resection of the tumor was achieved in 41 patients. Surgical mortality was 3.9%.Conclusion:Effective management of meningioma depends largely on adequate and complete surgical resection and results in good outcomes. Adequate preoperative assessment, including visual assessment, and hormonal assessment in olfactory groove and sphenoid region meningiomas, is necessary.

Histologically Confirmed Intracranial Tumors Managed at Enugu, Nigeria

“…On the overall scale, however, the higher proportion of meningioma in this study is also similar to the pattern of brain tumors seen in Nigeria and some other parts of Africa where published reports in the past two decades show a trend toward higher incidences of meningioma relative to gliomas. [ 6 7 15 16 ] Although factors such as life expectancy should be considered, the relative low glioma incidence from this study compared with the Western countries where glioblastoma prevalence is very high, especially among the elderly might suggest racial differences. [ 11 ] This study observed a very low incidence of tumors among the elderly, an age range where the incidence of gliomas should be high.…”

“…[ 4 5 ] More recent reports from sub-Saharan Africa suggest an increasing incidence of meningioma among the brain tumors in the past two decades. [ 3 6 7 ] These findings are strikingly different from the Caucasians, where gliomas, especially glioblastoma predominate. It has been argued that the results from sub-Saharan Africa concerning the epidemiology of ICTs may have been influenced by factors such as shorter life expectancy, poor hospital attendance habit, sociocultural factors that may delay patient decision to seek expert care, dearth of expertise, and relevant facilities needed for proper diagnosis of brain tumors.…”

Review of Treatment Options for Smaller Benign Cranial Meningiomas: Observation, Stereotactic Radiosurgery, and Rarely, Open Surgery

“…In Mezue’s (2012) series of 74 patients with meningiomas, symptoms included; headaches (67.3%), seizures (40.4%), and visual impairment (38.5%), along with increased motor/sensory deficits [Table 2]. [6] For the 100 recurrent meningiomas from Alvernia et al . 2011 series, the authors reviewed of the Karnofsky Performance Scale scores before and after secondary surgery; 92.6 ± 4.6 and 97.9 ± 2.2 [Table 1].…”

“…More females than males develop cranial meningiomas, with ratios varying from 1.08:1 to 2.4:1 to 3:1 [Table 2]. [3,6,10] The average age for all patients undergoing cranial surgery for meningiomas ranged from 49.6 – 64 years of age; males were typically in their fifties (average age 57.6), while females were usually in their late fifties/early sixties (average age 59.5) [Table 2]. [3,6,10]…”

Microsurgical Treatment for Central Gyrus Region Meningioma With Epilepsy as Primary Symptom

“…The surgery may damage the cortex in the functional area or affect the gyrus veins in the cortex, which greatly increases the risks of postoperative disability and severe surgical complications. 10 , 11 Therefore, the key is that microtechnique should be used to process the central sulcus vein and the affected sagittal sinus.…”