A preliminary survey of central nervous system tumors in Tema, Ghana

Abstract

Background: In January 2000, the first ever neurosurgical program in Tema was established. This preliminary survey was conducted for the following purposes. 1) to determine the relative frequencies of the various histopathological types of CNS tumors. 2) To relate the occurrence of the various types of CNS tumors to age, sex, symptoms, neurologic findings and location. 3) to review the current use of neurodiagnostic modalities.

Methods: A retrospective analysis of the records of 30 consecutive patients seen at T. I. N. with histologically proven CNS tumors was carried out. The following parameters were analysed; sex, age, symptoms, neurologic status, surgical procedure, histopathological diagnosis, pre and post operative Karnofsky rating.

Results: 30 patients (14M, 16F) constituted the series. Their mean age was 39.8 (R 2-72, SD, 18.7) years. The difference between the mean ages of patients with intracranial or spinal tumors was not significant (P>0.05). For intracranial tumors, there was a significant difference between the mean ages of those with infratentorial and supratentorial tumors. Spinal tumors constituted 13% of the series and they all presented with paraplegia. Eighty seven percent had intracranial tumors; of these 27% presented with headaches and 31% with seizures. Only 62% of patients with intracranial tumors presented with neurologic deficits. CT scanning was the diagnostic modality utilized in the diagnosis of all the intracranial tumors. Cerebral angiography was not obtained in any case. Myelography and post myelography CT scanning diagnosed all spinal tumors. Surgical procedures for CNS tumors constituted 23% of all neurosurgical surgical procedures performed during the study period. All patients with spinal tumors underwent laminectomy only. Sixty five percent of those with intracranial tumors underwent craniotomy; 34% underwent stereotactic biopsy. The most common intracranial tumor was high-grade astrocytoma (HGA), 23%. The left frontal lobe was the most common location of the intracranial tumors (54%), followed by the left temporal lobe (36%). No significant relationship was demonstrated in the brain tumor sites (P>0.05). At presentation, 46% of those with intracranial tumors had a karnofsky rating >70. One week after surgical intervention, this had increased to 62%. There was no significant relationship between tumor histopathology and preoperative or postoperative Karnofsky rating. The mortality rate in the first 10 days following intracranial tumor surgery was 8%; there were no deaths in the spine surgery group. The post operative complication rate for CNS tumor surgery was 11.5%.

Conclusion: Intracranial tumors are the most common type of CNS tumors in Tema. More than one third of patients with intracranial tumors presented without neurologic deficits. HGA is the most frequently seen intracranial tumor. All patients with spinal tumors presented with neurologic deficits, specifically paraplegia.