FUNCTIONAL OUTCOME OF SURGICALLY TREATED INTRACRANIAL MENINGIOMAS AT AABET HOSPITAL, ADDIS ABABA, ETHIOPIA

Abstract

Abstract Background: Intracranial meningiomas are the most common brain tumors operated in Addis Ababa burn, emergency and trauma hospital (AABET),St.Paul Hospital Millennium medical college(SPHMMC). This study reviews the functional outcome of surgically treated intracranial meningiomas in a resource-limited setup. Objective: - The objective of this study was to assess functional outcome of surgically treated intracranial meningiomas at AABET hospital, Addis Ababa, Ethiopia Methods: - A retrospective cross sectional single institution-based study was conducted among patients who had undergone surgery for intracranial meningiomas at AaBET hospital, Addis Ababa, Ethiopia over 4 years’ period (between January 1,2018 to December 30, 2021). All patients who were operated in the study period with histologic diagnosis of meningioma who fulfilled the inclusion criteria were included. Patient data regarding sociodemographics, presenting complaint, neurologic deficit, preoperative imaging findings, postoperative neurologic findings, intraoperative findings including degree of resection, and histopathologic results were collected from patient charts. The current functional status was assessed using Karnofsky Performance Status Scale (KPS) for adult and Lansky performance scale (LPS) for age 16 years and below via in person interview or phone interview by trained junior neurosurgical residents using pretested questionnaires. Descriptive summary measures were used to analyze the specific objectives. Multi variate analysis was used to assess association between multiple independent variables with the dependent variable.P value less than 0.05 was taken as statically significant. Results: Out of 134 patients operated for intracranial meningioma in the study period, the study was conducted on 112 patients who fulfilled the inclusion criteria. The mean follow-up period was 20.4 months (range from 3 to 53 months). Meningioma was common in females (n=81,72.3%) with a female to male ratio of 2.6:1. The mean age at presentation was 43.2 years ± 12.8 years with a range of 12 to 75 years of age. Headache (n=106,94.6%), followed by cranial nerve palsy (n=53,47.3%), motor deficit(n=47,42%) and seizure(n=47,42%) were the most common presenting symptoms. The most common tumor locations were convexity (n=27, 24.1%) followed by parasagittal (n=20, 17.9%) and sphenoid wing (n=17, 15.5%), respectively. Most of the patients had tumor size > 5cm (n=69 ;61.6%) while only 2 patients (1.8%) had tumor size < 3cm. Significant number of our patients had WHO grade I tumor (n=101,90.2%) with III Meningothelial(n=63,56.3%) subtype accounting for the majority of the cases. Gross total resection (Simpson grade 1 to 3) was achieved in 71 patients (63.4%) and subtotal resection (Simpson 4 & 5) was done for 41(36.6%). Twenty-seven (24.3%) patients in our study had reoperation. The most common indication was postoperative infection. Thirteen (11.6%) patients had post-operative infection, of which 9 (9.1%) of them require surgery. The surgical mortality rate was 4.5%. Thirty-two (28.6%) patients had poor final functional outcome with KPS score of less than 70% and the rest (n=80,71.4%) had good functional outcome with KPS of 70% and above. Multivariate analysis showed the presence of preoperative focal neurologic deficit and post-operative complications were an independent predictor of poor functional outcome in this study. Those patients who had preoperative focal neurologic deficit were having 9.067 times more likely to have poor functional outcome than those who presented without focal deficit (AOR=9.067,95%CI:1.025,82.705 and p value of 0.041). Patients who had post-operative complications were 4.906 times more likely to have poor functional outcome compared to those patients who had no postoperative complications (AOR=4.906,95%CI:1.568,15.350 and p value of 0.006). This study didn’t show significant association between age, tumor size, tumor location, extent of resection & WHO grade with functional outcome. Conclusion: The presence of preoperative focal neurologic deficit and post-operative complications were associated with poor functional outcome. It was shown that the functional outcome of patients with surgically treated intracranial meningioma is encouraging in resource limited set up. Key words: Intracranial meningioma, functional outcome, Karnofsky score